1. daignostic process and history 11-2-2014

Oral Diagnosis 12014

Dr. Khalid Al-JohaniAssistant Professor/Consultant

Level 6

Course

No.

Course Title

Contact Hours Credit

sTheory Clinic

344 DSD

Oral Diagnosis 1 1

1 2

Course Contents:

Introduction/Diagnostic Method Infection Control Patient History Methods of Clinical Examination Physical Assessment Extra-oral Examination Intra-oral Examination Examination of Teeth Examination of Periodontium Examination of Occlusion and Edentulous Mouth Radiographic Examination Treatment Plan Supplementary Examination Clinical Signs of Disease

Assessment :

Continuous assessment (Quizzes, Discussion & Attendance, clinical assessment, activities)

60%

Final Exam 40 %

Oral Diagnosis, Oral Medicine and Treatment Planning Steven L. Bricker, Robert P. Langlais , Craig S. Miller

Diagnostic Process2014


Oral Diagnosis Course

Oral Diagnosis: is that area of dental practice which deals with gathering, recording, and evaluating information that contributes to identifying abnormalities of the head and neck region which relate to the patients total health.

Oral Diagnosis Course

The purpose of obtaining this information is to establish a diagnosis from which a rational treatment plan can be formulated

Diagnosis

Diagnosis: is an understanding of patient’s condition (problems)

Clinical Evaluation

Types of Clinical Evaluation: Comprehensive Abbreviated

Screening and recall Emergency

Diagnostic Process

The clinician's ability to arrive at an accu rate diagnosis involves several skills:

the power of observation knowledge and the ability to listen

Diagnostic Process

Path ognomonic sign or a symptom

Diagnostic Process

Path ognomonic sign or a symptom

How ever, usually the process of diagnosis is more com plex.

The collection of information about an individual (baseline information) is the first step in the sequence of the diagnos tic process.

Diagnostic process also called diagnostic sequence.

Diagnostic process/di agnostic sequence

Diagnostic sequence: is a series of steps that enables the dentist to elicit and or ganize information.

To en sure that all information is collected, recorded, analyzed, and constantly reexamined in the light of new facts as they are gathered.

Information may vary from the observation of the gingival bleeding resulting from poor dental hygiene to the observation of gingival bleeding from systemic cause.


Diagnostic Sequence: Detection and examination of

abnormalities


Diagnostic Sequence:1. Detection and examination of abnormalities2. History and examination of patient3. Reexamination4. Classification of the abnormalities 5. List of possible diagnoses 6. Development of differential diagnosis7. Development of working diagnosis 8. Final diagnosis


1. Detection and examination of abnormalities

(Painful or Painless)


1. Detection and examination of abnormalities


2. History and clinical examination

This step produces a major part of information pool.


3. Reexamination

This reexamination is performed in the light of the information produced from the patient's history and the comprehensive exam ination.


4. Clas sification of the abnormalities

Clas sification or grouping may be according to:

Appearance Location (soft tissue or bone) Rate of growth (slow growing or rapid

expan sion) Associated symptoms (painless or painful)

Clas sification of the abnormalities-Appearance




Appearance Location (soft tissue or bone)

Clas sification of the abnormalities-Location

Clas sification of the abnormalities-Rate of growth

Slow growing or rapid expan sion

Clas sification of the abnormalities-Associated symptoms

Painful or Painless




Appearance Location (soft tissue or bone) Rate of growth (slow growing or rapid

expan sion) Associated symptoms (painless or painful)


5. List of possible diagnoses

Relies on the knowl edge collected throughout education and career.

Developed from the study of:• normal anatomy• variations of normal anatomy• and pathology.

Random listing without ordering.

The objective is to list every entity that could produce at least some of the findings.


6. Development of differential di agnosis

List pos sible diagnoses and ordering them by rank.

Some of the possible diagnoses may be elim inated if part of the information would ren der that diagnosis impossible.



Example: Pulpitis is a possible diagnosis for pain,

but it would be eliminated if the patient is edentu lous.



Most probable diagnosis at the top and the least at the bottom.

A common criterion used in listing a

differential diagnosis is frequency of occurrence (age, race, and other associated factors).

List of possible diagnoses:Recurrent aphthous stomatitisRecurrent intraoral herpesDrug induced mouth ulcerSquamous cell carcinomaMucous membrane pemphigoidOral lichen planusBullous pemphigoidPemphigus vulgarisLinear immunoglobulin A diseaseDermatitis herpetiformis

Differential di agnosis: Mucous membrane pemphigoidOral lichen planusPemphigus vulgarisLinear immunoglobulin A diseaseDermatitis herpetiformis


7. development of a working diagno sis.

The 1-2 diseases at the top of the list of DD are the working diagnosis, and appropriate therapy is now instituted.


Addi tional tests to narrow the differential diagno sis to the working diagnosis should be per formed.

Fortunately, in many cases it is pos sible to obtain enough information to go di rectly from the differential diagnosis to the final diagnosis without resorting to a work ing diagnosis.

The working diagnosis is needed wherein a part or all of the therapy is required to make the final diagnosis.

For example, in a differential diagnosis of nonspecific ulcer and squamous cell carci noma treatment through excisional biopsy is nec essary to make the final diagnosis.

The work ing diagnosis (the one considered most likely) would help determine the surgical ap proach.


8. determination of the final diagnosis.

This may be obtained through: biopsy; clinical, laboratory examination to eliminate other possibilities;

OR a pathogno monic sign or symptom.

In some cases, it may never be determined.

Diagnostic Process11.02.2014


1. daignostic process and history 11-2-2014

Health & Medicine