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List the (8) Diagnostic Categories
- 1. Clinical
- 2. Radiographic
- 3. Historical
- 4. Laboratory
- 5. Microscopic
- 6. Surgical
- 7. Therapeutic
- 8. Differential
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Clinical Diagnosis
- Ability to diagnose lesions based on the basis of:
- -color,
- -shape,
- -location, &
- -history of lesion (sometimes historical information is needed for clinical diagnosis)
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Lesions that can be clinically diagnosed
- -fordyce granules
- -torus palatinus
- -mandibular Tori
- -melanin pigmentation
- -retrocuspid papillae
- -lingual varicosities.
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Benign Conditions of Unknown Cuase:
- -Fissured Tongue
- -Median Rhomboid Glossitis
- -Geographic tongue
- -Hairy tongue
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Radiographic Diagnosis
- Radiograph provides sufficient information to establish diagnosis.
- -IE: Periapical pathosis
- --Internal resporption
- --External resporption
- --Heavy Interproximal calculus
- --Dental Caries
- --Compound Odontoma
- --Complex Odontoma
- --Supernumerary Teeth
- --Impacted Teeth
- --Calcified Pulp
- --Unerupted Teeth
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Historical Diagnosis
- -Historical data constitutes important information in every diagnosis.
- --Personal history
- --Family history
- --Past, Present, Medical & Dental histories
- --History of drug ingestion
- --History of presenting disease/lesion
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Examples of Pathologic conditions in which family history contributes in diagnosis:
- -Amelogenisis Imperfecta
- -Dentinogenisis Imperfecta
- -Other Genetic Disorders
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Laboratory Diagnosis
- -Lab tests that provide information & contribute to a diagnosis
- --Blood Chemistries
- --Urinalysis
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Microscopic Diagnosis
- -Form of laboratory diagnosis
- -Main component of definitive diagnosis
- -Biopsy is taken-->
- --skill of practitioner taking biopsy is important
- ---Brush Test
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Brush Test
- Formerly known as: Brush Biopsy
- -Uses circular brush to obtain cells from the full thickness of the epithelium.
- -Includes ceslls from the keratin layer through the basal layer
- -Assess whether normal, abnormal, or dysplastic cells are present.
- -Results help determine if scalpel biopsy is needed to establish definitive diagnosis.
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Surgical Diagnosis
-Diagnosis is made using the information gained during the surgical procedure
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Therapeutic Diagnosis
- -Rx meds & observing the results w/out culturing the bacteria applies the principle of therapeutic diagnosis
- -It is based solely on clinical & historical information w/confirmation by the response of the condition to therapy
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Differential Diagnosis
- -The point in the process when the practitioner decides which test or procedure is required to rule out the conditions originally suspected
- --Establish the definitive or final diagnosis
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(8) Variants of Normal
- 1. Fordyce Granules
- 2. Torus Palatinus
- 3. Mandibular Tori
- 4. Melanin Pigmentation
- 5. Retrocuspid Papilla
- 6. Lingual Varicosities
- 7. Linea Alba
- 8. Leukoedema
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(5) Benign Conditions of Unknown Cause
- 1.Lingual Thyroid Nodule
- 2.Median Rhomboid Glossitis
- 3.Geographic Tongue
- 4.Fissured Tongue
- 5.Hairy Tongue
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Fordyce Granules
- -Clusters of ectopic sebaceous glands
- -Most commonly observed on the lips and buccal mucosa
- -Clinically: tiny yellow lobules distributed over buccal mucosa and vermillion border of lips
- -80% of adults over the age of 20 have fordyce granules
- -asymptomatic
- -require no treatment
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Torus Palatinus
- -Exophytic growth of normal compact bone
- -Inherited
- -Occur more often in women
- -Asymptomatic
- -Develop gradually
- -Occur at the midline of the hard palate
- -Take on various shapes, sizes
- -May be lobulated
- -Covered by normal soft tissue
- -when large enough may be seen as radiopaque mass on radiograph
- -No treatment indicated unless interferes with:
- --speech,
- --swallowing or
- --prosthetic appliance
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Mandibular Tori
- -Outgrowths of normal dense bone
- -Found on the lingual aspect of the mandible --(premolars above the mylohyoid ridge)
- -Usually bilateral
- -Often lobulated or nodular
- -Can appear fused
- -No predilection for either sex
- -No Tx required unless patient needs prosthontic appliance & interferes w/fabrication and placement
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Melanin Pigmentation
- -pigment that gives color to:
- --skin,
- --eyes,
- --hair,
- --mucosa,
- --gingiva
**In oral mucosa normally observed in dark-skinned individuals
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Retrocuspid Papilla
-sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids.
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Lingual Varicosities
- -Prominent lingual veins
- -Usually observed on the lateral and ventral aspects
- -Red to purple vessels or clusters
- -Thought to be related to the aging process.
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Linea Alba
- -"white line" that extends anteroposteriorly on the buccal mucosa along the occlusal plate
- -May be bilateral
- -Can be prominent in Pts who clench or brux
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Leukoedema
- -Generalized opalescence imparted to the buccal mucosa
- -Most commonly observed in black adults (85%(
- -Gray-White film diffused throughout the buccal mucosa, giving opaque quality.
- --If mucosa is stretched becomes less prominent.
- -More pronounced in smokers
- -Integral part of buccal mucosa and cannot be removed.
- -Benign anomaly
- -Requires No Tx.
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Lingual Thyroid Nodule
- -Thyroid gland develops in 1st month of fetal life.
- -Located initially in the foramen cecum on posterior of tongue.
- -Normal development descends to the neck
- -Does not DESCEND--Lingual Thyroid Nodule results.
- --HIGH Predilection in females
- --emergence linked with:
- ---Hormonal Changes
- ---Puberty
- ---Pregnancy
- ---Menopause
- *Usually sessile base 2-3cm wide
- **Tx requires careful evaluation of the patient to determine whether thyroid gland is present in normal location
- ****Surgical intervention not always required.
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Median Rhomboid Glossitis
- -Cause not clear
- --Associated w/chronic Candida albicans
- --Appears flat, or slightly raised oval or rectangular erythematous area in the midline of the dorsal surface of the tongue.
- --Devoid of filiform papillae
- --Texture is smooth
- **No specific Tx
- **antifungal agent can be applied
- **Sometimes resolves with no specific Tx.
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Geographic Tongue
- -Genetic factor suggested
- -Exacerbated by stress
- -Histologic factors w/those found in psoriasis
- -Involves the dorsal and lateral borders of the tongue
- -Diffuse areas devoid of filiform papillae can be observed.
- -Erythematous patches that are surrounded by a white or yellow perimeter
- -Does not remain static
- -Burning discomfort associated
- **No Tx indicated
- **ECTOPIC GEOGRAPHIC TONGUE: found on mucosal surfaces other than the tongue.
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Fissured Tongue
- -Cause unknown
- -Seen in about 5% of the population
- -Genetic patterns probably involved
- -Dorsal surfaces appear to have deep fissures or grooves
- -Fissures can become irritated if food debris collects
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Hairy Tongue
- -Increased accumulation of keratin on the filiform papillae resulting in white "hairy" appearance
- -Tobacco and certain foods may discolor papillae
- -Hydrogen peroxide, alcohol, or chemical rinses have been suggest to stimulate elongation of the filiform papillae
- ** Direct Pt to brush tongue gently w/ toothbrush wet with water only.
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