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Oral diagnosis and systemic diseases

Dental presentation

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Oral diagnosis and systemic diseases

  1. 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. 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. 3. Categories of Diagnosis: Spot diagnosis Tentative diagnosis Definitive diagnosis
  4. 4. To reach a definitive diagnosis, pretreatment evaluation of a case should be achieved through: - History taking - Clinical examination - Special Investigations
  5. 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. 6. *Means of clinical examination: Inspection Palpation Percussion Auscultation
  7. 7. *SpecialInvestigations - Biopsy: Is the technique of choice for diagnosis of a soft-tissue lesion in the mouth. - Serological tests including PCR - Urinalysis.
  8. 8. Digitalsubtraction MRI CT -Microbiological culturing -Conventional and advanced radiographic techniques
  9. 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. 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. 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. 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. 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. 14. Ulcers Agranulocytosis/ cyclic neutropenia/ aplastic anemia. Leukemia Lupus Erythematosus Lichen Planus Mucocutaneous ocular Syndromes Syphilis Tuberculosis Herpetic Stomatitis
  15. 15. AgranulocytosisAgranulocytosis - Absence of granulocytes - W.B.Cs < 2000/mm3
  16. 16. Herpetic Stomatitis Smear Viral Culture Antibody titre AIDS?
  17. 17. LeukemiaLeukemia - Full blood picture - Bone marrow biopsy
  18. 18. Lichen Planus - Biopsy - Grinspan syndrome?
  19. 19. Lupus Erythematosus - Biopsy - Increased ESR - autoantiboies +ve LE test
  20. 20. Mucocutaneous Ocular SyndromesMucocutaneous Ocular Syndromes Steven-Johnson Behcet Reiter Mild leukocytosis Hypergamaglobulinema leukocytosis Pyuria Clinical picture/biopsy Seronegative Polyartheritis
  21. 21. SyphilisSyphilis - Direct smear - Serological test
  22. 22. Biopsy Sputum culture Chest Radiography Tuberculosis
  23. 23. White lesions Lupus Erythematosus Lichen Planus Syphilis
  24. 24. Lichen PlanusLichen Planus
  25. 25. Lupus Erythematosus
  26. 26. SyphilisSyphilis
  27. 27. BleedingBleeding Hemophilia Thrombocytopenia Polythycemia Leukemia Scurvy
  28. 28. HemophiliaHemophilia Normal bleeding time Normal PT Increased PTT
  29. 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. 30. PolycythemiaPolycythemia Increase in all blood elements Increased bleeding time
  31. 31. ScurvyScurvy Normal blood picture Increased bleeding time Dietary history
  32. 32. Thrombocytopenia / ThrombocytosisThrombocytopenia / Thrombocytosis Decreased platelets count Increased bleeding time Increased bleeding time Increased platelets count
  33. 33. Hyperpigmentation Addison’s Disease Kaposi’s sarcoma Icterus Peutz-Jeghers Syndrome
  34. 34. Addison’s Disease Blood pressure Plasma electrolytes Cortisol levels Response to ACTH
  35. 35. IcterusIcterus Hemolytic Anemia? Hepatitis? CBC Liver Function PCR
  36. 36. Kaposi’s SarcomaKaposi’s Sarcoma Biopsy AIDS?
  37. 37. Peutz-Jeghers SyndromePeutz-Jeghers Syndrome Clinical Features
  38. 38. Tongue lesions Atrophic Glossitis Geographic Tongue
  39. 39. Iron Atrophic glossitis Folic acid Vit. B 12 Blood picture Vitamin Assay
  40. 40. Geographic TongueGeographic Tongue Psoriasis? History of migrating pattern
  41. 41. Gingival enlargement Drug-induced gingival hyperplasia Diabetes mellitus Leukemia Scurvy
  42. 42. Drug-induced gingival hyperplasiaDrug-induced gingival hyperplasia Phenytoin Nifedipine History of taking the drug Blood picture Biopsy
  43. 43. Leukemia Vit. C deficiency Blood picture Fasting blood sugar level / glucose tolerance test Diabetes mellitus
  44. 44. Multiple Abscess Formation Diabetes Mellitus TB.
  45. 45. Thank you