Oral Diagnosis and Manifestations of Some

Systemic Diseases

Dr.Usama M. MadanyB.Ch.D, M.Sc., Ph.D.

Professor, Oral Medicine Periodontology, Diagnosis and Oral Radiology, Faculty of Dentistry, Al-Azhar Univ.

Oral Diagnosis:

Is the art and science of collecting data concerning the patient's chief problem that urged him/her to seek the dental help.

Categories of Diagnosis:

Spot diagnosis

Tentative diagnosis

Definitive diagnosis

To reach a definitive diagnosis, pretreatment evaluation of a case should be achieved through:

- History taking

- Clinical examination

- Special Investigations

Essential elements of history taking; Chief complaint History of the present illness Past medical historySocial history Family history

Review of systems Dental history

*Means of clinical examination:

Inspection

Palpation

Percussion

Auscultation

*Special Investigations

- Biopsy: Is the technique of choice for diagnosis of a soft-tissue lesion in the mouth.

- Serological tests including PCR

- Urinalysis.

Digital subtractionMRICT

-Microbiological culturing

-Conventional and advanced radiographic techniques

If a blood disease or disorder is suspected CBC (hemogram) should be requested:

- R.B.Cs count- W.B.Cs count/differential leukocytic count

- Platelets count- Hemoglobin concentration- Hematocrit value

Screening tests for a case of bleeding:

-Platelet count; normal values = 150,000-450,000 platelets/mm3

-Prothrombine time (PT); normal values = 10-13 seconds.

-Partial thromboplasine time (PTT); normal values =25-36 seconds.

-Bleeding time; normal values = < 9 minutes.

Polymerase chain reaction (PCR):

Is a technique developed by researchers in molecular biology for enzymatic amplification of DNA sequence. Because of its high sensitivity, it proved marked clinical potential in diagnosing viral diseases affecting humans.

Objectives of pretreatment evaluation:- Establishment of diagnosis.

- Determination of underlying medical condition.

- Discovery of concomitant illness.

- Prevention of medical emergencies associated with dental treatment.

Some systemic diseases and disorders may have oral manifestations, and some oral diseases ( lesions) may be associated with systemic diseases or disorders. According to oral manifestations, the systemic diseases can be classified as those which may produce/be accompanied by:*Ulcers.

*White lesions.

*Hyperpigmentation/change in color of oral mucosa.*Spontaneous bleeding/ with minimal touch.

*Gingival enlargement.

*Multiple abscess formation.*Tongue lesions

Ulcers

Agranulocytosis/ cyclic neutropenia/ aplastic anemia.

Leukemia

Lupus Erythematosus

Lichen Planus

Mucocutaneous ocular Syndromes

Syphilis

Tuberculosis

Herpetic Stomatitis

AgranulocytosisAgranulocytosis

- Absence of granulocytes- W.B.Cs < 2000/mm3

Herpetic StomatitisSmear

Viral Culture

Antibody titre

AIDS?

LeukemiaLeukemia

- Full blood picture

- Bone marrow biopsy

Lichen Planus

- Biopsy

- Grinspan syndrome?

Lupus Erythematosus

- Biopsy

- Increased ESR

- autoantiboies

+ve LE test

Mucocutaneous Ocular SyndromesMucocutaneous Ocular Syndromes

Steven-Johnson Behcet Reiter

Mild leukocytosis

Hypergamaglobulinema

leukocytosis

PyuriaClinical picture/biopsy

Seronegative Polyartheritis

SyphilisSyphilis

- Direct smear

- Serological test

Biopsy Sputum culture Chest Radiography

Tuberculosis

White lesions

Lupus Erythematosus

Lichen Planus

Syphilis

Lichen PlanusLichen Planus

Lupus Erythematosus

SyphilisSyphilis

BleedingBleeding

Hemophilia

Thrombocytopenia

Polythycemia

Leukemia

Scurvy

HemophiliaHemophilia

Normal bleeding time

Normal PT

Increased PTT

Leukemia

W.B.Cs count is abnormal in early stage. It varieis from 100,000 – 500,000 in different types.

Numbers of R.B.Cs, platelets and different leukocytes show increase or decrease according to the type

PolycythemiaPolycythemia

Increase in all blood elements

Increased bleeding time

ScurvyScurvy

Normal blood picture

Increased bleeding time

Dietary history

Thrombocytopenia / ThrombocytosisThrombocytopenia / Thrombocytosis

Decreased platelets count

Increased bleeding time Increased bleeding time

Increased platelets count

Hyperpigmentation

Addison’s Disease

Kaposi’s sarcoma

Icterus

Peutz-Jeghers Syndrome

Addison’s Disease

Blood pressure

Plasma electrolytes

Cortisol levels

Response to ACTH

IcterusIcterus

Hemolytic Anemia?

Hepatitis?

CBC

Liver Function

PCR

Kaposi’s SarcomaKaposi’s Sarcoma

Biopsy AIDS?

Peutz-Jeghers SyndromePeutz-Jeghers Syndrome

Clinical Features

Tongue lesions

Atrophic Glossitis

Geographic Tongue

Iron

Atrophic glossitis

Folic acid

Vit. B 12

Blood picture

Vitamin Assay

Geographic TongueGeographic Tongue

Psoriasis?

History of migrating pattern

Gingival enlargement

Drug-induced gingival hyperplasia

Diabetes mellitus

Leukemia

Scurvy

Drug-induced gingival hyperplasiaDrug-induced gingival hyperplasia

Phenytoin Nifedipine

History of taking the drug Blood picture

Biopsy

Leukemia Vit. C deficiencyBlood picture

Fasting blood sugar level / glucose tolerance test

Diabetes mellitus

Multiple Abscess Formation

Diabetes Mellitus

TB.

Thank you