Diagnosis of oral disease

Abstract

Abstract The most common oral diseases are dental caries and periodontal dis­ease. The diagnosis and treatment of these diseases are the focus of the majority of dentists, dental therapists, and dental hygien­ists. Nevertheless, it is the responsibility of the dental healthcare pro­fessional to provide a holistic approach to management that ensures both good oral and general health for their patients. A broad knowledge of the range of diseases that affect the oral cavity is essential and also an appreciation that oral disease may be the first sign of an underlying systemic disease. Before this knowledge can be applied, the clinician must obtain an accurate patient history and undertake a systematic clinical examination. These key clinical skills underpin both medicine and dentistry, and are an absolute requirement to formulate a differ­ential diagnosis. The use of imaging modalities and laboratory tests are often required to reach a definitive diagnosis, and it is the justification and informed choice of these additional investigations that will facili­tate a timely and accurate diagnosis. Following diagnosis, appropriate treatment can be instituted, the ideal outcome being a return to health or control of the patient’s symptoms in recalcitrant chronic diseases. Obtaining a clear and precise clinical history is essential. The clinician must listen carefully to the information conveyed by the patient and then use direct questioning to collect additional data to construct an accurate picture of the patient’s problem. This can be a significant challenge and requires excellent communication skills to build a good patient–clinician relationship. The most common presenting problems relate to pain or the development of a lesion: swelling, lump, ulcer, or white/red patch. To establish a comprehensive pain history, the features listed in Table 1.1 should be addressed. Obtaining an accurate history for a lesion is dependent on the patient noticing the abnormality in the first instance and, as a consequence, the information may be rather vague; however, it is important to ascertain the key points listed in Table 1.2. A comprehensive medical history (Box 1.1) will identify any concur­rent disease that may be relevant to the presenting oral condition (Chapter 10) and highlight any issues relating to proposed medical or surgical interventions.