Diagnosis in dental clinic ...

1. PRINCEPLSE OF ORAL DIAGNOSIS
BY :
Baha’adeen Ali

2. CASE SHEET

3.  Finger clubbing
 Sign of heart disease

4.  Cyanosis
 Sign of heart
disease

5.  Icterus
 Sign of liver disease

6. Laboratory test

8. * Extra-oral examination :
1- Expression :
# calm
# frightened
# suffering
# depressed

9. 2- Skin :
• Skin color :
# cyanosis
# anemia
# jaundice
# pigmentation
• Skin eruptions
• Petechial

10. 3- Swelling
4- Lymphnode examination

11. 5- Temporo-mandibular joint
• Inspection:
# Anyswelling over the joint region
# Symmetryand extent of movement
# Clickingsound
• Palpation: Pre-auricular and intra-auricular
# Extent and symmetryof movement
# Temperature of the overlying skin
# Tenderness
#Crepitus
• Auscultation: Clicking

12. Clinical examination of T.M.J :
Direct examination of T.M.J involves palpation & auscultation
palpation of the condyle is done both in the pre-auricular area &
via the external auditory meatus while the teeth are in occlusion
and during opening & closing movements . By palpation one can
check for tenderness & feel the joint movement . Sound arising
from the T.M.J are sometimes clearly audible to the examiner ,
other are reported by the pt. & can be confirmed by listening to
the joint with a stethoscope .
Crepitation is usually a sign of organic pathology in T.M.J , while
clicking or popping sound indicate functional derangements
associated with masticatory muscle spams .

13. * T.M.J examination

14. Radiographic examination :
1. Trans-cranial view or trans-pharyngeal view .
2. Lateral oblique .
3. Panoramic x-ray .
4. Arthrography .
5. C.T scanning .
6. M.R.I .
*M.R.I
*O.P.G

15. *Lateral oblique
*Arthrography
*C.T scane

16. * Intra-oral examination :
1. Teeth & Periodontium
2. Oral Mucous Membrane
3. Detailed examination of area of chief complaint

17. THE DIAGNOSTIC PROCESS
Armamentarium for Intra-oral Examination:
Equipment:
• Dentalchairwithinstrumenttray,spittoonand operatinglight
Instruments:
• Mouthmirror
• Straightprobe-plain& graduated
• Curvedprobe
• tweezers
• Spoonexcavator
• Air &watersyringe
•Electricalpulptester
Materials:
• Mouthrinse
• Anestheticspray
• Cottonandgauze
• Dentalfloss

18. For the clinician:
> Clean full-sleeved apron
> Sterile gloves
> Mask

19. THE DIAGNOSTIC PROCESS
Operator position for
maxillary right & left
quadrants; and mandibular
left quadrant
Operator position for
mandibular right quadrant

20. # Type of dentition
# Teethpresent & teethabsent
(commensuratewiththe age of the patient)
# Occlusion - Angle’s classification& toothposition
# Developmental disorders - no., shape,size, structure
# Dental caries - G. V. Black’s classification
# Painon percussion - vertical & lateral
# Attrition, abrasion, erosion & fracture
# Stains & discoloration
# Deposits - plaque, materiaalba, calculus
# Mobility
# Vitality
 Intra-oral examination :
Teeth :

21. * Teeth :
Pulp tasting

22. OcclusionCheck

23. Percussion Check

24. Mobility Check

25. Caries

26. Severe Erosion

27. Severe Abrasion

28. Hutchinson's Teeth

29. White and red lesion of oral mucosa :
1- Hereditary white lesion :
a. Leukoedema .
b. White sponge nevus .
*Leukoedema
* ORAL LESIONS

