341 MDS- Oral Diagnosis Course director: Dr Asma’a Faden Course contributors: Dr Maysara AlShawaf...

341 MDS- Oral Diagnosis

Course director: Dr Asma’a Faden

Course contributors: Dr Maysara AlShawaf

Dr Aziza AlMobeeriek

Dr Khawaja

DiagnosisDiagnosis

Definition:

• DiagnoseDiagnose is to distinguish, to identify a disease by

an investigation of the signs & symptoms.

• DiagnosisDiagnosis: is the process of evaluating the

patient’s health, as well as the resulting opinions

formulated by the clinician.

Oral DiagnosisOral Diagnosis

Definition:

• Oral DiagnosisOral Diagnosis is the artart of using scientific

knowledge to identify oral disease processes

& to distinguish one disease from another.  

• The clinical manifestations of routine dental

diseases (e.g., dental caries and gingivitis) can be

recognized by ARM approach “Appearance Appearance

Recognition Method”Recognition Method”.

• The challenge is with non-dental & mucosal

conditions !!!!!!!!!!! (e.g., oral ulcersoral ulcers)

• It has common appearance with diversity of

possible causes.

• ARM approach is not applicable.

• Another approach should be approached which

allows comparison of several disease known to

produce primary manifestation of the patient’s

abnormality in the expectations that some of the

possible causes can be eliminated on the basis of

contradictory features.

• This approach is called Differential DiagnosisDifferential Diagnosis

Differential DiagnosisDifferential Diagnosis

Definition:

• It is the determination of which of two or

more diseases with similar signs & symptoms

is the one that the patient is suffering.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i.i. Categorization of the Abnormality by Primary Manifestation.Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

• Could be the suspected abnormality be an anomalies???

• If lesion, Is It soft tissue or bone in origin???

• Is there any change in color, loss of mucosal integrity or swelling????

• Any additional feature is called Secondary Secondary Clinical Features.Clinical Features.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

ii. Listing of Secondary Clinical Features.

• Careful visual examination allows observation of

the lesion size, shape, location, isolated or

multiple, consistency, surface texture and

alteration of adjacent structures e.g., displacement

of teeth.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

ii. Listing of Secondary Clinical Features.

• Contributing factors includes:

- Demographic information's: age, gender, race, habits.

- Recent history of injury, infection & surgery.

- Medical conditions: chronic illness & recent acute diseases.

- Current medical treatments.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

• Accurate differential diagnosis of most non-dental

abnormalities REQUIRES consideration of many

possible causes.

• The differential diagnosis is more likely to yield a

correct diagnosis if the typical features of many

possible conditions are compared with those of the

patient’s abnormality.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

iv. Elimination of Unlikely Causes.

• Secondary findings and additional clinical

information to be compared to eliminate unlikely

causes.

• The GOAL is to eliminate as many causes from

consideration as posible.

• Also, elimination of particularly serious conditions

e.g., malignancy.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

v. Ranking of Possible Causes by Probability.

• This is based on the secondary feature that

correspond with the typical features of each

possible diagnosis.

• The condition considered the most likely cause is

referred to as the workingworking, tentativetentative or preliminarypreliminary

diagnosisdiagnosis or the clinical impressionclinical impression.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

v. Ranking of Possible Causes by Probability.

• The working diagnosis and the less likely

diagnostic possibilities provide the basis for

additional diagnostic procedures (e.g., biopsy, lab

test).

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

• If all but one disease are eliminated from the

differential diagnosis, then that is the DefinitiveDefinitive or

Final DiagnosisFinal Diagnosis.

• Definitive treatment is then administered.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

iv. Re-evaluation and Re-call.

• The final aspect of differential diagnosis is re-evaluation and re-call.

• The course of the condition over a period of time with or without specific treatment is one source of confirmational diagnostic information.

• Incorrect diagnosis unexpected results.

• Recurrence of lesions require additional treatments.

