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Diagnosis

Definition:

Diagnose is to distinguish, to identify a disease by


an investigation of the signs & symptoms.

Diagnosis: is the process of evaluating the


patients health, as well as the resulting opinions
formulated by the clinician.
Oral Diagnosis

Definition:

Oral Diagnosis is the art of using scientific


knowledge to identify oral disease processes
& to distinguish one disease from another.
The clinical manifestations of routine dental

diseases (e.g., dental caries and gingivitis) can be

recognized by ARM approach Appearance

Recognition Method.
The challenge is with non-dental & mucosal
conditions !!!!!!!!!!! (e.g., oral ulcers)

It has common appearance with diversity of


possible causes.

ARM approach is not applicable.


Another approach should be approached which
allows comparison of several disease known to
produce primary manifestation of the patients
abnormality in the expectations that some of the
possible causes can be eliminated on the basis of
contradictory features.

This approach is called Differential Diagnosis


Diferente de diagnostic

Definitie:
Reprezinta determinarea a doua sau mai
multe bolii cu semne si simptome diferite de
care sufera pacientul.
Concepts

Seria diagnosticului

i. Identificarea anormalitatii inca de la prima manifestare.

ii. Listare a aspectelor clinice secundare.

iii. Listare a conditiilor cunoscute inca de la prima


manifestare.

iv. Excluderea cauzelor improbabile.

v. Ranking cu probabilitatea cauzelor posibile.

vi. Re-evaluare si Re-apelare..


Concepts

Seria diagnosticului

i. Identificarea anormalitatii inca de la prima manifestare.

ii. Listare a aspectelor clinice secundare.

iii. Listare a conditilor cunoscute inca de la prima manifestare.

iv. Excluderea cauzelor improbabile.

v. Ranking cu probabilitatea cauzelor posibile.

vi. Re-evaluare si Re-apelare.


Concepts

Seria Diagnosticului

i.Identificarea unei anormalitati inca de la prima mnifestare .

Poate fi considerate aceasta suspecta


anormalitate drept o anomalie???
In cazul unei leziuni, vorbim de tesut moale sau os
la originea acesteia???
Se observa o schimbare a culorii,pierderea
integritatii mucoaselor sau umflare????
Orice caracteristica suplimentara se va numi
Aspect Clinic Secundar.
Concepts of Differential Diagnosis

Seria Diagnosticului

i. Identificarea anormalitatii inca de la prima manifestare.

ii. Listare a aspectelor clinice secundare.

iii. Listare a conditiilor cunoscute inca de la prima manifestare.

iv. Excluderea cauzelor improbabile.

v. Ranking cu probabilitatea cauzelor posibile.

vi. Re-evaluare si Re-apelare.


Concepts of Differential Diagnosis

Seria Diagnosticului

ii. Listare a aspectelor clinice secundare.

O examinare vizuala atenta permite observarea


tipului leziunii,formei, localizarii,daca este izolata
sau multipla, consistentei, texturii suprafetei si
modificarea structurilor adiacente ex., deplasarea
dintilor .
Concepts of Differential Diagnosis

Seria Diagnosticului

ii. Listare a aspectelor clinice secundare.

Factorii contributivi includ:


-Informatii demografice: varsta, sex, rasa,
obiceiuri.
- Un istoric recent al leziunilor, infectiilor
&operatiilor chirurgicale.
- Conditii medicale: boli cronice & boli acute
recente.
- Tratamente medicale recente.
Concepts of Differential Diagnosis

Seria diagnosticului

i. Identificare a anormalitatii inca de la prima manifestare.

ii. Listare a aspectelor clinice secundare.

iii. Listare a conditilor cunoscute inca de la prima


manifestare .

iv. Excluderea cauzelor improbabile.

v. Ranking cu probabilitatea cauzelor posibile .

vi. Re-evaluare si Re-apelare.


Concepts of Differential Diagnosis

The Diagnostic Sequence

iii. Listing of Conditions Known to Cause the Primary


Manifestation.

Accurate differential diagnosis of most non-dental


abnormalities REQUIRES consideration of many
possible causes.

The differential diagnosis is more likely to yield a


correct diagnosis if the typical features of many
possible conditions are compared with those of the
patients abnormality.
Concepts of Differential Diagnosis

The Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary


Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.


Concepts of Differential Diagnosis

The Diagnostic Sequence

iv. Elimination of Unlikely Causes.

Secondary findings and additional clinical


information to be compared to eliminate unlikely
causes.

The GOAL is to eliminate as many causes from


consideration as posible.

