ORAL DIAGNOSIS

Components of Diagnosis
● art of determining the nature of a disease Case History includes: personal data, chief
by gathering, recording and evaluating complaint (CC), history of present illness (HPI),
information that contributes to the medical history, past dental and medical history,
identification of abnormalities of the head familial history, personal and social history and
and neck region which relate to the total review by systems
health of the patient. Clinical examination includes: general
● compilation and study of the patient’s dental examination, extraoral examination, intraoral
history and detailed clinical examination of the examination
oral tissues and radiographs to assess oral Diagnosis: preliminary and final diagnosis
health, with the object of developing a
treatment plan to restore tooth structure and Treatment plan. Defined as the sequence of
proper occlusion and promote healing and procedures planned for the treatment of a patient
better oral health. after diagnosis.
Definition of Terms
SIGNS Types of Examination
● objective Thorough or Complete Examination
● physical manifestation utilizes all skills of interviewing, physical examination
● something that can observed externally and supplementary diagnostic aids. It includes:
● findings that are discovered by the dentist - Case History
SYMPTOMS - Clinical Examination
● subjective - Diagnosis
● something that is felt by the patient internally - Treatment Plan
SYNDROME Screening Type of Examination
● Set of symptoms - includes brief clinical examination of the teeth
TENTATIVE DIAGNOSIS- can change after further and its supporting structures and the mouth
examination with limited X-ray examinations utilizing the
● preliminary diagnosis bitewing radiographs.
● educated guess - directed towards a particular disease
● temporary diagnosis - precursor to a more thorough examination.
FINAL DIAGNOSIS Emergency Type of Examination
● diagnosis arrived at a thorough examination - for diagnosis and management of acute and
and analysis of all pertinent data emergency conditions
● definitive - limited to the procedure related to the
DIFFERENTIAL DIAGNOSIS complaint of the patient
● determination of a disease by systematic - limited to the signs and symptoms of the
comparison and contrasts of symptoms of the disease and its causative agent
one of several diseases from which a patient - simplest form consists only of the patient
is suffering through the process of opening his mouth and the examiner’s
contrasting clinical, pathological and observation of the disease.
laboratory data. History consists solely of:
PROGNOSIS - Time of occurrence
● Forecast as to the probable result of an attack - Manner in which the accident occurred
of a disease - Presence or absence of associated
● prospect as to the recovery from a disease as signs and symptoms, systemic
indicated by the nature and symptoms disease of immediate importance to
● dependent on: severity of symptoms, location history
of nature of the lesion, etiologic agent, body - Clinical Examination consists of
resistance of the patient. inspecting the fracture to determine
 involvement of the condition of the
pulpal tissue
Periodic Health Maintenance Examination
● includes a complete examination of the
patient's mouth
● results are then used in subsequent
examinations to measure what deviations
might have occurred during the interval.
● ideal time interval is 6 months-1 year.
● factors such as age, sex and initial
examination

Universal precautions are as follows:

1. Immunization
2. Use of personal protective barrier techniques.
These includes gown, face mask, protective
INFECTION CONTROL eyewear and gloves
series of steps that healthcare facilities and hospitals 3. Maintaining hand hygiene
take to prevent the spread of infectious diseases to
prevent further spreading of disease

Rationale for Infection control

- microorganisms can spread from one person
to another via direct contact, indirect contact,
droplet infection and airborne infection
- Two factors that are important in infection
control:
1. Prevention of spread of microorganisms
2. Killing or removal of microorganisms from
objects and surfaces