Concepts of Differential DiagnosisConcepts of Differential Diagnosis

The Diagnostic SequenceThe Diagnostic Sequence

i.i. Categorization of the Abnormality by Primary ManifestationCategorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary

Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.

InitialInitial categorization of suspected categorization of suspected abnormalitiesabnormalities

• Could be the suspected abnormality be an anomalies or a

lesion???

• If lesion, Is It soft tissue or bone in origin???

Normal Tissue VariationsNormal Tissue Variations

• Typical features of normal tissue variations Typical features of normal tissue variations include:include:

A. Bilateral symmetryBilateral symmetry in:

- Location- Degree or extent of the unusual appearance.

B. Predictable locationsPredictable locations: e.g., mental foramen, parotid papilla.

C. AsymptomaticAsymptomatic: tenderness disease.

D. Independent findingsIndependent findings: Most variations are identified

as independent findings. Intra-oral lesions often present

secondary changes as erythema.

Normal Tissue VariationsNormal Tissue Variations

• Typical features of normal tissue variations include Typical features of normal tissue variations include

(Cont’d):(Cont’d):

E. StaticStatic: Remain unchanged.

F. Increased prominence with ageIncreased prominence with age: More prominent

with increased age or more noticeable after years of

exposure to the oral environment.

G. Remain unchanged following empiric treatmentRemain unchanged following empiric treatment:

most lesions either improve or worsen under the

influence of treatment.

Categorization of Abnormalities by Tissue Categorization of Abnormalities by Tissue affected and Primary Manifestationaffected and Primary Manifestation

• Categorization of abnormalities on the basis of the

tissues affected and by the primary manifestation

simplifies the differential diagnosis.

• The initial oral lesion categorization is based on the

tissue affected as either:

- Surface mucosa.

- Deeper soft tissues.

- Bone.

• In addition, some conditions are characterized by

multiple abnormalities affecting several different tissues or

anatomic sites which suggests SYNDROMESSYNDROMES.

Categorization of Abnormalities by Tissue Categorization of Abnormalities by Tissue affected and Primary Manifestationaffected and Primary Manifestation

• Alteration in the appearance of the superficial oral

mucosa is considered as Mucosal lesion Category.

• Evidence of enlargement, bony or any other tissue

suggests a secondary lesion.

• Therefore, these additional findings imply

additional differential diagnosis.

Categorization of Abnormalities by Tissue Categorization of Abnormalities by Tissue affected and Primary Manifestationaffected and Primary Manifestation

• Oral mucosal lesions without enlargement are Oral mucosal lesions without enlargement are

divided on the basis of appearance as:divided on the basis of appearance as:

1. White mucosal lesions.

2. Dark mucosal lesions.

3. Loss of mucosal integrity.

Categorization of Abnormalities by Tissue Categorization of Abnormalities by Tissue affected and Primary Manifestationaffected and Primary Manifestation

• Oral mucosal lesions with enlargement are divided Oral mucosal lesions with enlargement are divided

as:as:

1. Soft tissue enlargements.

2. Radiographic lesions.

Clinical SyndromesClinical Syndromes

-The term syndromesyndrome refers to the association of

several clinically recognizable features, signs signs (discovered

by a physician), symptomssymptoms (reported by the patient),

phenomena or characteristics which often occur together, so

that the presence of one feature alerts the physicianphysician to the

presence of the others

•Abnormalities may be related by a common developmental

or metabolic condition.

• Abnormality affects more than one tissue or site.

Clinical SyndromesClinical Syndromes

• Why is it difficult to diagnose clinical syndromes?Why is it difficult to diagnose clinical syndromes?

1. Certain diseases produce multiple lesions of similar

character. Primary manifestation is multi-focal.

2. Coincidence of manifestation of several diseases as seen in

elderly.

3. Rare occurrence. Recognize the combination of clinical

features, apparently dissimilar abnormalities & compare

with features of Head & Neck Syndromes.

SUMMERYSUMMERY

Differential Diagnosis provides the diagnostic approach

needed to compare the diagnostic finding exhibited by the

patient with those of several diseases capable of producing

the clinical findings.