1. Introduction to Oral Diagnosis and all you need to know PDF

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and all you need to know about the trigeminal nerve and everything there is to know and pain that relates to the trigeminal nerve...

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ORAL DIAGNOSIS REVIEWER PT. 1

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PATIENT REQUIREMENTS      

At least 18 years old Preferably no medical condition. If he has medical condition, ask for clearance from medical doctor Preferably no extraction/endodontic treatment case Minimum of 5 caries (pits/fissure caries not included) For mild/moderate case of oral prophylaxis For prosthodontic treatment (Jacket Crown/FPD/RPD)

PRELIM REQUIREMENTS   

Oral Diagnosis with complete forms (OD Form/Compre Form signed by CI) – 20 pts Oral Prophylaxis – 20 pts One Restoration – 20 pts

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Oral Diagnosis  

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Deadline: 3 days after prelims MIDTERM REQUIREMENTS   

Complete Restoration – 20 pts Oral Diagnosis of Prostho Case – 20 pts Clinical Conference (RPD, Temporary Crown (JC,FPD)) – 20 pts

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FINALS REQUIREMENTS Final Impression of Patient – 40 pts

Deadline: Finals Examination INTRODUCTION TO ORAL DIAGNOSIS Goals 

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Personal account of the patient’s problem Most important component of clinical diagnosis Data Gathering Process: o Correlate learned facts, experience and observations to achieve a consistency in arriving at a proper conclusion o Opportunity to hear the patient’s complaints, hence, provide clues for diagnosis Detects the dentist’s need for precaution

Objectives of Case History  

Gather Data > Arrive at a Diagnosis > Develop a Treatment Plan

Identification of a disease by a systematic synthesis of all its manifestations Art of determining the nature of a disease by gathering, recording, and evaluating information that contributes to the identification of abnormalities of the head and neck region which relate to the total health of the patient Three elements of Diagnosis o History o Examination o Diagnostic Test

Case History

Deadline: 3 days after midterms

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Definitive Diagnosis o Final diagnosis o Final diagnosis arrived at through the examination and analysis of all pertinent data Multifactoral Diagnosis o Problem list

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Definition of Terms

To arrive at a tentative diagnosis, to identify new disease and conditions with important implications for the dentist To determine any systemic factor that may affect affirmation of diagnosis To determine any systemic condition that requires special precaution

Advantages of Case History 

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Diagnosis o The process of evaluating the patient’s health as well as the resulting opinions formulated by the clinicians o The assessment of findings which specifies what is happening to a patient and why Snap Diagnosis o Quick assessment (on the spot) Tentative Diagnosis o Working diagnosis o Preliminary diagnosis o Educative guess Differential Diagnosis o Set of findings o Is the determination of a disease by systematic comparison and contrasts of symptoms of the one of several diseases from which a patient is suffering through the process of contrasting clinical, pathological, and laboratory data

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Establishment of a written record that may serve as a diagnostic instrument Protection from possible disease contact Basis for future reference Provision of documents that may serve as legal evidence on legal basis

Case History 

Composed of 3 Stages: o Brief Introductory Phase o Listening to Patient’s Account o Structured Questioning

STAGE 1: Introductory Phase   

Breaking the ice Dentist/Clinician’s introduction Rule of Thumb: Use plain medical/dental terms

speech!

Don’t

use

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Record: o Patient’s biographic data (Name, Gender, Address, Phone number, Birthdate, Occupation) o Patient’s statement

STAGE 2: Listening to Patient’s Account 

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Listen to patient’s complaint/reason of seeking dental treatment Chief Complaint o Is usually the reason for the patient’s visit o It is stated in patient’s own words in chronological order of their appearance and their severity o The chief complaint aids in diagnosis and treatment therefore should be given utmost priority  “Nanigniglo ngipin ko”  “Masakit ang bagang ko”

STAGE 3: Structured Questioning  

Data gathering process: Diagnostic Interview Subdivided into five headings: o History of the Present Illness o Medical History o Previous Dental History o Family History o Social History

Leading Question

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Open Question

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The verbal exchange between the patient and the clinician that elicits the patient’s knowledge concerning health information The goal is to identify all relevant info efficiently Different methods of phrasing the same question can produce different answers o The way in which a question is asked is one of the most useful techniques for maintaining control of the interview

Questioning Techniques

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Prompts the patient into a narrative discussion Directs the patient to describe the entire topic with the expectation that most of the info will be contributory Patient is in control of the discussion “Can you tell me about the surgery that you underwent last year?”

