Making a diagnosis Flashcards
What are the steps to making a diagnosis?
History, Examination, provisional diagnoses, special investigations, definitive diagnoses, treatment plan
In what percentage of cases does history give a diagnosis?
75%
C/O meaning
complaining of (symptoms of disease in patient’s own words)
HPC meaning
history of present complain - patient description of problem including duration, severity and exacerbating/relieving factors
PMH meaning
past medical history - e.g. diabetes, allergies, epilepsy, drug history (may cause dry mouth/uleration?)
PDH meaning
past dental history - attitude to dentists and past experiences
SH meaning
social history - alcohol, tobacco, carer, work, stress, wind instrument
What does the extraoral examination involve?
Observing symmetry, aesthetics and palpating muscles, joints and lymph nodes
What are the muscles of mastication that are palpated in an extraoral examination?
Masseter and temporalis
What is the technical term for enlarged lymph nodes?
Lymphadenopathy
Potential causes of lymphadenopathy
infection/inflammation or a malignant neoplasm (primary or metastatic)
What is the difference between primary and metastatic cancer?
primary cancer is the original site where cancer began whereas metastatic cancer is cancer that has spread from its origin
What are the clinical characteristics of an enlarged lymph node that suggests it is malignant?
Firm to palate, fixed to adjacent structures, not painful, enlarged
What may be the cause of asymmetrical masseters?
unilateral chewing or bruxism/clenching on one side
What makes up an intraoral examination?
Look at the soft and hard tissues (radiograph), Listen using percussion, Palpate for mobility or tenderness.
What can the sound of percussion on a tooth reveal?
Whether there is a fracture or if there is an apical lesion
What must you make sure to remove before an intraoral examination?
Dentures (removable prosthesis)
What is leucoplakia?
white patch in the mouth that may be precancerous. May have been caused by alcohol, tobacco or a virus.
What is erythroplakia?
Red patch in mouth caused typically by tobacco. May or may not be cancerous.
Where is there a high risk zone for oral cancer?
U-shaped area (under tongue)
What type of leucoplakia has a high risk of malignant transformation?
Speckled leucoplakia
Examples of special investigations
(sensitivity/) vitality test, mobility tests, radiographs, plaque score, biopsy.
What can be used to do a vitality test?
Electric pulp test or ethyl chloride
How do you use an electric pulp test to check tooth vitality?
Compare the number given to numbers for adjacent teeth. Next appointment repeat check to see if vitality is deteriorating.
How do you use ethyl chloride for a vitality test?
Apply cold ethyl chloride for a few seconds to the tooth surface using a pellet.
What does a mobility test test for?
periodontally compromised teeth
What does a grade 1 in a mobility test mean?
tooth can be saved. PD attachment can regenerate
How to conduct a mobility test?
Place the blunt end of an instrument on one side of the tooth and use a finger to judge its movement
Why is ‘oral ulceration’ a provisional diagnosis?
because you are uncertain of what the ulcer is and its cause
Possible causes of an ulcer
Trauma (thermal, chemical, mechanical), idiopathic (uncertain cause e.g. ROU), inflammatory (viral, bacterial, allergic), neoplastic (oral cancer, haematological), autoimmune (Behcet’s syndrome)
ROU meaning
recurrent oral ulceration - e.g. from stress, reduced immunity
Example of a viral infection that causes ulceration
primary hepatic gingivostomatitis
How to identify a traumatic ulcer?
Should heal within 2 weeks after removing suspected aetiology (e.g. denture, irritating cusp)
Observable features of squamous cell carcinoma (SCC)
necrotic centre, raised margins, bleeding, infiltration to neck lymph nodes
What special investigations should be done on an oral ulcer?
Biopsy - haematological investigations, microbiological tests, allergy testing
What is a biopsy?
Taking a small sample of tissue so that it can be examined under a microscope
Difference between an excision and incision biopsy
excision biopsy only removes a small part of the lesion whereas an incision biopsy removed the whole lesion
How do you determine the periodontal status?
using probing to measure pocket depth, bleeding, subgingival calculus, plaque retention factors
How can you record periodontal status?
On a pocket chart
What can be used to demonstrate the areas the patient failed to brush?
disclosing agent
What is tooth erosion?
non-carious tooth surface loss (not from bacteria acid)
What dental diagnoses may a diet diary be useful for?
caries, tooth erosion
What are the common dental diagnoses?
caries, gingivitis, pulpitis, periodontitis, tooth wear, failure of restorations, recurrent oral ulceration (ROU)
Types of tooth wear
erosion, attrition, abfraction (loss of tooth structure at cervical line)
