Name: •A patient usually likes to be called by name.

•This will help to elicit the history properly & it will also be of physiological benefit to the patient.

Age: • Knowing the patient’s age is beneficial to the clinician in more ways than one.
o diagnosis: certain diseases are more common at certain ages. o treatment plan: if there is complete absence of teeth even at the age of 4-5 yrs. It is more frequently in association with hereditary ectodermal dysplasia.

• Delayed eruption of teeth may be associated with rickets, cretinism or certain local factors. • If the permanent tooth does not erupt in its eruption period we have to check by radiograph whether the permanent tooth bud is present or not.
o behavior management technique: it differs acc. to the age of the patient.

Sex:
o diagnosis: certain diseases are common in certain sex.

• •

E.g. In males, attrition, leukoplakia, basal cell carcinoma, verrucous carcinoma. In females, iron deficiency anemia, caries, malignant melanoma.
o gifting: in case of pediatric patients, gifting varies acc. To the sex of the child. o esthetic: girls are very much conscious about esthetics. o emotion: girls are very emotional & sensitive. Hence one must be very careful during treatment.

Failure to thrive, educational & emotional abuse are most common in case of female patient.
o Child abuse: sexual abuse or exploitation is, more common in case of girls. o dose: females have smallest body weight & require small dose as compared to males.

Address: • It’s necessary for future correspondence. Full postal address of the patient should be taken for future communication. • Geographic prevalence of dental disease:
o A few disease have got geographical distribution o Dental caries & mottled enamel are dependent on the fluoride content of domestic water. o In Mumbai, in cancer patients common site affected is the tongue & in Chennai its buccal mucosa. o Dental caries is more common in modern industrial areas while periodontal disease is more common on rural areas.

Geographic prevalence of medical disease:
o o o o Filariasis is common in orrisa. Leprosy in bankuar distt. Of west Bengal. Gall bladder disease on west Bengal & Bangladesh. Peptic ulcer in N-W & southern part of India.

Occupation: • to know the financial status: • Disease: some disease is peculiar to certain occupations.
o Hepatitis b – dentists, surgeons are very prone to it. o Varicose veins- common ion bus conductors & traffic policeman. o Carcinoma of scrotum- common on chimney sweepers or people working o In tar & oil companies.

• To establish a correct a diagnosis it is always advisable to spend some time on history taking. It sis desire that the patient should be allowed to speak freely & listened with patient in order to understand the problem. • Chief Complaint: The complaints of the patient along with the nature & duration of the problem should be listed in chronological order.

• History of present illness: The patient narrated the illness in his/her own style & give imp. Clues to significant symptoms the history should be recorded clearly & in chronological order specifying mode of onset, course of the disease., duration of the disease, relation to the function & the present status of the disease. • History of past illness: Information regarding the earlier disease & injury should be recorded specifying onset, duration, complication, management. Place of treatment & name of the attending physician.

• Personal history: It should include the social & occupational history including the economical & social status of the patient. The patient should be asked about smoking drinking of alcohol, diet & marital status. • Family History: The history is recorded to evaluate the patients inherited tendencies or possibility of exposure to disease within family & living standards.

Medical history • The case history should be followed by the evaluation of the health status of the patient & a comprehensive medical history is recorded. • The following condition & disease should be taken into consideration while recording the medical history.
o cardiovascular diseases- angina pectoris, myocardial infarction, any history of previous heart attack. o metabolic disorder – diabetes – adrenal malfunctioning disease of thyroid & parathyroid gland. o bleeding disorder- anemia is one the commonest problem in India that should npt tbe ongnpred epsecula y in female patients. Other disorder like haemophilia, leukaemias, purpura, liver disorders, Vit. C & k deficiencies should be considered. o drug allergy – any history of allergy to medicine & symptoms produced are recorded. In case the pt. is on long term steroid therapy for these problems, it should be taken in to account n all drug allergies should be boldly recorded on the face of the patients bed ticket.

o respiratory problems - pneumonia, bronchitis, asthma, deviated nasal septum are recorded. o chronic ailments- patient with chronic aliments are checked if they are on medicine such as anticoagulants , steroids, antihistamines, oral contraceptive & anti diabetic drugs. o renal disorder.- Acute or chronic renal failure , raised blood urea, haematuria. o neurological & physiachtric problems - epliptic fits & seizures & acute depressions are recorded. o hepatic disorders – amoebic abscess, obstructive jaundice & cirrhosis of liver should be recorded. o malignant disease- any history of malignant diseases including those on radiotherapy & chemotherapy should be brought on recorded. o miscellaneous conditions – like pregnancy, nutritional deficiency, old age, addiction to alcohol, use of tobacco, drugs, git disorders & infection should be recorded.

