Treatment Planning And Oral Diagnosis
Posted by John Doe at Dental Assistant on March 6, 2010.
Categories: Dental Secrets
Share
Print
Email-
+3
Vote
5 votes
1. What are the objectives of pretreatment evaluation of a patient?
- Establishment of a diagnosis
- Determination of underlying medical conditions that may modify the oral condition or the patient's ability to tolerate treatment
- Discovery of concomitant illnesses
- Prevention of medical emergencies associated with dental treatment
- Establishment of rapport with the patient
2. What are the essential elements of a patient history?
- Chief complaint
- Family history
- History of the present illness (HPI)
- Review of systems
- Past medical history
- Dental history
- Social history
3. Define the chief complaint.
The chief complaint is the reason that the patient seeks care, as described in the patient's own words.
4. What is the history of the present illness?
The HPI is a chronologic description of the patient's symptoms and should include information about duration, location, character, and previous treatment.
5. What elements need to be included in the medical history?
- Current status of the patient's general health
- Medications
- Hospitalizations
- Allergies
6. What areas are routinely investigated in the social history?
- Present and past occupations
- Smoking, alcohol or drug use
- Occupational hazards
- Marital status
7. Why is the family history of interest to the dentist?
The family history often provides information about diseases of genetic origin or diseases that have a familial tendency. Examples include clotting disorders, atherosclerotic heart disease, psychiatric diseases, and diabetes mellitus.
8. How is the medical history most often obtained?
The medical history is obtained with a written questionnaire supplemented by a verbal history. The verbal history is imperative, because patients may leave out or misinterpret questions on the written form. For example, some patients may take daily aspirin and yet not consider it a "true" medication. The verbal history also allows the clinician to pursue positive answers on the written form and, in doing so, to establish rapport with the patient.
9. What techniques are used for physical examination of the patient? How are they used in dentistry?
Inspection, the most commonly used technique, is based on visual evaluation of the patient. Palpation, which involves touching and feeling the patient, is used to determine the consistency and shape of masses in the mouth or neck. Percussion, which involves differences in sound transmission of structures, has little application to the head and neck. Auscultation, the technique of listening to differences in the transmission of sound, is usually accomplished with a stethoscope. In dentistry it is most typically used to listen to changes in sounds emanating from the temporomandibular joint and in taking a patient's blood pressure.
10. What are the patient's vital signs?
- Blood pressure • Respiratory rate
- Pulse • Temperature
11. What are the normal values for the vital signs?
- Blood pressure:120mmHg/8O
- Respiratory rate: 16-20 mmHg respirations per minute
- Pulse: 72 beats per minute
- Temperature: 98.6°F or 37°C
12. What is a complete blood count (CBC)?
A CBC consists of a determination of the patient's hemoglobin, hematocrit, white blood cell count, and differential white blood cell count.
13. What are the normal ranges of a CBC?
Hemoglobin: men, 14-18 g/dl Differential white blood count women, 12-16 g/dl Neutrophils, 50-70% Hematocrit: men, 40-54% Lymphocytes, 30-40% women, 37-47% Monocytes, 3-7% White blood count: 4,000-10,000 Eosinophils, 0-5% cells/mm3 Basophils, 0-1%
14. What is the most effective blood test to screen for diabetes mellitus?
The most effective screen for diabetes mellitus is fasting blood sugar.
15. What is the technique of choice for diagnosis of a soft-tissue lesion in the mouth?
With few exceptions, biopsy is the diagnostic technique of choice for virtually all soft-tissue lesions of the mouth.
16. Is there any alternative diagnostic technique to biopsy for the evaluation of suspected malignancies of the mouth?
Exfoliative cytology may be used as a screening technique for oral lesions. This technique is analogous to the Papanicolaou smear used to screen for cervical cancer. Unfortunately, a high rate of false negatives makes exfoliative cytology a dangerous practice in the screening of suspected oral cancers. It has value mainly in the diagnosis of certain viral, fungal, and vesiculobullous diseases.
17. When is immunofluorescence of value in oral diagnosis?
Immunofluorescent techniques are of value in the diagnosis of a number of autoimmune diseases that affect the mouth, including pemphigus vulgaris and mucous membrane pemphigoid.
18. What elements should be included in the dental history?
- Past dental visits, including frequency, reasons, previous treatment, and complications
- Oral hygiene practices
- Oral symptoms other than those associated with the chief complaint, including tooth pain or sensitivity, gingival bleeding or pain, tooth mobility, halitosis, and abscess formation
- Past dental or maxillofacial trauma
- Habits related to oral disease, such as bruxing, clenching, and nail biting
- Dietary history
19. When is it appropriate to use microbiologic culturing in oral diagnosis?
- Bacterial infection. Because the overwhelming majority of oral infections are sensitive to treatment with penicillin, routine bacteriologic culture of primary dental infections is not generally indicated. However, cultures are indicated in patients who are immunocompromised or myelosuppressed for two reasons: (1) they are at significant risk for sepsis, and (2) the oral flora often change in such patients. Cultures should be obtained for infections that are refractory to the initial course of antibiotics before changing antibiotics.
- Viral infection. Immunocompromised patients who present with mucosal lesions may well be manifesting herpes simplex infection. A viral culture is warranted. Similarly, other viruses in the herpes family, such as cytomegalovirus, may cause oral lesions in the immunocompromised patient and should be isolated, if possible. Routine culturing for primary or secondary herpes infections is not warranted in healthy patients.
- Fungal infection. Candidiasis is the most common fungal infection affecting the oral mucosa. Because its appearance is often varied, especially in immunocompromised patients, fungal cultures are often of value. In addition, because candidal infection is a frequent cause of burning mouth, culture is often indicated in immunocompromised patients, even in the absence of visible lesions.
Other articles
You can trackback from your own site.