Importance of Infection control

● Both patient and dental healthcare personnel Preparation and Packaging of Instruments
can be exposed to pathogens 1. Materials:
● Contact with blood, oral respiratory ● Rubber Stamp (font size 14),
secretions, and contaminated equipment ● Sterilization Pouches (different sizes)
occurs ● Masking tape (50mmX20mm)
● Proper procedures can prevent transmission 2. Hand Instruments
of infections among patients Wrap clean & dry instruments using
sterilization pouch (do not overload) of proper
size
 3. Sterilization Pouch
● Stamp/write name on each pouch (upper left
corner)
● If more than 1 pouch, bundle-up 5 pouches
with prescribed size of masking tape on the
mid part or right side of pouches
● I bundle = 2 to 5 pouches
● Limit to 2 bundles only / clinician
● Endorse instruments to sterilization area
● Sign in the Logbook. Memorize your registry
number (2 bundles=2 numbers)
● Claim your sterilized instruments within the
day showing your ID, stating your registry
number and signing out in the logbook
● Sterilized instruments must be signed by the
OD personnel and are good for 7 days
● Failure to claim on the given time= 1 hour
penalty
● Used, dirty instruments and perforated
pouches will not be accepted
Sterilization involves any process, physical or
chemical that will destroy all forms of life, including
bacterial, fungi, spores and virus
The accepted methods of sterilization in the dental
practice are:
● Moist/steam heat sterilization (autoclave)
● Dry heat sterilization
● Chemical vapor pressure sterilization
● Ethylene oxide sterilization
Case History
● procedures embrace many inquiries and
activities, including physical examination
● correlate learned facts, experience and
observations to achieve a consistency in
arriving at a proper conclusion
● most important part of examination of patient,
yet it is generally the least understood and
most undervalued
Principles of Case History
● brief and concise
● primarily a diagnostic record
● opportunity to hear the patients complains,
hence, provide clues for diagnosis
● detects the dentist need for precaution
Techniques for obtaining patient history
● Questionnaires and forms
● Patient Interview
COMPONENTS OF CASE HISTORY
1. Personal Data
● Name. Recording keeping,
administrative purposes, better
communication
● Age. Diseases that may affect certain
age group (measles,pubertal gingivitis,
or degenerative age changes)
● Sex. Sex linked diseases, gingival
enlargement related to pregnancy
● Address. Patient’s social and home
background & for patient recall
● Occupation. Jobs that may cause
abnormal wear of dental hard tissues
and or oral lesions due to systemic
absorption of metallic andnon-metallic
compounds
2. Chief Complaint
Primary reason, or reasons, that the patient
has presented for treatment
● patients expression of a disease
● written in the patient's own words
● limited to a word, phrase or sentence
● there could be more than complaint
● best obtained by asking the patient an
open ended question, such as, “What
brought you to see me today?” or “Is
there anything in particular you are
hoping I can do for you?”
Dependent on: Age stress, health, fatigue,
preoccupation, social custom, demeanor of
the dentist.
3. History of Present Illness
● chronologic account of the patient’s chief
complaint and related symptoms.
● should include all relevant information since
the time of the complaint.
● relevant facts in the patient medical history
● exacerbating and relieving factors/ stimuli
must be included

(OLDCART Acronym)
1 chief complaint is equivalent to 1 history of
present illness
IDEAL GUIDE FOR TREATMENT PLANNING
- OP
- Exo
- Resto
- Endo (pwede mauna muna endo sa resto)
- Protho (always last treatment of choice)
4. Past history (divided into past medical and
past dental)
● should include all constitutional
diseases, serious illnesses,
manifestations of allergic states and
accidents and operations
● determine and provide what was done,
when, where and why and by whom,
and the outcome of prior treatment
● Divided into Past Dental and Past
Medical
Past Medical
● includes past systemic disease,
injuries and operation that may be
related directly or indirectly to dental
treatment
● not only aids in diagnosis but also
provides information about patient’s
susceptibility and reactions to infection
, bleeding/ prescribed medications and
emotional status
● precautionary measures are
sometimes indicated
● serious illness
● hospitalization
● allergies
● bleeding disorders
● medication taken in the last six months
● childhood diseases (like rheumatic
fever)
CVA- Stroke
Past Dental History
● provides the dentist with valuable prognostic
as well as diagnostic information of patient’s
past dental experience
● provides valuable information about patient’s
attitudes toward health, care and treatment
● frequency of visit to the dentist
● past experience to local anesthesia,
extraction- bleeding and healing process
● other dental operative procedures done
5. Familial history
● includes important conditions that have
tendencies to be inherited as well as
indication of possibility of ineffective contact
● general health of the family history of mental
disease, cause of death of parents if
deceased, history of chronic infectious
diseases in the family, history of dental
problems
● diseases that may render the patient
susceptible are:
diabetes, cancer, anemia, allergic diseases,
diseases of the nervous, renal, digestive and
musculoskeletal system
Immediate family lang, but if the immediate family is
healthy, thats the time na magtanong about sa
extended family.
If orphan ang patient, must ask about the cause of
death ng parents
 Note: when none of the members of the family
has/ had any genetic or infectious diseases,
must check on the health status of relatives of
the patient
6. Personal and Social history
● includes brief summary of patient’s
marital status,occupation, financial
status, type of personality, habits and
religion
● also help to identify psychosomatic
imbalances that otherwise would be
recognized only as somatic symptoms
● occupational history is important
whenever the physical environment
may produce oral or skeletal lesions
● personal habits like oral hygiene
habits, bruxism or thumb sucking,
smoking, drinking alcohol should be
included