Assessment of system: • The assessment of individual system helps on detecting illness in other parts of body that others conveniently forget to detail.
o skin: color & texture of skin is seen for anaemia & jaundice. Signs of blood dyscrasis, petechiae, haemorrhages are looked for. o head: imp. Symptoms like headache, especially unilateral headache, history of trauma, fainting or unconsciousness is recorded. o Eyes: visual disturbance of sclera & conjunctiva is looked for anaemia & jaundice. o Ears: impaired hearing, loss of hearing discharge from ears, tinnitus etc. o Nose & Para nasal sinuses: discharge from or obstruction of nasal cavity, epistaxis, sinusitis, pain in infra orbital, aural & forehead areas & total or partial loss of sense of smell is recorded.

o Jaws: trauma to jaw bones, fracture dislocation, pain, trismus, swelling & gross deformities are looked for. o Oral cavity: pain, swelling, haemorrhage from the gums tongue , loosening of the teeth, occlusion, bruxism, salivation , odor, etc. should be noted. o Pharynx: hoarseness of voice difficulty swallowing, pain, swelling, haemorrhage, mass in pharynx are looked for. o Neck: check for movements of the neck, lump in the neck, cervical lymphadenopathy,

o Respiratory system: dyspnoea, haemoptysis, cough, wheezing are looked for. o Cardiovascular system: hypertension, dyspnoea, or exertion, changes in heart rate, chest pain, coronary artery disease etc. are required to be investigated. o Gastrointestinal tract: loss of weight, indigestion, pain in epigastrium, anorexia, haematemesis & history of nausea , vomiting & diarrhoea. o Genitor-urinary system: polyuria, dysuria, haematuria, oliguria, urethral discharge & any sexual diseases are recorded. o Endocrine system: changes in colour or texture of skin, patients behaviour, polydypsia, polyuria, polyphagia are looked for diabetes mellitus.

o Nervous system: fainting, unconsciousness, convulsions, paralysis, paraesthesia or any painful lesions. o Blood & lymphatic system: anaemia, hemophilia, purpura, leukaemias, petechiae, etc. are investigated o Bones & joints: pain, limitation of movements, swelling of joints& clicking in joints are recorded. o Gynaecologic system: An abnormality in menstrual cycle, no. of children’s, pregnancy, abortions, etc. is recorded.

Physical examination: • Once the medical history & review of various systems have been completed one should proceed with physical examination on the basis of history recorded. The clinical examination of oral & maxillofacial region should involve extra oral & intra oral examination. Steps of examination are:
    Inspection. Palpation Percussion Auscultation

Provisional Diagnosis: • All the historical records & the clinical findings are clubbed together to frame a provisional diagnosis. • One can always keep couple of possibilities in mind & differentially diagnose the problem on the basis of clinical knowledge & lab. Investigations.

Laboratory Investigations: 1. hematological investigations 2. urine analysis 3. biochemical analysis 4. radiological investigations 5. histopathological investigations 6. microbiological investigations 7. special investigations

Hematological investigations Routine investigations for blood are advised. The normal values for routine tests are as follows: • Hemoglobin 12-14 gm% in females 14-16 gm% in males • bleeding time 1-5 min ( by dukes method) • clotting time 4-10 min ( by Lee-White method) • TLC: 4000-11000 cells/mm3 • DLC: Neutrophils – 50-70 % Lymphocyte – 25-40 % Monocyte – 2-6 % Eosinophils: 1-4% Basophils: 0-1% • RBC: 4.5-5.5 million cells/mm3 • Platelet count: 150000-400000cells/mm3 • Prothrombin time: 11-15 sec. • ESR: 0-20mm/hour in females 0-10 mm/hr in males

2. urine analysis it should consist of physical , microscopic, & chemical examination. Following investigations are generally carried out: Gross examination:  Volume  Colour  Appearance  Odour  Specific gravity

Clinical examination:  Reaction  Protein  Glucose  Ketone  Bile salts  Pigments  Haemoglobin Microscopic examination:  Sediments  R.B.C  W.B.C  Epithelial cell casts  Bence Jones proteins

Biochemical investigations  fasting blood glucose 65-110 mg%  blood glucose random <160mg%  total protein 6-8 gm/100 ml  serum calcium 9-11 mg/100 ml  serum phosphorus 2.5-4.5 mg/100 ml  serum cholesterol 150-300mg/100 ml  serum uric acid 2.5-8mg/100 ml  serum creatinine 0.7-1.4 mg/100 ml  alkaline phosphatase 1.5-4.5 bodansky units  SGOT 8-40 mu/ml  SGPT 6-36 mu/100 ml  Blood urea 10-46 mg/100ml  Serum bilirubin 0.1-1 mg/100ml

radiological investigations • routine radiological examination • face & jaws present unusual problems in radiographic examination. • To overcome these problems a lot many special projections have been devised with which oral surgeon should be familiar.

• Extra oral projections

Special radiological examination • Cephalometric x-ray: these radiographs are helpful in studying the growth pattern of maxillo-facial skeleton. • Sialography: the salivary glands & ducts are radiologically examined after injecting radiopaque dye. • OPG: opg’s cover a relatively large area of the jaws. • CAT scan: it is of tremendous imp. As a diagnostic aid in oral & maxillofacial surgery especially maxillofacial traumatology. The improved version of CT scan are MRI, nuclear magnetic resonance imaging, 3-D scan, spiral CT scan & PET. • Ultrasound scan: Computerized Ultrasound scanning is a noninvasive, safe, painless & inexpensive aid in diagnosis of swellings in the neck region.

Histopathological investigations • Autopsy is the histopathological study of tissues removed after death of individual. • Biopsy is the study of tissues removed from living organism to confirm diagnosis through histopathological study.

Microbiological investigations: • For bacterial infections culture & antibiotic sensitivity test should be preformed. • Both aerobic & anaerobic culture should be considered. • In septicaemia blood culture is advised. • The antibody patient serum against a given virus during the acute & convalescent phase of illness should be studied. • The oral surgeon are supposed to be particularly cautious about viral hepatitis & HIV infections since they are at a potential risk of contacting these diseases.

Special Investigations • Sialography • Lymph node biopsies • Tuberculin test.

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