Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
COLLEGE OF DENTISTRY
DEPARTMENT OF MAXILLOFACIAL SURGERY
AND
DIAGNOSTIC SCIENCES [MDS]
ORAL DIAGNOSIS [242 MDS]
CLINICAL MANUAL
Course Director
Dr Mohammed Malik Afroz
Page 1
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Oral Diagnosis Clinical Manual
Definition –
Case History – a planned professional conversation that enables the patient to
communicate their symptoms, feelings and fears to the clinician so that the
nature of the patient’s real and suspected illness and mental attitudes may be
determined.
Objective of case history –
1. To formulate (form) a pattern of asking relevant (to the point) questions to get
a relevant (to the point) data for the diagnosis as well as to alleviate the fear in
the patient towards the disease and its treatment.
2. To help in recording the intra oral and extra oral examination done based on
their anatomic locations and relation to the complaint of the patient.
3. To record the specific intra oral lesions and extra oral lesions for the record
purpose, diagnosis and effective treatment planning.
4. Understanding the need for referral to other departments and the expectations
of the outcome of the referral.
Infection Control –
Infection control is one of the important components of case history taking. The
clinician should see that he uses the sterilized instruments for each patient.
Before he starts with the case history he must be sure that the clinic is prepared
to receive the patient. The instruments must be kept ready in the clinic and at his
disposal, the clinician should know which compartment has what instruments in
order to save time and avoid contamination of the other instruments.
Page 2
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Guidelines –
1. No student should enter the clinic without wearing apron and the college
dress code
2. No student should examine the patient without gloves and the mouth mask
3. all the students must drape the patient once patient enters the clinic
4. till the history is taken the student should not use the instruments
5. Once the student takes the instruments he should finish the examination
before disposing it, and then should complete the case history writing.
6. All the students should dispose the used materials in a waste before leaving
the clinic.
Case History
Personal Identification Data
Chief Complaint
History
1.History of Present
Illness
2.Past Dental History
3.Past Medical History
4.Family History
Habits
1.Deleterious
Habits
2. Para Functional
Habits
5.Social History
Page 3
Clinical Examination
Diagnosis
1.General Physical
Examination
1.Provisional
Diagnosis
2. Extra Oral
Examination
2.Differential
Diagnosis
3. Intra oral
Examination
3.Investigation
4.Final Diagnosis
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Session – 1
Objectives –
1. Is to record the patient data as much as possible in his own words
2. To be able to formulate the chief complaint based on severity
3. To be able to co relate the history of present illness with the chief complaint
Chief Complaint –a primary with which a patient reports to the hospital. It is
written in patient’s own words and in the order of preference.
History of Present Illness – is related to the chief complaint and demands the
examiner to ask leading questions in order to reach to the basic understanding of
the complaint. It usually is based on questions like –
1. How it started
2. When it started
3. Any postural variation
4. Any diurnal (related to morning/evening time) variations
5. Any previous history of the same type
6. Any treatment taken before or any medication being taken now.
Session – 2
Clinical Examination –
Objectives –
1. To be able to take the recording accurately so that it can be helpful for
diagnosis
2. To be able to manage the patient during the dental treatment
3. To understand the special needs if any for the concerned patient before,
during and after the dental treatment.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Clinical examination comprises of examining the patient general status as well as
specific status
The general examination comprises of – examining and noting down the cardinal
signs of well being –
Pulse rate – A normal pulse rate is 60 beats/min. in stenious (difficult) exedrcises
it may reach upto 220beats/min.
Pulse rate is related to the heart beat of the patient which is a discontinuous
process, as once the heart pumps out the blood it relaxes till it gets the fresh
blood. It is calculated by placing the hand of the patient to his chest level either
on the table or on the dental chair and asking the patient to relax.
Three fingers namely the index finger, second finger and third finger is used. The
index finger is used to palpate the blood vessel to know its viability; second finger
calculates the pulse rate while the third finger acts as a guide to avoid over
compressing the blood vessel.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Blood Pressure – is recorded using the sphigmomanometer and it tells about
the pressure with which the blood flows in the arteries and hence acts as a basic
investigation which points towards further examination.
