Lecture 1: Diagnostic Techniques for Evaluating Oral Diseases Flashcards
Information that can be measured or perceived by the investigating clinician:
OBJECTIVE
Patients own interpretation of a clinical circumstance, relying on neurological and psychological experiences:
SUBJECTIVE
temp, size, color, duration, consistency, surface contour:
SIGNS (objective)
patient awareness of presence of a lesion, pain intensity, pain quality (stabbing, burning, shocking)
SYMPTOMS (subjective)
What is involved in a differential diagnosis? (4)
- orderly sequential approach
- gathering and analyzing data
- knowledge and experience enable recognition of abnormal findings
- include/exclude disease processes based on an educated assessment of process
T/F: The following are all included in gathering and analyzing data:
-history
- specific signs
- specific symptoms
- lab data
true
When making a differential diagnosis, be aware of: (5)
- radiographic appearances
- clinical manifestations
- age
- gender
- location
- single vs. multiple
- location
- relative proximity to adjacent structions
- size in dimension (mm)
- outline (well demarcated vs. diffuse)
- color (red, white, mixed, pigmented)
- consistency (firm, flaccid, compressible)
- intensity (mild, moderate, intense, striated, lacy)
- base and surface
These are all:
clinical descriptions
The following describe:
- smooth
- corrugated
- eroded
- raised
- depressed
surface
The following describe:
- pedunculated
- sessile
- nodular
- dome shaped
base
Compressing tissue with a glass slide to determine the vascular nature of a lesion:
diascopy
To feel and press a lesion to yield information about texture, consistency, temperature, and function:
palpation
Palpation with an instrument:
probing
Striking tissues with fingers or an instrument and listening to resulting pressure changes in tissues:
percussion
The withdrawal of fluids from a body cavity:
aspiration
Listening for sounds within the body:
auscultation
What the the 3 DIAGNOSTIC LAB TESTS for oral lesions?
- biopsy (incisional, excisional, aspirational, needle)
- immunofluorescence
- exfoliative cytology
A biopsy is one of the three diagnostic lab tests for oral lesions. The types of biopsies include:
- excisional
- incisional
- aspirational
- needle
What are some indications for biopsies? (6)
- lesion with greater than 14 day duration
- unusual location
- unusual appearance
- any excised tissue
- confirmed diagnosis of systemic disease
- suspicion of neoplasia
What might make you suspicious of neoplasia?
- persistent ulceration
- persistent erythroplasia
- induration
- fixation
- chronicity
- lymphadenopathy
A needle biopsy may also be called:
fine needle aspiration or fine needle aspiration and cytology
- to determine the cause of tissue enlargement
- to distinguish between benign and malignant processes
- to stage metastatic cancer
The following are indications for:
needle biopsy
What are limitations to a needle biopsy?
- more technique sensitive with additional preservative and lab processing
- does not localize cells to affected tissues
- appositional information to adjacent tissues is lost
A technique for determining the location of an antigen or antibody in tissues by reaction with an antibody or antigen labeled with fluorescent dye:
Immunofluorescence
List the INDICATIONS of oral exfoliative cytology:
- Innocuous lesion
- suspicious lesion with negative biopsy
- patient refuses biopsy
- follow up of treated malignancy
- lesion where patient is poor candidate for surgery
List the CONTRAINDICATIONS of oral exfoliative cytology:
- Keratotic or crusty mucosa
- Red, vesicular, or velvety mucosa
- Submucosal swelling with normal mucosa
- Suspicion of malignancy
T/F:
Exfoliative cytology is indicated as a follow up for treated malignancy. Exfoliative cytology is contraindicated if there is suspicion of malignancy
Both statements true
List the INDICATIONS of culture and sensitivity testing:
- life threatening infection
- unsuccessful previous antibiotic therapy
- immunosuppressed patient
Why is cultural and sensitivity testing limited in dentistry?
Difficult for anaerobic conditions
Assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone:
Oral cancer screening aids
Increases the ability to distinguish the lesion mucosa and healthy mucosa:
Tissue autofluorescence imaging
Tissue autofluorescence imaging has _____ sensitivity and _____ specificity in distinguishing pre-malignant and chronic inflammatory lesions:
HIGH sensitivity; LOW specificity
Tissue autofluorescence imaging has _____ sensitivity and ____ specificity in identifying areas of dysplasia and invasive cancer that extend beyond the evident lesion
HIGH sensitivity; HIGH specificity
What drives autofluorescence of oral mucosa?
Refractory index of tissue
With autofluorescence of oral mucosa we see:
500-600 nm
With autofluorescence of oral mucosa, blue light of the scope is:
400-460 nm
With autofluorescence of oral mucosa, UV =
<400nm
What are some of the ENDOGENOUS fluorescing products? (7)
- tryptophan
- pophyrins
- collagen
- elastin
- flavins
- NADH
- Fluorophores
What does Flavin Adenine Dinucleotide (FAD) excite at?
515 nm
What does nicotinamide adenine dinucleotide (NADH) excite at?
450 nm