30. *Nicotinic stomatitis*smokeless tobacco keratosis

31. 3- Infectious white lesion :
a. Oral hairy leukoplakia .
b. Candidiasis :
1. Acute pseudomembranous candidiasis .
2. Acute atrophic candidiasis .
3. Chronic atrophic candidiasis :
a) Denture stomatitis .
b) Angular cheilitis .
3- Infectious white lesion :
a. Oral hairy leukoplakia .
b. Candidiasis :
1. Acute pseudomembranous candidiasis .
2. Acute atrophic candidiasis .
3. Chronic atrophic candidiasis :
a) Denture stomatitis .
b) Angular cheilitis .
*Denture stomatitis*Angular cheilitis

32. 4. Chronic hyperplastic candidiasis .
5. Chronic multifocal candidiasis .
6. Chronic mucocutaneous candidiasis .
7. Immune compromised ( H.I.V )
associated candidiasis .
*Chronic hyperplastic candidiasis

33. 4- Idiopathic ( True ) leukoplakia .
5- Erythroplakia .
6- Lupus erythematous :
a. Systemic lupus (S.I.E) .
b. Discoid lupus (D.I.E) .
*Systemic lupus *Discoid lupus

34. 7- Developmental white lesion .
8- Fordyce's granules .
9- Gingival and palatal cyst of new born and adult .
10- Miscellaneous lesion ( geographic tongue ) .
*Fordyce's granules

35. * ex. Of labial mucosa lesions
:
Mucocele

36. Mucocele granuloma

37. * ex. Of buccal mucosa lesions :
Linea alba

38. Cheek-chewing

39. Fibroma

40. Lichen planus

41. Fordyce granules (also seen on buccal
mucosa)
*ex. Of lips lesions :

42. Herpes labialis

43. Melanotic macule

44. * ex. Of Palatal Lesion :
Torus

45. Inflammatory papillary hyperplasia

46. *ex. Of Gingivae lesions :
Mandibular tori

47. Amalgam tattoo

48. Pericoronitis

49. Acute necrotizing ulcerative gingivitis

50. Most common lesions of the tongue :
1- Ankyloglosia

51. 2- Macroglossia

52. 3- Microglossia

53. 4- Geographic Tongue (erythema migrans )

54. 5- Black hairy tongue

55. 6- Glossodynia

56. 7- Fissured tongue

57. 8- Median rhomboid glossitis

58. 9- Cancer

59. * NO SPECIFIC LOCATION :
Traumatic ulcer

60. Aphthous ulcer

61. Papilloma

62. Leukoplakia

63. Ulcerative & vesiculobullous lesions :
Pemphigus

64. Mucous membrane pemphigiod

65. Herpes zoster

66. Aphthous related

67. Behçet’s disease

68. Oral cancer :

69. Signs and symptoms :
Early sign of oral cancer occurring on the floor of the mouth ,
soft palate and ventral or lateral tongue include red velvety
erythroplastic patches often with tiny area of ulceration , these
lesions may be first sign of malignant changes .
Leukoplakia lesion a tissue response to chronic irritation often
associated with oral cancer , white patches of Leukoplakia may
developed anywhere on the oral mucosa.
The surface of this precancerous lesion may smooth and thin or
leathery and thick tissue or ulcer may develop on a Leukoplakia
plaque , and must be carefully observed for malignant changes .

70. *oral cancer

71. Oral pigmentation :
Pigmentation or discoloration of the soft oral
tissue and skin may occur from localization of
endogenous substances produced by the body
or exogenous .

72. Classification of oral pigmentation :
A. Endogenous pigmentation :
1.Melanin .
2.Bilirubin .
3.Iron .

73. B. Exogenous pigmentation :
1. Pigments introduced in to the body
systemically :
a. Bismuth .
b. Mercury .
c. Arsenic .
d. Silver .
e. Gold .
f. Lead .
g. Antimalarial .
h. Chlorpromazine .

74. 2. Pigments introduced in to the oral mucosa
locally :
a.Amalgam .
b.Industrial accidents involving various
materials such as lead or copper .
c. Graphite ( pencil tips ) .

75. A.Miscellaneous pigmentation :
1.Black hairy tongue .
2.Stains from tobacco and medications .

76. THANK YOU