Close Ended Questions

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Demands specific information Phrased to limit the answer to a single sentence or less Clinician is in control of the conversation “When did you have your last dental surgery?”

States inconsistent info and allows the patient to resolve the contradiction Designed for the patient to face the contradiction (by making a misleading statement or tell the truth) “Since you did not mention that you have diabetes, is there another reason why you are taking metformin?”

Indirect Questions

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Presents a topic in such a way that the patient will reveal info beyond what is specifically requested by the question Useful in understanding sensitive or conflicting info Useful in exploring the patient’s attitude “Have you had any complication during or after previous dental treatment?”

Strategies during Diagnostic Interview       

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Open Ended Questions

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Effective for sensitive topics Effective for forgetful patients Can manipulate a response from indecisive patients “Does it get more painful when drinking old or hot beverages?”

Contradiction Question

Diagnostic Interview 

A technique that suggests the answer within a question Usually used for unresponsive patients or for winning the confidence of suspicious individuals “I guess you always grind your teeth during sleep?”

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Opening Choice of Questioning Technique Timing and Sequence Avoid wasting time Gestures and Prompts Non-verbal Communication Humor o Note: Sexual, Ethnic and similar forms of humor have a negative impact Confrontation o Remember: The dentist should remain professionally reserve rather than participate in a conflict Summary and Confirmation Sources of info other than patient

What to get from Case History? 

Patient’s Complaint o History of the Present Illness o Medical History o Previous Dental History o Family History o Social History

Chief Complaint

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The patient’s expression of a disease Subjective symptoms What problem brought you to see me? What prompted you to see treatment? It may be a word, a phrase, or a sentence If there are two or more chief complaints, number them on the history sheet If the patient’s statement is more of what he wants, lead him to make it a complaint Common Chief Complaint o Pain o Sensitivity o Ulceration o Swelling o Difficulty in Eating

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Achy – Achy pain occurs continuously in a localized area, but a mild or moderate level. You may describe similar sensations as heavy or sore Dull – Like aching pain, dull discomfort occurs at a low level over a long period of time. Dull pain, however, may intensify when you put pressure on the affected body part Raw – Rawness usually affects the skin. If you have rawfeeling pain, your skin may seem extremely sore or tender Sharp – When you feel a sudden, intense spike of pain , that qualifies as “sharp”. Sharp pain may also fit the descriptors cutting and shooting Throbbing – Throbbing pain consists of recurring achy pains. You may also experience pounding, beating, or pulsing pain

Past Medical History  

Past systemic diseases, injuries and operation that may be related directly or indirectly to the dental treatment Include general assessment of the patient before the complaint, previous history and results of physical examination, idiosyncrasies to drugs, allergies, previous operations, injuries, hospitalizations and results

History of Present Illness (HPI)   

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Course of the patient’s chief complaint Elaborate the chief complaint of patient Direct and specific questions are used to elicit this information and should be recorded in the patient record in narrative form Dentist/Clinician asks for related symptoms o Symptom Characterization  When and how it began; what exacerbates and what ameliorates the complaint (when applicable); if and how the complaint has been treated, and what was the result of any such treatment, and what diagnostic tests have been performed

Health Questionnaire   

Functions as a “net” to identify potentially significant topics of the patient’s history Accomplished by non-specific questions about general health and specific questions concerning common diseases This saves time and provides documentation of the health history during the initial evaluation

Points to consider on Health Questionnaires Dentist must assume that the patient.. 1. 2. 3. 4. 5.

Can read the questions Understands the questions Wants to accurately respond to the questions Knows or remembers the answers to the questions Correctly marks or writes the appropriate responses

What if no medical condition exists? Pain Characterization

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The patient never had any systemic diseases, injuries, or previous operation that is related directly or indirectly to the dental treatment. No allergies were also noted

Note: Evidence of a negative history of adverse drug reaction can be of medico-legal significance if the initial occurrence of a drug complication results from the dentist’s prescription o Past Dental History 

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Includes frequency of visit to dentists, past experience to local anesthesia, past experience during extraction and healing process, other dental operative treatments Patient’s history of dental treatment

