Diagnosis and management of oral medicine problems Flashcards
(37 cards)
Why is past medical history important?
Oral disease may be a manifestation of systemic disease
Oral disease may be iatrogenic
Management of oral disease may be affected by systemic disease e.g. pregnancy
When do you take a biopsy?
To confirm diagnosis To exclude other pathologies When we are not sure of the diagnosis When we remove a lump When a lesion changes
What are the 4 types od biopsies
Incisional
Excisional
core
fine needle aspiration
When do you take blood tests to help diagnosis?
To check there’s no underlying condition e.g. anaemia leading to mouth ulcers or controlled hyperglycaemia leading to oral candidosis
To monitor condition e.g. Sjogrens pts developing lymphomas
To make sure it is safe for a pt to receive the treatment e.g prior to starting immunosupressants in lichen planus
To monitor if it is safe to continue treatment
What are other special investigations?
Imaging Oral rinses/swabs sialometry Shrirmer's Dental Clincal
What is difflam?
benzydamine hydrochloride mouth rinse
what is the immediate aim for the consultation?
Make working diagnosis and arrange special test to confirm
Address pt’s concerns and reassure
consider pt’s discomfort and dysfunction e.g. pain relief
Educate - smoking, diet, OH
Can the problem be easily solved?
What is the short-term management?
Reassure Educate - condition and management address risk factors can it be managed with medications more investigations needed? Arrange follow up
What is the long-term management?
Reassure
Educate
Address risk factors
What can be done to control the condition? e.g. steroid mouth rinse for oral ulceration, immunosuppressants for erosive oral lichen planus
What is a biopsy?
Removal of tissue for histological examination
What are incisional biopsies for?
For large lesions to establish diagnosis or where treatment depends on diagnosis.
When pre-malignant or malignant
How do you take an incisional biopsy?
take of part of the lesion and normal mucosa too.
Why do you not remove it all?
Differential diagnoses
Examples where incisional biopsies are used?
SCC, pre-cancer, dysplasia, candida
What is an excisional biopsy?
Entire lesion is removed
When do you use excisional biopsy?
Small or certain it is not precancer or cancer.
For small lesions, used to confirm the diagnosis or for large lesions to establish the completeness of excision
When do you do fine needle aspiration?
to obtain cells from deep lesions.
suspected malignancy or cystic lesions.
NOT for oral cavity
What is core/needle biopsy used for?
obtain a small sample or core of the tissue from a deep lesion preserving the architecture.
(has a cutting edge)
What are smears used for?
examination of cells
Generally for fungal infections
Which lesions should be biopsied?
When confident of the diagnosis and able to carry out treatment
What 2 things do you not biopsy?
Bone (unless apicectomy)
Any lesion you suspect is malignant - send via hospital pathway
How do you send of tissue for histopathological diagnosis?
10% formol saline: screw top jar
What do you include on form for the tissue?
Clinical details Description of lesion Site, size duration Associated lesion systemic disease incisional biopsy hard or soft tissue
What must the carriage of specimens in the post comply with?
IATA 650 packaging instructions UN3373