Normal Blood pressure – 120/80mmHg. An addition of 10mmHg is seen from
an increasing age of 40years to 50 years.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Procedure – patient hand should be placed at the level of his heart and should be
allowed to relax. Then BP cuff should be placed in such a way that its neither too
tight nor too loose for the patient. The cuff is slowly inflated and the rise in the
level of mercury in the apparatus is noticed. Doctor places the stethoscope at the
hand of the patient to listen to the sound. The moment he starts listening to the
sound that is called as diastolic, to the last level of mercury till he listens to the
sound is the systolic
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Respiratory Rate – 24 cycles/minute. – is calculated in cycles as the respiration
is a continuous process with inspiration and expiration running in a cycle without
any gap unlike heart beat.
Procedure – the palm of the right hand is placed at the junction of his chest and
stomach. The patient is advised to relax and breathe normally, the rise of his
stomach and expansion of his chest followed by its relaxation back to normal is
taken as one cycle. The procedure is repeated for a period of one minute and the
reading is calculated.
Session – 3
Built – is the skeletal growth of the patient and is calculated based on height to
weight ratio
Nourishment – is the muscular development seen in the patient. It is done by
calculating the Basal Metabolic Rate
Pallor – is the clinical assessment for the amount of blood circulation in the body.
It is assessed by pressing the nasal bed with a light pressure till the nasal bed
becomes pale and then leaving it and seeing how fast the blood flows back to fill
the area which was previously pressed. If the blood level is good then
immediately it is filled.
It can also be done by examining the inner eyelids of the patient, the patient is
asked to look up and his lower eyelids are pressed down by gentle pressure, if the
blood circulation is good then the eyelid mucosa appears normal or if the
circulation is less then it appears pale.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
It can also be assessed by looking at the oral cavity, where pale appearance of
mucosa can be seen in patients who have less blood circulation. It can be also
assessed on the tongue which shows loss of papilla, pale appearance on tongue,
parched tongue and formation of cricoid webs in the tonsillar region in severely
anemic patients.
Interpretation – if pallor is seen patient is sent for blood investigation, if the
hemoglobin level is less than 5gm/dl then no invasive treatment which leads to
loss of blood is carried out.
Icterus – is the yellowish appearance seen in patients who have high SGOT and
SGPT levels.
Interpretation – it suggests loss or decreased liver function hence no medicines
which gets dissolved or act on liver can be given.
Cyanosis – is the bluish appearance seen at the extremities in those patients who
have less blood circulation or have high carbon di oxide level in them
Page 9
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Interpretation – for lack of oxygen diffusion
Extra Oral Examination
Session – 4
Objectives –
1. To be able to identify the extra oral landmarks and record it for the treatment
purpose
2. To make the patient understand his facial profile and educate him the best
treatment for his profile
3. Motivate the patient for the other treatments that we can offer apart from
satisfying his chief complaint
Facial Profile – This is formed by connecting soft tissue glabella (G),subnasale (Sn)
,and soft tissue pogonion (Pg)
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Interpretation is done in the form of –
Concave – Class I facial and dental has vertical maxillary excess or vertical
maxillary deficiency
Straight Profile – Class II – it means maxillary protrusion or vertical maxillary
excess or mandibular retrusion.
Convex – Class III – it means Maxillary retrusion or vertical maxillary deficiency
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
TMJ Examination –
Session – 5
Objectives –
1. Visualizing the TMJ for any abnormality that can aid in diagnosing the TMJ
disorders
2. To identify the patients with trauma from occlusion and suggest them the
adequate treatment
3. To help the dentist understand the TMJ comdition and modify his treatment
for the benefit of the patient.
The doctor should be in front of the patient and hold the patients head with
both hands in such a way that his last finger is just inside the ear, the ring
figure at the TMJ and the other fingers are at his forehead and above
stabilizing the head to be straight. The patient should then be asked to open
and close his mouth till he can feel the TMJ opening and closing normally.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
A
Dr Mohd Malik Afroz
Course Director
B
C
D
F
E
I
O
H
G
J
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13
The clinical
examination.
A, measuring
maximum
interincisal opening.
B Palpation of the
pregragus area; the
lateral aspect of the
TMJ.
C, Intra-auricular
palpation; the
posterior aspect of
the TMJ.
D, Palpation of the
masseter muscles.
E, Bi-manual
palpation of the
masseter muscle.
F, Palpation of the
lateral pterygoid
muscle.
G, Palpation of the
medial pterygoid
muscle.
H, Palpation of the
temporalis muscle.
