Making a diagnosis

Question 1

What are the steps to making a diagnosis?

Answer 1

History, Examination, provisional diagnoses, special investigations, definitive diagnoses, treatment plan

Question 2

In what percentage of cases does history give a diagnosis?

Answer 2

75%

Question 3

C/O meaning

Answer 3

complaining of (symptoms of disease in patient’s own words)

Question 4

HPC meaning

Answer 4

history of present complain - patient description of problem including duration, severity and exacerbating/relieving factors

Question 5

PMH meaning

Answer 5

past medical history - e.g. diabetes, allergies, epilepsy, drug history (may cause dry mouth/uleration?)

Question 6

PDH meaning

Answer 6

past dental history - attitude to dentists and past experiences

Question 7

SH meaning

Answer 7

social history - alcohol, tobacco, carer, work, stress, wind instrument

Question 8

What does the extraoral examination involve?

Answer 8

Observing symmetry, aesthetics and palpating muscles, joints and lymph nodes

Question 9

What are the muscles of mastication that are palpated in an extraoral examination?

Answer 9

Masseter and temporalis

Question 10

What is the technical term for enlarged lymph nodes?

Answer 10

Lymphadenopathy

Question 11

Potential causes of lymphadenopathy

Answer 11

infection/inflammation or a malignant neoplasm (primary or metastatic)

Question 12

What is the difference between primary and metastatic cancer?

Answer 12

primary cancer is the original site where cancer began whereas metastatic cancer is cancer that has spread from its origin

Question 13

What are the clinical characteristics of an enlarged lymph node that suggests it is malignant?

Answer 13

Firm to palate, fixed to adjacent structures, not painful, enlarged

Question 14

What may be the cause of asymmetrical masseters?

Answer 14

unilateral chewing or bruxism/clenching on one side

Question 15

What makes up an intraoral examination?

Answer 15

Look at the soft and hard tissues (radiograph), Listen using percussion, Palpate for mobility or tenderness.

Question 16

What can the sound of percussion on a tooth reveal?

Answer 16

Whether there is a fracture or if there is an apical lesion

Question 17

What must you make sure to remove before an intraoral examination?

Answer 17

Dentures (removable prosthesis)

Question 18

What is leucoplakia?

Answer 18

white patch in the mouth that may be precancerous. May have been caused by alcohol, tobacco or a virus.

Question 19

What is erythroplakia?

Answer 19

Red patch in mouth caused typically by tobacco. May or may not be cancerous.

Question 20

Where is there a high risk zone for oral cancer?

Answer 20

U-shaped area (under tongue)

Question 21

What type of leucoplakia has a high risk of malignant transformation?

Answer 21

Speckled leucoplakia

Question 22

Examples of special investigations

Answer 22

(sensitivity/) vitality test, mobility tests, radiographs, plaque score, biopsy.

Question 23

What can be used to do a vitality test?

Answer 23

Electric pulp test or ethyl chloride

Question 24

How do you use an electric pulp test to check tooth vitality?

Answer 24

Compare the number given to numbers for adjacent teeth. Next appointment repeat check to see if vitality is deteriorating.

Question 25

How do you use ethyl chloride for a vitality test?

Answer 25

Apply cold ethyl chloride for a few seconds to the tooth surface using a pellet.

Question 26

What does a mobility test test for?

Answer 26

periodontally compromised teeth

Question 27

What does a grade 1 in a mobility test mean?

Answer 27

tooth can be saved. PD attachment can regenerate

Question 28

How to conduct a mobility test?

Answer 28

Place the blunt end of an instrument on one side of the tooth and use a finger to judge its movement

Question 29

Why is ‘oral ulceration’ a provisional diagnosis?

Answer 29

because you are uncertain of what the ulcer is and its cause

Question 30

Possible causes of an ulcer

Answer 30

Trauma (thermal, chemical, mechanical), idiopathic (uncertain cause e.g. ROU), inflammatory (viral, bacterial, allergic), neoplastic (oral cancer, haematological), autoimmune (Behcet’s syndrome)

Question 31

ROU meaning

Answer 31

recurrent oral ulceration - e.g. from stress, reduced immunity

Question 32

Example of a viral infection that causes ulceration

Answer 32

primary hepatic gingivostomatitis

Question 33

How to identify a traumatic ulcer?

Answer 33

Should heal within 2 weeks after removing suspected aetiology (e.g. denture, irritating cusp)

Question 34

Observable features of squamous cell carcinoma (SCC)

Answer 34

necrotic centre, raised margins, bleeding, infiltration to neck lymph nodes

Question 35

What special investigations should be done on an oral ulcer?

Answer 35

Biopsy - haematological investigations, microbiological tests, allergy testing

Question 36

What is a biopsy?

Answer 36

Taking a small sample of tissue so that it can be examined under a microscope

Question 37

Difference between an excision and incision biopsy

Answer 37

excision biopsy only removes a small part of the lesion whereas an incision biopsy removed the whole lesion

Question 38

How do you determine the periodontal status?

Answer 38

using probing to measure pocket depth, bleeding, subgingival calculus, plaque retention factors

Question 39

How can you record periodontal status?

Answer 39

On a pocket chart

Question 40

What can be used to demonstrate the areas the patient failed to brush?

Answer 40

disclosing agent

Question 41

What is tooth erosion?

Answer 41

non-carious tooth surface loss (not from bacteria acid)

Question 42

What dental diagnoses may a diet diary be useful for?

Answer 42

caries, tooth erosion

Question 43

What are the common dental diagnoses?

Answer 43

caries, gingivitis, pulpitis, periodontitis, tooth wear, failure of restorations, recurrent oral ulceration (ROU)

Question 44

Types of tooth wear

Answer 44

erosion, attrition, abfraction (loss of tooth structure at cervical line)