Treatment Planning And Oral Diagnosis
Posted by John Doe at Dental Assistant on February 4, 2012.
Categories: Dental Secrets
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20. How do you obtain access to a clinical laboratory?
It is easy to obtain laboratory tests for your patients, even if you do not practice in a hospital. Community hospitals provide virtually all laboratory services that your patients may require. Usually the laboratory provides order slips and culture tubes. Simply indicate the test needed, and send the patient to the laboratory. Patients who need a test at night or on a weekend can generally be accommodated through the hospital's emergency department. Commercial laboratories also may be used. They, too, supply order forms. If you practice in a medical building with physicians, find out which laboratory they use. If they use a commercial laboratory, a pick-up service for specimens may well be provided. The most important issue is to ensure the quality of the laboratory. Adherence to the standards of the American College of Clinical Pathologists is a good indicator of laboratory quality.
- What is the approximate cost of the following laboratory tests: complete blood count, platelet count, PT, fasting glucose, bacterial culture, and fungal culture?
- What are the causes of halitosis?
| CBC | $18 |
| Fasting glucose | $13 |
| Platelet count | $18 |
| Bacterial culture | $32 |
| PT | $29 |
| Fungal culture | $42 |
Halitosis may be caused by local factors in the mouth and by extraoral or systemic factors. Among the local factors are food retention, periodontal infection, caries, acute necrotizing gingivitis, and mucosal infection. Extraoral and systemic causes of halitosis include smoking, alcohol ingestion, pulmonary or bronchial disease, metabolic defects, diabetes mellitus, sinusitis, and tonsillitis.
23. What are the most commonly abused drugs in the United States?
- Alcohol Prescription medications
- Marijuana Tricyclic antidepressants
- Cocaine Sedative-hypnotics
- Phencyclidine (PCP) Narcotic analgesics
- Heroin Anxiolytic agents
- Diet aids
24. What are the common causes of lymphadenopathy?
- Infectious and inflammatory diseases of all types. Common oral conditions causing lymphadenopathy are herpes infections, pericoronitis, aphthous or traumatic ulceration, and acute necrotizing ulcerative gingivitis.
- Immunologic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and drug reactions 3. Malignant disease, such as Hodgkin's disease, lymphoma, leukemia, and metastatic disease from solid tumors
- Hyperthyroidism
- Lipid storage diseases, such as Gaucher's disease and Niemann-Pick disease
- Other conditions, including sarcoidosis, amyloidosis, and granulomatosis
25. How can one differentiate between lymphadenopathy associated with an inflammatory process and lymphadenopathy associated with tumor?
- Onset and duration. Inflammatory nodes tend to have a more acute onset and course than nodes associated with tumor.
- Identification of an associated infected site. An identifiable site of infection associated with an enlarged lymph node is probably the source of the lymphadenopathy. Effective treatment of the site should result in resolution of the lymphadenopathy.
- Symptoms. Enlarged lymph nodes associated with an inflammatory process are usually tender to palpation. Nodes associated with tumor are not.
- Progression. Continuous enlargement over time is associated with tumor.
- Fixation. Inflammatory nodes are usually freely movable, whereas nodes associated with tumor are hard and fixed.
- Lack of response to antibiotic therapy. Continued nodal enlargement in the face of appropriate antibiotic therapy should be viewed as suspicious.
- Distribution. Unilateral nodal enlargement is a common presentation for malignant disease. In contrast, bilateral enlargement often is associated with systemic processes.
26. What is the most appropriate technique for lymph node diagnosis?
The most appropriate technique for lymph node diagnosis is biopsy or needle aspiration. Needle aspiration is preferred, but is technique-sensitive (see question 63).
27. What are the most frequent causes of intraoral swelling?
The most frequent causes of intraoral swelling are infection and tumor.
28. Why does Polly get parrotitis?
Too many crackers.
29. Why do humans get parotitis?
Infection of viral or bacterial origin is the most common cause of parotitis in humans. Viruses causing parotitis are mumps, Coxsackie, and influenza. Staphylococcus aureus, the most common bacterial cause of parotitis, results in the production of pus within the gland. Other bac teria, such as actinomyces, streptococci, and gram-negative bacilli, also may cause suppurative parotitis.
30. What are common causes of xerostomia?
- Advanced age
- Certain medications
- Radiation therapy
- Sjögren's syndrome
31. What is the presentation of a patient with a tumor of the parotid gland? How is the diagnosis made?
The typical patient with a parotid gland tumor presents with a firm, fixed mass in the region of the gland. Involvement of the facial nerve is common and results in facial palsy. Fine-needle biopsy is a commonly used technique for diagnosis. However, the small sample obtained by such technique may be limiting. CT and MRI are also often helpful in evaluating suspected tumors.
32. What are the major risk factors for oral cancer?
Tobacco and alcohol use are the major risk factors for the development of oral cancer.
33. What is the possible role of toluidine blue stain in oral diagnosis?
Because tolujdjne blue is a metachromatic nuclear stain, it has been reported to be preferentially absorbed by dysplastic and cancerous epithelium. Consequently, it has been used as a technique to screen oral lesions. The technique has a reported false-positive rate of 9% and a false-negative rate of 5%.
34. What are the common clinical presentations of oral cancers?
The two most common clinical presentations for oral cancer are a nonhealing ulcer or an area of leukoplakia, often accompanied by erythema.
35. What percent of keratotic white lesions in the mouth are dysplastic or cancerous?
Approximately 10% of such oral lesions are dysplastic or cancerous.
36. What is a simple way to differentiate clinically between necrotic and keratotic white lesions of the oral mucosa?
Necrotic lesions of the mucosa, such as those caused by bums or candidal infections, scrape off when gently rubbed with a moist tongue blade. On the other hand, because keratotic lesions result from epithelial changes, scraping fails to dislodge them.
37. How long should one wait before obtaining a biopsy of an oral ulcer?
Virtually all ulcers caused by trauma or aphthous stomatitis heal within 14 days of presentation. Consequently, any ulcer that is present for 2 weeks or more should be biopsied.
38. What is the differential diagnosis of ulcers of the oral mucosa?
- Traumatic ulcer
- Chancre of syphilis
- Aphthous stomatitis
- Noma
- Cancer
- Necrotizing sialometaplasia
- Tuberculosis
- Deep fungal infection
39. Why is it a good idea to aspirate a pigmented lesion before obtaining a biopsy?
Because pigmented lesions may be vascular in nature, prebiopsy aspiration is prudent to pre vent hemorrhage.
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