I, Palpation of the
sternocleidomatoid
muscle.
J,Palpation of the
trapezius muscle.
Note that the lateral
and medial
pterygoid muscle
palpations are from
an intra-oral
approach.
J
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Examination of Lymph Nodes –
Session – 6
Objective –
1. To identify the lymph nodes involved in the infection
2. To understand the severity of the condition
3. To be able to map the progress of the infection and hence suggest the
required emergency treatment.
Is done for examining the sub mandibular and sub mental lymph nodes
which gets inflamed in infections. Throughout the examination the examiner
should be looking to the patient especially in the eyes to see any signs of
discomfort.
Sub mental lymph node is examined by placing one hand on the head of the
fingers and stabilizing it, while the other hand is placed just below the chin to see
for any swelling, this is the area where sub mental lymph node lies.
Sub mandibular lymph node is examined one at a time, where the patient head is
stabilized by one hand and the fingers of other hand just slide below the base of
the mandible. The patients head must be slightly tilted to the side which is being
examined.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Note – In case of bimanual palpation of the lymph nodes, index finger of one
hand is placed inside the patient’s mouth and the fingers of the other hand are
placed outside the patient’s mouth at the area of respective lymph node.
The readings of examination are recorded in the form of –
1. Single/ Multiple.
2. Palpable/Non palpable
3. Movable/Fixed/Matted
4.Tender/Non tender
Basic Protection – gloves
Mouth Mask
Doctor Apron/Gown
Diagnostic Instruments – these comprises of –
Session – 7
Objectives –
1. To expose the students to different armamentarium he can use in order to
attain an adequate examination
2. To make him aware of the uses of each instrument
Mouth Mirror
Probe
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Tweeser
Dr Mohd Malik Afroz
Course Director
Explorer
Intra Oral Examination –
Session – 8
Objectives –
1. To make the students aware of the procedure of examination
2. To help him remember the various points necessary in examination of the
intra oral structures
3. To know the correct method of writing it in the case sheet after adequate
examination
Should first comprise of examination of soft tissue structures like the mucosa,
tongue, soft palate which should be followed by gingival examination, periodontal
examination and lastly the dental examination.
Mucosa Examination – reflection of the mucosa for easy viewing is an
important aspect of examination. It can be done easily for upper and lower labial
mucosa by holding the patient lips and retracting it to view the mucosa.
Buccal Mucosa – it can be retracted by using the butt end of the mouth mirror
and probe placed inside the buccal mucosa and retracted against the teeth in
order to have a clear view.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Examination of Tongue – is done by asking the patient to pull his tongue
outwards. Then a gauze piece or cotton is placed on the tip of the tongue, the
examiner holds the gauzed tongue region with gloved hands and pulls it outwards
by asking the patient to relax his tongue. Then the tongue can be moved by the
examiners hand on right or left side to have a complete view. A tongue depressor
can be used in other hand in order to depress the tongue.
In case of Palpation the examiner should place the index finger of one hand above
while the index finger of other hand is below in order to slide his fingers over the
tongue for palpation.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Session – 9
Gingiva –
Marginal gingiva.
Free gingiva - The area of gingiva above the attachment at CEJ is called as free
gingiva because it is not attached to any underlying tissue.
Gingival sulcus – is an area extending from the margin to the attachment level
of the gingiva. The gingiva is attached at the cemeto enamel junction (CEJ).
The groove formed on the inner side of the gingiva (towards the tooth)
between the gingival margin and the CEJ attachment is called as gingival
sulcus.
For anterior teeth – The gingival sulcus is normally 2 to 3mm clinically above
the CEJ. This can be assessed by passing the probe along the gingival sulcus.
Histologically the gingival sulcus is 1.5 to 1.8mm.
Attached gingiva is the gingiva seen below the gingival sulcus and it is attached
to the underlying tissue (periosteal bone)for anterior teeth - 3.5 to 4.5mm in
the maxilla and 3.3 to 3.9mm in mandible anteriorly
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
In the posterior teeth the attached gingiva is – 1.9 mm in maxilla and 1.8mm in
mandible.
Interdental gingiva is the gingiva present between the two teeth. In the
anterior teeth the inter dental free gingiva is cone shaped while in the
posterior teeth it is dome shaped and covers till the contact point if any two
adjacent teeth.
