oral diagnosis and systemic diseases
TRANSCRIPT
Oral Diagnosis and Manifestations of Some
Systemic Diseases
Dr.Usama M. MadanyB.Ch.D, M.Sc., Ph.D.
Professor, Oral Medicine Periodontology, Diagnosis and Oral Radiology, Faculty of Dentistry, Al-Azhar Univ.
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.
Categories of Diagnosis:
Spot diagnosis
Tentative diagnosis
Definitive diagnosis
To reach a definitive diagnosis, pretreatment evaluation of a case should be achieved through:
- History taking
- Clinical examination
- Special Investigations
Essential elements of history taking; Chief complaint History of the present illness Past medical historySocial history Family history
Review of systems Dental history
*Means of clinical examination:
Inspection
Palpation
Percussion
Auscultation
*Special Investigations
- Biopsy: Is the technique of choice for diagnosis of a soft-tissue lesion in the mouth.
- Serological tests including PCR
- Urinalysis.
Digital subtractionMRICT
-Microbiological culturing
-Conventional and advanced radiographic techniques
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
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.
Polymerase chain 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.
Objectives of pretreatment evaluation:- Establishment of diagnosis.
- Determination of underlying medical condition.
- Discovery of concomitant illness.
- Prevention of medical emergencies associated with dental treatment.
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
Ulcers
Agranulocytosis/ cyclic neutropenia/ aplastic anemia.
Leukemia
Lupus Erythematosus
Lichen Planus
Mucocutaneous ocular Syndromes
Syphilis
Tuberculosis
Herpetic Stomatitis
AgranulocytosisAgranulocytosis
- Absence of granulocytes- W.B.Cs < 2000/mm3
Herpetic StomatitisSmear
Viral Culture
Antibody titre
AIDS?
LeukemiaLeukemia
- Full blood picture
- Bone marrow biopsy
Lichen Planus
- Biopsy
- Grinspan syndrome?
Lupus Erythematosus
- Biopsy
- Increased ESR
- autoantiboies
+ve LE test
Mucocutaneous Ocular SyndromesMucocutaneous Ocular Syndromes
Steven-Johnson Behcet Reiter
Mild leukocytosis
Hypergamaglobulinema
leukocytosis
PyuriaClinical picture/biopsy
Seronegative Polyartheritis
SyphilisSyphilis
- Direct smear
- Serological test
Biopsy Sputum culture Chest Radiography
Tuberculosis
White lesions
Lupus Erythematosus
Lichen Planus
Syphilis
Lichen PlanusLichen Planus
Lupus Erythematosus
SyphilisSyphilis
BleedingBleeding
Hemophilia
Thrombocytopenia
Polythycemia
Leukemia
Scurvy
HemophiliaHemophilia
Normal bleeding time
Normal PT
Increased PTT
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
PolycythemiaPolycythemia
Increase in all blood elements
Increased bleeding time
ScurvyScurvy
Normal blood picture
Increased bleeding time
Dietary history
Thrombocytopenia / ThrombocytosisThrombocytopenia / Thrombocytosis
Decreased platelets count
Increased bleeding time Increased bleeding time
Increased platelets count
Hyperpigmentation
Addison’s Disease
Kaposi’s sarcoma
Icterus
Peutz-Jeghers Syndrome
Addison’s Disease
Blood pressure
Plasma electrolytes
Cortisol levels
Response to ACTH
IcterusIcterus
Hemolytic Anemia?
Hepatitis?
CBC
Liver Function
PCR
Kaposi’s SarcomaKaposi’s Sarcoma
Biopsy AIDS?
Peutz-Jeghers SyndromePeutz-Jeghers Syndrome
Clinical Features
Tongue lesions
Atrophic Glossitis
Geographic Tongue
Iron
Atrophic glossitis
Folic acid
Vit. B 12
Blood picture
Vitamin Assay
Geographic TongueGeographic Tongue
Psoriasis?
History of migrating pattern
Gingival enlargement
Drug-induced gingival hyperplasia
Diabetes mellitus
Leukemia
Scurvy
Drug-induced gingival hyperplasiaDrug-induced gingival hyperplasia
Phenytoin Nifedipine
History of taking the drug Blood picture
Biopsy
Leukemia Vit. C deficiencyBlood picture
Fasting blood sugar level / glucose tolerance test
Diabetes mellitus
Multiple Abscess Formation
Diabetes Mellitus
TB.
Thank you