ACCURATE DIAGNOSIS IS THE ONLY TRUE CORNERSTONE ON WHICH RATIONAL TREATMENT CAN BE BUILT. C Noyek

Transcription

1 ACCURATE DIAGNOSIS IS THE ONLY TRUE CORNERSTONE ON WHICH RATIONAL TREATMENT CAN BE BUILT. C Noyek

2 Oral diagnostics Definition of the discipline That area of dentistry, the which deals with gathering, recording and evaluating information contributing to the identification of abnormalities of the head and neck region. The purpose of obtaining this information is to establish a diagnosis, from which a rational treatment plan can be formulated.

3 Oral diagnostics?

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6 Collecting Diagnostic information Patient history Physical examination Adjunctive diagnostic procedures

7 Physical examination General physical appraisal vital signs (pulse, blood pressure, respiration, body temperature) Extraoral examination Intraoral examination

8 Adjunctive diagnostic information Radiographic examination Clinical laboratory studies Histology Microbiologic studies Consultation and referrals

9 Evaluation of Diagnostic information Organizing diagnostic information Physical assessment Dental conditions Non-dental conditions Preliminary Decisions Concerning Diagnostic information relationship, reliability, consistency, clinical significance

10 Diagnosis Health status compromised health, allergy; medications; suspected systemic disease Dental Disease caries,pulp involvement gingivitis, periodontitis, periapical lesion due to pulp necrosis; developmental problems Non-dental diseases mucosal lesions, tissue enlargements; bone lesions, clinical syndromes

11 Histological examination

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13 Steps of Head and Neck examination Infoming the patients on receiving a comprehensive exam Taking a complete medical and dental case history Inspection: extraoral, intraoral Using some adjunctive methods (lupe, vital staining, brush biopsy, fluorescences devices) Recording and documentation of all findings (photos, if needed) Inform the patients about the findings ( both positive and negative), and next steps of further action

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33 Intraoral examination

34 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

35 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

36 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

37 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

38 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

39 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

40 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

41 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

42 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

43 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

44 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

45 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

46 Steps of stomato-oncological examination I. Case history II. Extraoral inspection, palpation III. Intraoral examination 1. Lips 2. Buccae 3. Attached gingiva 4. Tongue 5. Floor of the mouth 6. Palate 7. Pharynx IV. Intraoral palpation We are looking for : Tissue excess Tissue defect (atrophy, ulceration ) Alterations in color (mainly white and red )

47 Preliminary classification of mucosal lesions Normal, anatomical variation Pathological lesion Bilateral simmetry Tipical localisation symptomless Unchanged Age:elder

48 Lingua fissurata, geographica

49 Tonsilla linguae lateralis

50 Hyperplasia of papillae circumvallatae

51 Lichen oris

52 Ecchymosis

53 Praecancerosus laesions Homogenous leukoplakia Erythroplakia Cheilitis chronica actinica Cheilitis glandularis Cornu cutaneum

54 Praecancerosus laesions Homogenous leukoplakia Erythroplakia Cheilitis chronica actinica Cheilitis glandularis Cornu cutaneum

55 Erythroplakia

56 Oral Cancer & Ideal time for Discovery & Intervention is in the Premalignant stages Dysplastic Progression Mild Dysplasia Moderate Dysplasia Severe Dysplasia Potentially Malignant Disease Stages Carcinoma-In-Situ (CIS) Squamous Cell Carcinoma (SCC)

57 Lipoma

58 Early stage carcinoma

59 Early stage carcinoma

60 Cc. labii inf.

61 Carcinoma

62 Carcinotic ulcer

63 Oratest (toluidin blue)

64 Brush biopsy-cytology

65 Tissue Fluorescence and Dysplastic Progression Breakdown of Collagen Matrix (prelude to invasion) Collagen cross-links Fluorescence Metabolic Activity FAD Fluorescence Micro-Vascularization (recruitment of new blood supply) Blood absorption Fluorescence Florescence intensity decreases with dysplastic progression Nuclear back-scattering Fluorophores excited Fluorescence

66 Fluorescence Visualization Blue light excites natural fluorophores in both the epithelium and stroma which emit their own light, fluorescence, at longer wavelengths green, yellow & red. VELscope s proprietary filtering makes fluorescence visualization possible by blocking the blue reflectance and enhancing the fluorescence image

67 Oral Mucosa looks predominantly green under fluorescence visualization Buccal Mucosa

68 A cancerous lesion looking dark compared to the adjacent normal tissue

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71 There are two cornerstones: prevention and early diagnosis

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73 Mortality of oral cancer in Hungary Year No. of death Death/ , , , , , , , , , , , ,0

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75 Condyloma accuminatum Verruca vulgaris Papilloma

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78 Collecting Diagnostic Information Dental Diagnostic Database Seek additional information Evaluation of diagnostic information classification of abnormalities

79 Health Status Dental abnormalities Non-dental abnormalities Physical assessment Differential diagnosis Medical consultation Modification of Dental treatment if necessary Clinical impression Treatment Plan Treatment Definitive diagnosis Reassessment Initial clinical management

80 The health Questionnaire Nonspecific questions about general health, specific questions concerning common diseases advantages: - saving time - provides a documentation in the patient s handwriting Disadvantages potential for errors and omissions Common problems: - omitting the clarification discussion - obtained by an auxiliary person

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82 Táplálkozás Beszéd Lubrikáció Antimikrobiális Hatás Clearance Remineralizáció Nyálkahártya védelem Pufferolás

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85 GASTROESOPHAGEALIS REFLUX