Muco - gingival Junction – it is the junction where the attached gingiva joins
with the mucosa of the oral cavity. It can be seen by retracting the lower or
upper lip and seeing the movement of the mucosa just below the attached
gingiva.
Attached Gingiva
Interdental Gingiva
Free marginal gingiva
Muco Gingival Junction
Color of gingiva – pink with melanin pigmentation. The color of gingiva also defers
based on the race (e.g. – Europeans have coral pink gingiva, while Asians and arab
world has gingiva with melanin pigmentation)
Texture – can be assessed by drying the gingiva using a cotton swab. The Gingiva
is dried by holding the cotton swab in tweeser and passing it over the gingiva.
Texture means the appearance of the gingiva.
Consistency – it is normally firm and resilient. That means the gingiva cannot be
lifted up as it is attached to the bone and has sufficient elasticity to take up
stresses of occlusion. In people who do not have healthy gingiva, the gingiva
appears swollen and the gingival margins become thickened. The gingiva can be
slightly lifted by using the periodontal probe. These are unhealthy signs of gingiva
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Edematous gingiva which is a sign
of gingival inflammation. The
contour of the gingival margin is
also lost
Contour – is the margins of the gingiva. In a healthy person the margins are sharp,
well defined and at the cemeto – enamel junction (CEJ).
Stains and Calculus are assessed on the basis of oral hygiene index simplified –
(OHI – S) – was developed by John C Green and Jack R Vermilion in 1960 to
classify and assess the oral hygiene based on the extrinsic stains/debris and
calculus.
Score
0
1
Criteria
No debris or stain present
Soft debris or extrinsic stains covering not more than one third of the
tooth surface
2
Soft debris covering more than one third but less than two third of the
tooth surface
3
Soft debris covering more than two third of the tooth surface
Calculus Index –
Score
0
1
2
3
Criteria
No calculus present
Supra gingival calculus covering not more than one third of the tooth
surface
Supra gingival calculus covering more than one third but less than two
third of the tooth surface
Supra gingival calculus covering more than two third of the tooth surface
or a heavy band of sub gingival calculus around the cervical portion of
the tooth or both the criteria.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Session – 10
Community Periodontal Index – this can be done by using Russel’s
Periodontal Index
Instruments used – Mouth mirror and CPITN – C probe
Procedure – the dentition is divided into sextants (sixths of the dentition), for
assessment of periodontal treatment needs. Each sextant is given a score.
Sextants are –
17 – 14
13 – 23
24 – 27
47 – 44
43 – 33
34 – 37
For adults, aged 20 years or more, only 10 teeth known as the index teeth are
examined. These teeths have been identified as the best estimators of the worst
periodontal condition of the mouth. The ten specified index teeth are –
17/16
11
26/27
47/46
31
36/37
The molars are examined in pairs and only the highest id recorded. Only one score
is recorded for each sextant.
For people under 19 years only six index teeth are examined. The second molars
are excluded at these ages because of the high frequency of false pockets ( non
inflammatory, associated with tooth eruption)
Probing Procedure – a tooth is probed to determine the pocket depth and to
detect sub gingival calculus and bleeding response. The probing force can be
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
divided into Working Component – used to know the pocket depth and Sensing
Component – used to detect sub gingival calculus because we can only feel the
sub gingival calculus by probing but cannot see it as it is present below the
gingiva.
The probe is inserted between the tooth and the gingiva, the sulcus depth and
pocket depth is noted against the color code or visible lines. The end of the probe
should be kept in contact with the root surface and direction should, whenever
possible be in the same plane as the long axis of the tooth. For sensing sub
gingival calculus, the lightest possible force which will allow the movement of the
probe is used. Pain to the patient while probing is in most cases indicative of use
of too heavy probing force.
Examination Procedure – the aim is to determine highest score applicable to each
sextant with the least number of measurements.
First decide whether the sextant can be examined based on whether it has more
than one functional tooth present. If ‘no’ functional tooth present then put ‘X’
and go to the next sextant. If ‘yes’ examine index teeth for highest score to the
lowest score in the order. Determine (find out) appropriate highest score for each
sextant and record it
Score Criteria
0
1
2
3
4
X
9
Healthy
Bleeding observed directly or by using a
mouth mirror after probing
Calculus detected during probing, but all of
the black band on the probe visible
Pocket 4 – 5mm (gingival margin within the
black band of the probe)
Pocket 6mm or more (black band on the
probe not visible)
Excluded sextant (less than two teeth present
in sextant
Not recorded
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Session – 11
Examination of the teeth – Is done by using mouth mirror and explorer.
