Jan 12, 2016
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.