Diagnosis Procedure: DRG Sri Rezeki, SP - PM
Diagnosis Procedure: DRG Sri Rezeki, SP - PM
Diagnosis Procedure: DRG Sri Rezeki, SP - PM
PROCEDURE
DRG SRI REZEKI, SP.PM
FACTS THAT MAY HELP DENTIST TO DISPEL THE
SENSE OF ANXIETY & INADEQUACY DEALING
WITH ORAL LESION
• Most lesion category (soft tissue / hard tissue)
• White lesion
• Ulceration
• Vesiculo-bullous
• Tumor (epithel, mesenchym)
• Pigmented lesion
• Biographic data :
Name
Age
Address
FORM
Job
patient’s physician
2. CHIEF COMPLAINT
Intelligence
Education
Emotional
Open
Tell me about the pain?
Closed
What does the pain feel like?
Leading
Does the pain feel like an electric shock?
Allows patients to use their own Clinicians must listen carefully & avoid
words and summarise their view of interruptions to extract the relevant
the problem information
Open
Allows patient to partly direct the Patients tend to decide what information is
history taking gives them confident & relevant
quickly generates rapport
Elicits spesific information quickly Patients may infer that the clinician is not
really interested in their problem if only
Useful to fill gaps in the information closed question are asked
given in respone to open question
Closed Important information may be lost if not
Prevents vague patients from spesifically requested
rambling away from the complaint
Restricts the patient’s opportunities to talk
4. MEDICAL HISTORY
• Genetic conditions ?
• Communicable infections ?
• A formal medical history evaluates systemic disease affecting at
least three generations of the patient’s family.
FAMILY HISTORY
• Genetic
hemorrhagic, allergic, diabetic, hypertension, tumor
• A good medical history evaluates systemic disease affecting at
least three generations of the patient’s family
6. SOCIAL HISTORY
• Patient’s occupation, hobbies, dialy activities, habits, and emotional adaptation
• Consequence of recurring exposure to toxic materials or conditions certain
illnesses ?
• Outdoor occupation or hobby sun exposure UV damage skin and lip
cancer
• i.v drug habit possibility of hepatitis & HIV infection
• Tobacco, alcohol use ?
SOCIAL HISTORY
sun exposure (UV) skin - lip cancer smoking, alcohol, drug abuse
7.THE REVIEW OF SYSTEM
• ADDITIONAL examination
If needed, lesion on other area beside head-neck
Resolution with
NO Diagnosis
Ulceration
• Result from trauma, local/systemic disorder, carcinoma
• Induration border, base of lesion, surround mucosa
• Biopsy to any lesion fail to heal in 14 days
Vesiculobulosa
•Symptomatic •Asymptomatic
•Asymtomatic
•Opaque •Translucent
•Opaque
•Rough •Smooth
•Rough
•Soft •Does not rub off
•Does not rub off
•Rubs off leaving •Static or progress
•Persist or progress
a raw surface •A cause may be present
•May be a cause or
cofactor (s) •Regresses (heals)
•A cause may be present
RAU / SAR
DEFINITION
• Ulcer :
• In the mouth, ulcer are usually painful, except most
importantly malignat tumours, which be initially painless
Vesicle
• Circumscribed elevated
intraepithelial or subepithelial
lesion
• Size < 1 cm
Vesicle
• Contains : serous fluid
PRIMARY LESIONS OF THE SKIN
& ORAL MUCOSA
Bulla
• Circumscribed elevated
intraepithelial or
subepithelial lesion
• Size > 1 cm
• Contains : serous fluid
Bulla in a patient with
Pemphigus vulgaris
HISTORY
• “ Listen to your patient, he is telling you the diagnosis ”
• Age
• Viral infections, reccurent aphthae more common in
children & adolescent
• Erosive LP, MMP, SCC affect middle age to elderly
HISTORY
• Ask your patient :
• How long have you had the ulcer(s) ?
• A painless ulcer which has been present in an elderly patient for several
weeks suggest carcinoma
• How many are there?
• Multiple suggest viral
• If multiple & reccurent aphtous ulcer
• Where is the ulcer located?
• ANUG affects the interdental papillae at first
• Aphtous ulcer rarely affect the gingival margins
HISTORY
• Ask your patient :
• Is it Painful ?
• Most ulcers are painful
• However early stage of oral carcinoma are often painless
• Do you know of anything that may have caused the ulcer
• e.g trauma, eating hot or heavily spiced food?
• Have you ever had any ulcer before ?
• Reccurent vesicles/ulcers on the lips and other mucocutaneous junctions
likely to be herpes simplex. Reccurent intraoral ulcer aphthae
HISTORY
• Ask your patient :
• If yes, when? How many? How often? How long do they last?
• Are there any associated problems?
• e.g. pain, bleeding, halitosis
• Is it getting bigger, smaller, or staying at the same size?
• Smaller suggest healing
• Becoming larger and painful indicate a more serious aetiology
HISTORY
• Ask your patient :
• Do you get tingling or itching before the ulcer appear?
• Indicates possible viral aetiology, eg. Herpes simplex/zoster, or
aphtae
• Do the ulcers start as blisters?
• Pemphigus, Mucous membrane pemphigoid
• Do you get ulcers at other body sites, e.g skin, eyes, genital region?
• Behçet’s syndrome, erythema multiforme
HISTORY
• Ask your patient :
• Do you smoke ? If so, how many cigarettes per day and for how
long?
• Increased risk of oral cancer in heavy smokers and alcohol
drinkers.
• Do you drink alkohol? If yes, how many units per week?
• A glass of wine/measure of spirits/half pint of beer ≈ 1 unit
• > 21 units for ♂ & 14 for ♀ exceeds the government’s
recommended safe level of consumption alcohol.
HISTORY
• Ask your patient :
• Do you chew tobacco? If so, how much and how often ?
• Increased risk of OSCC
• Do you chew betel quid? If so, how often?
• Leads to submucous fibrosis (A premalignant condition)
• A comprehensive past medical history is also required (include
medications and serious skin, gastrointestinal and
haematological illness)
DD/ OF ORAL SOFT TISSUE
ENLARGEMENTS
TUGAS KELOMPOK
• Deskripsikan Lesi
CASE 1
CASE 2
CASE 3
CASE 4
CASE 5
CASE 6
CASE 7
LESION IDENTIFICATION
• Review
• Review
Epithelial
keratosis
Erythema
Contact pain
CLINICAL CHARACTERISTIC OF POTENTIALLY
MALIGNANT LESION
Erythema
Epithelial keratosis
No contact pain
EARLY STAGE OF ORAL CANCER
Smoker’s palate
Oral candidosis
CASE REVIEW
CASE REVIEW
Thank You