Mouth mirror is used for retraction of the buccal mucosa and indirect illumination
while the explorer is used to walk it along the grooves and ridges and to find any
dipping of its pit or for a catch. If there is a catch then it is considered as having
decay. The role of the dentist is to not only find the known decay which can be
seen easily but also to look for small pits which can lead to a future decay.
Decayed – Missing – Filled Tooth Surfaces Index (DMFS – Index) – was developed
by Henry T Klein, Carrole E Palmer and Knutson J.W in 1938 to assess the coronal
caries.
This index is based on the fact that dental hard tissues are not self healing and
established (which is seen) caries leaves a scar of some sort (type). The tooth
either remains decayed, or if treated may be filled or extracted.
Procedure – The DMFS is applied only to permanent teeth while the denotation
dmfs is applied for deciduous teeth. It is composed of 3 components –
D – used to describe decayed teeth surface
M – used to describe missing teeth surfaces due to caries
F – used to describe teeth surfaces previously filled due to caries.
The surfaces examined are –
1. for posterior teeth – 5 surfaces : facial, lingual, mesial, distal and occlusal
2. for anterior teeth – 4 surfaces : facial, lingual, mesial and distal.
Calculation of index –
If 28 teeth are examined (i.e exclusing third molars then)
16 posterior teeth (i.e 2molars and 2 premolars in each quadrant) – 16 X 5 = 80
surfaces
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
12 anterior teeth (i.e canine and 2 incisors in each quadrant) – 12 X 4 = 48
surfaces
Total – 128 surfaces
If third molars are included then (4 X 5) = 20 surfaces
Total – 148 surfaces.
Individual DMFS – final score is based on (D + M + F) in an individual.
Session – 12
Malocclusion – there are different types of occlusion seen in different
individuals, which has been classified by Angle’s as follows –
Angle’s Class I Malocclusion – this means the buccal cusp of maxillary
Ist molar occludes with the buccal grove of the mandibular first molar.
In case where Ist molar is missing there the mesial slope of maxillary Ist
molar coincides with the distal slope of mancibular Ist molar
Angle’s Class II Malocclusion – the distal cusp of maxillary Ist molar
occludes with the buccal grove of mandibular Ist molar. In case where
Ist molar is missing there the distal slope of maxillary canine occludes
with the mesial slope of mandibular canine. The maxillary central
incisors are protruded while the maxillary lateral incisors may be
retruded
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Angle’s Class II Subclass – where there is Angles class I malocclusion on
one side of molar relation and class II malocclusion on the other side of
molar relation.
Angle’s Class III Malocclusion – the maxillary Ist molar occludes with the
mandibular second molar or the junction of Ist and IInd mandibular
molar. The mandible is protruded anterior to the maxilla. There is
spacing between the maxillary anteriors with protrusion.
Angle’s Class III Subclass – there is Angle’s Class III Malocclusion on one
side and Angle’s Class I Malocclusion on the other side.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Session – 13
Dean’s Fluorosis Index –
It was introduced by Trendley H Dean in 1934 and modified in1942.
Score
0 – Normal
Criteria
The enamel represents usual
translucent semivitriform type of
structure. The surface is smooth,
glossy and usually of pale, creamy
white color
The enamel discloses slight
aberrations from the translucency
of normal enamel, ranging from a
few white flecks to white spots.
This classification is used in those
instances where a definite
diagnosis of the mildest form of
fluorosis is not warranted and a
classification of normal is not
justified.
Small, opaque, paper white areas
scattered irregularly over a tooth,
but not involving as much as 25%
of the tooth surface.
0.5 – questionable
1 – Very mild
2 – Mild
The white opaque areas in the
enamel of teeth are more
extensive, but do not involve as
much as 50% of the tooth.
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
3 – Moderate
All enamel surfaces of all the teeth
are affected and surfaces subject
to attrition show wear. Brown stain
is frequently a disfiguring feature
4 – Severe
All enamel surfaces are affected
and hypoplasia is so marked that
the general form of the tooth may
be affected. The major diagnostic
sign of this classification is discrete
or confluent pitting. Brown stains
are widespread and teeth often
present to corroded like
appearance.
