Dental presentation

1. Oral Diagnosis and
Manifestations of Some
Systemic Diseases
Dr.Usama M. Madany
B.Ch.D, M.Sc., Ph.D.
Professor, Oral Medicine Periodontology, Diagnosis and Oral
Radiology, Faculty of Dentistry, Al-Azhar Univ.

2. Oral Diagnosis:
Is the art and science of collecting
data concerning the patient's chief
problem that urged him/her to
seek the dental help.

3. Categories of Diagnosis:
Spot diagnosis
Tentative diagnosis
Definitive diagnosis

4. To reach a definitive diagnosis,
pretreatment evaluation of a case
should be achieved through:
- History taking
- Clinical examination
- Special Investigations

5. Essential elements of history taking;
Chief complaint
History of the present illness
Past medical history
Social history
Family history
Review of systems
Dental history

6. *Means of clinical examination:
Inspection
Palpation
Percussion
Auscultation

7. *SpecialInvestigations
- Biopsy: Is the technique of choice
for diagnosis of a soft-tissue lesion in
the mouth.
- Serological tests including PCR
- Urinalysis.

8. Digitalsubtraction
MRI
CT
-Microbiological culturing
-Conventional and advanced
radiographic techniques

9. If a blood disease or disorder is
suspected CBC (hemogram)
should be requested:
- R.B.Cs count
- W.B.Cs count/differential
leukocytic count
- Platelets count
- Hemoglobin concentration
- Hematocrit value

10. Screening tests for a case of bleeding:
-Platelet count; normal values = 150,000-450,000 platelets/mm3
-Prothrombine time (PT); normal values = 10-13 seconds.
-Partial thromboplasine time (PTT); normal values =25-36 seconds.
-Bleeding time; normal values = < 9 minutes.

11. Polymerasechain reaction (PCR):
Is a technique developed by
researchers in molecular biology for
enzymatic amplification of DNA
sequence. Because of its high
sensitivity, it proved marked clinical
potential in diagnosing viral diseases
affecting humans.

12. Objectives of pretreatment evaluation:
- Establishment of diagnosis.
- Determination of underlying
medical condition.
- Discovery of concomitant illness.
- Prevention of medical emergencies
associated with dental treatment.

13. Some systemic diseases and disorders may
have oral manifestations, and some oral
diseases ( lesions) may be associated with
systemic diseases or disorders. According to
oral manifestations, the systemic diseases can
be classified as those which may produce/be
accompanied by:
*Ulcers.
*White lesions.
*Hyperpigmentation/change in color of oral mucosa.
*Spontaneous bleeding/ with minimal touch.
*Gingival enlargement.
*Multiple abscess formation.
*Tongue lesions

14. Ulcers
Agranulocytosis/ cyclic neutropenia/ aplastic anemia.
Leukemia
Lupus Erythematosus
Lichen Planus
Mucocutaneous ocular Syndromes
Syphilis
Tuberculosis
Herpetic Stomatitis

15. AgranulocytosisAgranulocytosis
- Absence of granulocytes
- W.B.Cs < 2000/mm3

16. Herpetic Stomatitis
Smear
Viral Culture
Antibody titre
AIDS?

17. LeukemiaLeukemia
- Full blood picture
- Bone marrow biopsy

18. Lichen Planus
- Biopsy
- Grinspan syndrome?

19. Lupus Erythematosus
- Biopsy
- Increased ESR
- autoantiboies
+ve LE test

20. Mucocutaneous Ocular SyndromesMucocutaneous Ocular Syndromes
Steven-Johnson Behcet Reiter
Mild leukocytosis
Hypergamaglobulinema
leukocytosis
Pyuria
Clinical picture/biopsy
Seronegative Polyartheritis

21. SyphilisSyphilis
- Direct smear
- Serological test

22. Biopsy Sputum culture Chest Radiography
Tuberculosis

23. White lesions
Lupus Erythematosus
Lichen Planus
Syphilis

24. Lichen PlanusLichen Planus

25. Lupus Erythematosus

26. SyphilisSyphilis

27. BleedingBleeding
Hemophilia
Thrombocytopenia
Polythycemia
Leukemia
Scurvy

28. HemophiliaHemophilia
Normal bleeding time
Normal PT
Increased PTT

29. Leukemia
W.B.Cs count is abnormal in early stage. It varieis
from 100,000 – 500,000 in different types.
Numbers of R.B.Cs, platelets and different leukocytes
show increase or decrease according to the type

30. PolycythemiaPolycythemia
Increase in all blood elements
Increased bleeding time

31. ScurvyScurvy
Normal blood picture
Increased bleeding time
Dietary history

32. Thrombocytopenia / ThrombocytosisThrombocytopenia / Thrombocytosis
Decreased platelets count
Increased bleeding time Increased bleeding time
Increased platelets count

33. Hyperpigmentation
Addison’s Disease
Kaposi’s sarcoma
Icterus
Peutz-Jeghers Syndrome

34. Addison’s Disease
Blood pressure
Plasma electrolytes
Cortisol levels
Response to ACTH

35. IcterusIcterus
Hemolytic Anemia?
Hepatitis?
CBC
Liver Function
PCR

36. Kaposi’s SarcomaKaposi’s Sarcoma
Biopsy AIDS?

37. Peutz-Jeghers SyndromePeutz-Jeghers Syndrome
Clinical Features

38. Tongue lesions
Atrophic Glossitis
Geographic Tongue

39. Iron
Atrophic glossitis
Folic acid
Vit. B 12
Blood picture
Vitamin Assay

40. Geographic TongueGeographic Tongue
Psoriasis?
History of migrating pattern

41. Gingival enlargement
Drug-induced gingival hyperplasia
Diabetes mellitus
Leukemia
Scurvy

42. Drug-induced gingival hyperplasiaDrug-induced gingival hyperplasia
Phenytoin Nifedipine
History of taking the drug Blood picture
Biopsy

43. Leukemia Vit. C deficiency
Blood picture
Fasting blood sugar level / glucose tolerance test
Diabetes mellitus

44. Multiple Abscess Formation
Diabetes Mellitus
TB.

45. Thank you