Oral Diagnosis

Introduction and definitions

Scope of Oral Diagnosis:

- The basis for modern therapy is accurate diagnosis.
- This requires identification of the disease then proper treatment.

Oral diagnosis:
- It is the art of using scientific knowledge to identify oral disease processes and to
distinguish one disease from another.
Dia = through Gnostic = having knowledge

Types of oral diagnosis:

1) Comprehensive oral diagnosis:
- Diagnostic evaluation of all dental problems for patients requiring total dental
care. It is obtained through:
a) Case history.
b) Clinical examination.
c) Special investigations as blood or urine analysis, biopsy or x-ray.

- It includes the listing of all dental problems and oral findings that require treatment
(caries, exposure, edentulous area, etc….).

2) Emergency diagnosis:
- Immediate diagnosis of the patient’s complaint that requires immediate attention and
management by the dentist (acute dental pain, accidental fractures…..).
- The emergency interferes with obtaining adequate history or full clinical examination
(only the area of chief complaint).

3) Spot diagnosis:
- Rapid diagnosis (identification of the disease) done in simple cases and based on
minimal data.e.g. palatal ulcer + history of eating pizza = diagnosis of pizza burn.

4) Differential diagnosis:
- Collection and arrangement of data to develop a list of two or more different diseases
having similar clinical presentation.
- The most likely lesion is put on top of the list.

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 - Final diagnosis can be reached by exclusion after thorough history, clinical examination
and special investigations.

5) Tentative (working or provisional) diagnosis:

- Primary, uncertain diagnosis which is made before collection of all diagnostic data.
- Final or definitive diagnosis is then reached by confirming the tentative diagnosis or
changing it according to response to treatment or the results of diagnostic aids (e.g.
biopsy).

6) Definitive diagnosis:
- Final diagnosis based on accurate evaluation of all available data.

Diagnostic terms:

Symptoms (subjective findings):

- Complaints recognized and reported by the patient e.g. pain, parasthesia, sensitivity to
hot or cold, altered taste and past occurrence of bleeding or swelling.

Signs (objective findings):

- Changes or deviation from normal that are detected by the examiner e.g. swelling or
discoloration of teeth or tissues.

Diagnostic (technical) aids:

- Any technique or special instrument used to help the establishment of a diagnosis such as
pulp testing, biopsy, radiographs, blood analysis, urine analysis…..

Prognosis:
- To guess the final outcome of the disease.
- Prognosis is expressed as “excellent”, “good” or “poor”.
- Prognosis must be determined before the treatment is planned.
- It depends on the patient’s attitude, his oral hygiene and desire to retain his
natural dentition.

Treatment plan:
- It is a written plan of treatment. There are two types:

A. Emergency (immediate) treatment plan: It identifies the chief complaint directly,

and must be performed at once.

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B. Comprehensive (long-range) treatment plan: It deals with all dental problems
revealed by careful examination. It is carried out in stages over time.

Components of the comprehensive oral diagnosis:

I. Patient`s history:
a) Patient identification
b) Chief complaint
c) History of chief complaint
d) Dental history
e) Medical history and review of systems
f) Family history
g) Social history
h) Personal habits
II. Physical examination:
a) General physical appraisal and vital signs
b) Extraoral examination
c) Intraoral examination

III. Adjunctive diagnostic information:

a) Radiographic examination
b) Laboratory investigations
c) Microscopic examination (Biopsy) and microbiologic studies

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