Provisional Diagnosis –
Session – 14
Objectives –
1. Will be able to diagnose the condition without any investigation
2. Will be able to correlate the history and examination to reach to the
diagnosis
3. To apply his knowledge in understanding the condition and coming to a
proper diagnosis
It is the diagnosis based on the history and clinical features of the chief complaint.
It determines the probable disease and aids the clinician in the treatment
planning.
Differential Diagnosis –
Objectives –
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
1. Will be able to correlate other diseases with similar to relatively similar
history and / or examination
2. Will be able to keep in mind the other diseases which are close to the one
thought in provisional diagnosis and hence suggest adequate investigation.
Is a list of diseases with similar clinical picture, as appears in provisional
diagnosis according to probability of their appearance.
Investigation –
Objectives –
1. Will be able to advise adequate investigation which aids in diagnosis
2. Will be able to assess the outcome of the investigation before actually
advising for one of them.
There are various investigations that can be carried out in order to confirm
the provisional diagnosis and plan the treatment accordingly.
Treatment Planning –
Session – 15
Objectives –
1. Will be able to advise the best treatment plans looking into the needs of the
patient.
2. Will be able to correlate the treatment outcomes which can gain paitent
confidence by correct planning
It is a collective term which means the way a clinician decides to treat the
patient to the best of his knowledge and based on the requirement of the
patient. It should try to cover all the concerns of the patient and at the same
time should be ethically commendable (correct).
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
There are 4 departments in which the clinics are divided –
Department
Specialties
Operative Dentistry
Restorative Dental Sciences Endodontic
Code
RDS
Maxillofacial Surgery and
Diagnostic Sciences
Oral and Maxillofacial Surgery
Oral Pathology
Oral Diagnosis
Oral Medicine
Oral and Maxillofacial
Radiology
MDS
Preventive Dental Sciences
Periodontics
Orthodontics
Pediatric Dentistry
Community Dentistry
PDS
Prosthetic Dental Sciences
Prosthodontics
SDS
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Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Case Performa
Personal Identification Data
Name of the Patient –
Age of the patient –
Sex – M/F
Occupation –
Address –
Phone Number –
ID Number –
OP Number –
Education –
Income –
Case Sheet
Chief Complaint –
History of Present Illness –
Past Dental History –
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30
Dr Mohd Malik Afroz
Course Director
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Past Medical History
Family History –
Social History –
Habit History
Deleterious Habits –
Smoking –
Type
Frequency
Duration
Frequency
Duration
Chewing Habit –
Type
Para Functional Habits –
Lip biting
Nail Chewing
Tooth Grinding
Any other
Oral Hygiene Habits –
Type – Tooth Brush/Paste
Finger
Frequency
Duration
Miswak
Others
General Physical Examination –
Pulse Rate –
Blood Pressure –
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31
Temperature –
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Extra Oral Examination –
Facial Appearance –
Facial Profile –
Straight
Concave
Convex
TMJ Examination –
Lymph Node Examination –
Intra Oral Examination –
Soft Tissue Examination – N – Normal /
Lips
Labial Mucosa
Soft Palate
Hard Palate
Gingiva – Color
Stains –
A - Abnormal
Buccal Mucosa
Tongue
Texture
Calculus –
Periodontium –
Level of attachment of gingiva
Bleeding on Probing –
Any other Abnormality
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32
Contour
Consistency
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Hard Tissue Examination –
Examination of teeth –
D – Decayed/carious
M - Missing
F – Filled
Number of teeth Present –
Discoloration seen –
Extrinsic
Intrinsic
Any Morphological Changes
Crowding –
Spacing –
Irregularity –
Any Other Changes –
Examination of Specific Lesion –
Provisional Diagnosis –
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33
Type of Occlusion –
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Differential Diagnosis –
Investigation –
X ray
Pulp Vitality Test
Interpretation of Investigation –
Final Diagnosis –
Treatment Plan –
Habit Counseling –
Health Education –
Medications –
Restoration –
Extraction –
Dental correction –
Referral Departments –
MDS
PDS
RDS
SPS
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34
Biopsy
Oral Diagnosis
College of Dentistry
Lab Manual
Majmaah University
Dr Mohd Malik Afroz
Course Director
Clinical Evaluation –
Case No.
Clinical Note
Diagnosis
Page
35
Investigation
Staff Signature