Also, elimination of particularly serious conditions


e.g., malignancy.
Concepts of Differential Diagnosis

The Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary


Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.


Concepts of Differential Diagnosis

The Diagnostic Sequence

v. Ranking of Possible Causes by Probability.

This is based on the secondary feature that


correspond with the typical features of each
possible diagnosis.

The condition considered the most likely cause is


referred to as the working, tentative or preliminary
diagnosis or the clinical impression.
Concepts of Differential Diagnosis

The Diagnostic Sequence

v. Ranking of Possible Causes by Probability.

The working diagnosis and the less likely


diagnostic possibilities provide the basis for
additional diagnostic procedures (e.g., biopsy, lab
test).
Concepts of Differential Diagnosis

If all but one disease are eliminated from the

differential diagnosis, then that is the Definitive or

Final Diagnosis.

Definitive treatment is then administered.


Concepts of Differential Diagnosis

The Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary


Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.


Concepts of Differential Diagnosis

The Diagnostic Sequence

iv. Re-evaluation and Re-call.

The final aspect of differential diagnosis is re-


evaluation and re-call.
The course of the condition over a period of time
with or without specific treatment is one source of
confirmational diagnostic information.
Incorrect diagnosis unexpected results.
Recurrence of lesions require additional
treatments.
Concepts of Differential Diagnosis

The Diagnostic Sequence

i. Categorization of the Abnormality by Primary Manifestation.

ii. Listing of Secondary Clinical Features.

iii. Listing of Conditions Known to Cause the Primary


Manifestation.

iv. Elimination of Unlikely Causes.

v. Ranking of Possible Causes by Probability.

vi. Re-evaluation and Re-call.


Initial categorization of suspected
abnormalities

Couldbe the suspected abnormality be an anomalies or a


lesion???

If lesion, Is It soft tissue or bone in origin???


Normal Tissue Variations

Typical features of normal tissue variations


include:

A. Bilateral symmetry in:


- Location
- Degree or extent of the unusual appearance.
B. Predictable locations: e.g., mental foramen, parotid
papilla.
C. Asymptomatic: tenderness disease.

D. Independent findings: Most variations are identified


as independent findings. Intra-oral lesions often present
secondary changes as erythema.
Normal Tissue Variations

Typical features of normal tissue variations include


(Contd):
E. Static: Remain unchanged.

F. Increased prominence with age: More prominent


with increased age or more noticeable after years of
exposure to the oral environment.

G. Remain unchanged following empiric treatment:


most lesions either improve or worsen under the
influence of treatment.
Categorization of Abnormalities by
Tissue affected and Primary
Manifestation
Categorization of abnormalities on the basis of the
tissues affected and by the primary manifestation
simplifies the differential diagnosis.

The initial oral lesion categorization is based on the


tissue affected as either:
- Surface mucosa.
- Deeper soft tissues.
- Bone.
In addition, some conditions are characterized by
multiple abnormalities affecting several different tissues or
anatomic sites which suggests SYNDROMES.
Categorization of Abnormalities by
Tissue affected and Primary
Manifestation

Alteration in the appearance of the superficial oral


mucosa is considered as Mucosal lesion Category.

Evidence of enlargement, bony or any other tissue


suggests a secondary lesion.

Therefore, these additional findings imply additional


differential diagnosis.
Categorization of Abnormalities by
Tissue affected and Primary
Manifestation
Oral mucosal lesions without enlargement are
divided on the basis of appearance as:

1. White mucosal lesions.

2. Dark mucosal lesions.

3. Loss of mucosal integrity.


Categorization of Abnormalities by
Tissue affected and Primary
Manifestation

Oral mucosal lesions with enlargement are divided


as:

1. Soft tissue enlargements.

2. Radiographic lesions.
Clinical Syndromes

-The term syndrome refers to the association of


several clinically recognizable features, signs (discovered
by a physician), symptoms (reported by the patient),
phenomena or characteristics which often occur together, so
that the presence of one feature alerts the physician to
the presence of the others

Abnormalities may be related by a common developmental


or metabolic condition.

Abnormality affects more than one tissue or site.


Clinical Syndromes

Why is it difficult to diagnose clinical syndromes?

1. Certain diseases produce multiple lesions of similar

character. Primary manifestation is multi-focal.

2. Coincidence of manifestation of several diseases as seen

in elderly.

3. Rare occurrence. Recognize the combination of clinical

features, apparently dissimilar abnormalities & compare

with features of Head & Neck Syndromes.


SUMMERY

Differential Diagnosis provides the diagnostic approach

needed to compare the diagnostic finding exhibited by the

patient with those of several diseases capable of producing

the clinical findings.