Lecture 1: Diagnostic Techniques for Evaluating Oral Diseases

Question 1

Information that can be measured or perceived by the investigating clinician:

Answer 1

OBJECTIVE

Question 2

Patients own interpretation of a clinical circumstance, relying on neurological and psychological experiences:

Answer 2

SUBJECTIVE

Question 3

temp, size, color, duration, consistency, surface contour:

Answer 3

SIGNS (objective)

Question 4

patient awareness of presence of a lesion, pain intensity, pain quality (stabbing, burning, shocking)

Answer 4

SYMPTOMS (subjective)

Question 5

What is involved in a differential diagnosis? (4)

Answer 5

1. orderly sequential approach
2. gathering and analyzing data
3. knowledge and experience enable recognition of abnormal findings
4. include/exclude disease processes based on an educated assessment of process

Question 6

T/F: The following are all included in gathering and analyzing data:
-history
- specific signs
- specific symptoms
- lab data

Answer 6

true

Question 7

When making a differential diagnosis, be aware of: (5)

Answer 7

1. radiographic appearances
2. clinical manifestations
3. age
4. gender
5. location

Question 8

• single vs. multiple
• location
• relative proximity to adjacent structions
• size in dimension (mm)
• outline (well demarcated vs. diffuse)
• color (red, white, mixed, pigmented)
• consistency (firm, flaccid, compressible)
• intensity (mild, moderate, intense, striated, lacy)
• base and surface

These are all:

Answer 8

clinical descriptions

Question 9

The following describe:
- smooth
- corrugated
- eroded
- raised
- depressed

Answer 9

surface

Question 10

The following describe:
- pedunculated
- sessile
- nodular
- dome shaped

Answer 10

base

Question 11

Compressing tissue with a glass slide to determine the vascular nature of a lesion:

Answer 11

diascopy

Question 12

To feel and press a lesion to yield information about texture, consistency, temperature, and function:

Answer 12

palpation

Question 13

Palpation with an instrument:

Answer 13

probing

Question 14

Striking tissues with fingers or an instrument and listening to resulting pressure changes in tissues:

Answer 14

percussion

Question 15

The withdrawal of fluids from a body cavity:

Answer 15

aspiration

Question 16

Listening for sounds within the body:

Answer 16

auscultation

Question 17

What the the 3 DIAGNOSTIC LAB TESTS for oral lesions?

Answer 17

1. biopsy (incisional, excisional, aspirational, needle)
2. immunofluorescence
3. exfoliative cytology

Question 18

A biopsy is one of the three diagnostic lab tests for oral lesions. The types of biopsies include:

Answer 18

1. excisional
2. incisional
3. aspirational
4. needle

Question 19

What are some indications for biopsies? (6)

Answer 19

1. lesion with greater than 14 day duration
2. unusual location
3. unusual appearance
4. any excised tissue
5. confirmed diagnosis of systemic disease
6. suspicion of neoplasia

Question 20

What might make you suspicious of neoplasia?

Answer 20

1. persistent ulceration
2. persistent erythroplasia
3. induration
4. fixation
5. chronicity
6. lymphadenopathy

Question 21

A needle biopsy may also be called:

Answer 21

fine needle aspiration or fine needle aspiration and cytology

Question 22

• to determine the cause of tissue enlargement
• to distinguish between benign and malignant processes
• to stage metastatic cancer

The following are indications for:

Answer 22

needle biopsy

Question 23

What are limitations to a needle biopsy?

Answer 23

1. more technique sensitive with additional preservative and lab processing
2. does not localize cells to affected tissues
3. appositional information to adjacent tissues is lost

Question 24

A technique for determining the location of an antigen or antibody in tissues by reaction with an antibody or antigen labeled with fluorescent dye:

Answer 24

Immunofluorescence

Question 25

List the INDICATIONS of oral exfoliative cytology:

Answer 25

1. Innocuous lesion 2. suspicious lesion with negative biopsy 3. patient refuses biopsy 4. follow up of treated malignancy 5. lesion where patient is poor candidate for surgery

Question 26

List the CONTRAINDICATIONS of oral exfoliative cytology:

Answer 26

1. Keratotic or crusty mucosa 2. Red, vesicular, or velvety mucosa 3. Submucosal swelling with normal mucosa 4. Suspicion of malignancy

Question 27

T/F: Exfoliative cytology is indicated as a follow up for treated malignancy. Exfoliative cytology is contraindicated if there is suspicion of malignancy

Answer 27

Both statements true

Question 28

List the INDICATIONS of culture and sensitivity testing:

Answer 28

1. life threatening infection 2. unsuccessful previous antibiotic therapy 3. immunosuppressed patient

Question 29

Why is cultural and sensitivity testing limited in dentistry?

Answer 29

Difficult for anaerobic conditions

Question 30

Assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone:

Answer 30

Oral cancer screening aids

Question 31

Increases the ability to distinguish the lesion mucosa and healthy mucosa:

Answer 31

Tissue autofluorescence imaging

Question 32

Tissue autofluorescence imaging has _____ sensitivity and _____ specificity in distinguishing pre-malignant and chronic inflammatory lesions:

Answer 32

HIGH sensitivity; LOW specificity

Question 33

Tissue autofluorescence imaging has _____ sensitivity and ____ specificity in identifying areas of dysplasia and invasive cancer that extend beyond the evident lesion

Answer 33

HIGH sensitivity; HIGH specificity

Question 34

What drives autofluorescence of oral mucosa?

Answer 34

Refractory index of tissue

Question 35

With autofluorescence of oral mucosa we see:

Answer 35

500-600 nm

Question 36

With autofluorescence of oral mucosa, blue light of the scope is:

Answer 36

400-460 nm

Question 37

With autofluorescence of oral mucosa, UV =

Answer 37

<400nm

Question 38

What are some of the ENDOGENOUS fluorescing products? (7)

Answer 38

1. tryptophan 2. pophyrins 3. collagen 4. elastin 5. flavins 6. NADH 7. Fluorophores

Question 39

What does Flavin Adenine Dinucleotide (FAD) excite at?

Answer 39

515 nm

Question 40

What does nicotinamide adenine dinucleotide (NADH) excite at?

Answer 40

450 nm