7. Review of symptoms by 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
*wala sa OD form but nasa 2nd page to ng Compre
form

OD FORM

SYMPTOMATOLOGY
Symptoms
Subjective- those recognized and reported by the
patient and are obtained by inquiry, during the case
history
Examples: pain, discomfort, burning, numbness,
roughness and swelling
Cardinal Manifestations of Disease
1. Cardinal Signs of Inflammation
Inflammation is the immune system’s natural
response to injury or illness.
● pain (dolor)
● heat ( calor)
● redness (rubor)
● swelling (tumor)
● loss of function ( functio laesa)
2. Cardinal manifestations of Systemic
Disease
Symptoms may include:
● Fatigue
● Chest pain
● Abdominal pain
● Fever
● Rash
● Muscle pain
● Joint pain
● Mouth sores
Symptoms of organ involvement depend on the
particular organ affected.
For example:
- Inflammation of the heart (myocarditis) can
cause shortness of breath or fluid retention.
- Inflammation of the kidneys (nephritis) may
cause kidney failure or high blood pressure.
- Inflammation of the large intestine, known as
colitis, may cause cramps and diarrhea.
Pain
*main reason people visit the dentist
Unpleasant emotional experience usually stimulated
by noxious stimulus and transmitted over a
specialized neural network to the CNS where it is
interpreted.
Theories of pain: intensity, specificity, pattern,
chemical Lindhal’s biochemical, gate control theory
Somatic and visceral sensory innervation:
- Trigeminal (V)
- Facial Nerve (VII)
- Glossopharyngeal (IX)
- Vagus (X)
Type of Pain
1. Vague pain: mild continuous pain
e.g. periodontal sensation
2. Burning pain: occurs with burning sensation
e.g. reflex oesophagitis
3. Throbbing pain: pulsating
e.g. abscesses, pulpitis
4. Stabbing pain: severe, sharp and short lived
e.g. pulpal pain
5. Shooting pain: increases in severity in short
period
e.g. trigeminal neuralgia
Common types of oro-facial pain likely to cause a
patient to seek emergency care are categorized in
this figure. The character of the pain can point to a
diagnosis
*More prone sa dry socket pag nag memenstrate ang
babae because of fibrin production change
 moving object is Doppler shifted, and a signal
is produced.
Pulp Vascularity Test
● Cone Beam Computerized Tomography
(CBCT)
special type of x-ray equipment used when
regular dental or facial x-rays are not
sufficient. use this technology to produce
three dimensional (3-D) images of your teeth,
soft tissues, nerve pathways and bone in a
DIAGNOSTIC TECHNIQUES AND TESTS single scan.
● Visual and tactile inspection ● Magnetic Resonance Imaging (MRI)
● Anesthesia diagnosis of temporomandibular joint
● Percussion- *not a vital test diseases which may lead to a
● Occlusal Pressure Test degeneration of the discs inflammatory
● Palpation conditions of the facial skeleton, and in
● Gutta Percha Tracing examination of the salivary glands,
● Mobility maxillary sinuses, masseter muscles,
Transillumination in the detection of early bone changes
● Radiographs
● Staining PRIMARY AND SECONDARY LESIONS
● Thermal Tests
● Periodontal Examination
● Electric Pulp test
● Test cavity
● Study Cast Analysis.
Note: this will be discussed during the clinical
examination of the teeth
Other Methods
● Xeroradiography
highly accurate electrostatic imaging
technique conventional single-phase dental x-
ray unit is used as an x-ray source, but
instead of a silver-halide film image, a
uniformly charged selenium alloy plate
housed in a light-proof cassette is used

Advantage: enhanced visualization of the

borders between images, low contrast
enables differentiation between fat, muscle
and bones and wide exposure latitude
● Pulse-oximetry
It is effective and accurate while calculating
oxygen saturation of blood. It can be utilized
as a vital instrument for differentiating vital
and necrotic pulp.
● Laser Doppler Flowmetry
Non-invasive method to measure blood flow.
Uses a helium neon laser light beam that is
directed into the tooth. Light that contacts a