Frequency of Dental Care Routine Dental Care  Implies regular recall appointments and timely treatment of most dental needs Episodic Dental Care  Implies less than comprehensive dental care and irregular pattern of recall examination Symptomatic Dental Care  Indicates that the patient has generally consulted a dentist for relief of pain without regular attention to dental health Family History  It deals with the information about any health problems that may run in the family.  Directed to genetic conditions and communicable infections that may affect the patient Social History Includes information about patient’s habits and lifestyle.  Occupation  Hobbies  Daily activities  Habits (smoking, alcohol intake)  Eating habits  Emotional adaptation (stress) Review of Systems  Permits organization of some apparently unrelated symptoms  Decreases the possibility of overlooking important symptoms by including other areas of the body giving the examiner logical sequence for complete review of patient’s history  General health. Symptoms associated with decline of the patient’s general health include unexplained weight loss, recurring fever, night sweats, lack of energy, and nonspecific sensation of illness (malaise), loss of appetite, immobility, sleeping problems  Includes: o HEAD  EYES: Vision, diplopia, inflammatory disease  EARS: Hearing, tinnitus, vertigo  NOSE: Obstruction, epistaxis, frequent colds  THROAT: Hoarseness, tonsillitis, sore throat o CARDIORESPIRATORY

Angina/chest pain, dyspnea, orthopnea, palpitations, hemoptysis, cough, night sweats, rheumatic fever RESPIRATORY o Wheezes, rhonchi, crackles, GASTROINTESTINAL o

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Digestion, mastication, sore tongue, sore gums, saliva, occlusion, nausea, vomiting, diarrhea, and abdominal pain NEUROMUSCULAR o Paresthesia, anesthesia, paralysis, convulsions, neuralgia, arthritis, joint pains, limitations of motion, tremors, luxation and subluxation of the mandible o

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Clinical Examination  Extraoral Examination  Intraoral Examination  Supplementary Examination o Panoramic Analysis o Study Cast Analysis  Dental Charting Clinical Examination (CEU OD FORM)  Dental chart comprises the deciduous and permanent teeth  Use red and blue pencils/ball pen  Based OD through the anatomy of the tooth as some tooth may interchange or missing MARK THE FF WITH BLUE (WITH SHADE)  All restorations done  Amalgam (am)  Composite (c)  Glass ionomer (gi) MARK THE FF WITH BLUE PENCIL W/O SHADE:  All non-carious teeth present  Fixed partial dentures (fpd)  Jacket crowns (jc)  Pontics (p) and Abutments (ab)  Unerupted (un) MARK THE FF RED WITH SHADE  Caries (c)  Fractured (f) MARK THE FF WITH RED (WITHOUT SHADE)  Missing (x)  For extraction (ex)  Root Fragments (ex) Diagnostic Tests  Includes thermal tests (hot & cold), percussion, palpation, anesthetic test, test cavity, electric pulp test (ept) Tentative Diagnosis  Identification of a disease by an investigation of the signs & symptoms  Preliminary diagnosis  Temporary diagnosis based on the clinical symptoms  Answers the chief complaint/s Treatment Plan

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Dependent upon an accurate diagnosis Rationale for treatment plan is made with the following in mind: o Urgency of treatment, o Sequence of treatment, result expected from the treatment

Determination of Treatment Goals Patient’s Perspective  Chief complaint  Expectations  Financial limitations  Patient’s dental attitudes Dentist’s Perspective  Patient’s dental condition  Prognosis  Potential complications of the dental treatment  Referral to a specialist  Financial considerations Optimal Treatment Sequence Pretreatment Phase  Additional diagnostic procedures  Consultations Phase I – Treatment of Acute problems  To control pain and acute infection  Extraction  Incision and Drainage  Traumatic injury mgt  Pulpectomy  Pulpotomy  Sedative Pulp capping Phase II – Treatment to control Active Disease  Preparatory treatment phase  Controlling causative factors and eliminating lesions  Treatment of gingivitis before crown  Crown lengthening before crown  Restoration of abutments, clasp positions  Seat preparation, occlusal balance before an RPD  Alveoloplasty before CD Phase III – Restoration of Esthetics and Functtion  Relies on the effectiveness of phase II  Restoration of remaining carious teeth  Rehabilitation of edentulous spaces  Orthodontic treatment Phase IV – Re-evaluation of the treatment  No lesions have developed  Patient’s adjustment to the new appliance  Ability of the patient to maintain new restorations or appliance

SEQUENCE OF TREATMENT PLAN May interchange depending on urgency of situation

• Oral Prophylaxis • Extraction • Endodontic Treatment • Periodontal Treatment • Restorative/Operative Treatment • Prosthetic Treatment • Recall Note: Add tooth nos. (FDI SYSTEM) R’s for the Student Clinician  Responsibility—To be complete and thorough  Recognize—Deviations from normal (not to diagnose)  Record—Using appropriate clinical terms  Report—To supervising dentist or instructor...