How to establish diagnosis 692 421 Diagnosis and

How to establish diagnosis 692 -421 Diagnosis and treatment plan for comprehensive clinic Lecture room no. 4 Dr. Kanokporn Pangsomboon 15/10/2557

Learning objectives Identifying significant problems from the patient’s history and patient’s examination Writing problem lists for a case study Establish differential diagnosis for each sign and symptom on the problem list Know how to diagnosis of common oral symptoms Referral and consultation of other health care practitioners

Important of a diagnosis or diagnostic summary Effective treatment Health insurance Medicolegal reasons

When more than one health problem is identified Listed first for the primary compliant Followed by those detected through examination Previously diagnosed conditions that remain as potential problems with indicate the status “by history” “previously diagnosed” “treated”

Problem with not clearly diagnosed during the current evaluation listed with “ to be ruled out” Listed of diagnoses that actual or potential significance in the etiology or management of the diseases Not included medical history In case - do not relate to the current problem - are not of major health significance

For example 1. 2. 3. 4. 5. 36 Alveolar abscess Rampant dental caries secondary to radiation-induced salivary hypofunction Carcinoma of tonsillar fossa, by history, excised and treated with 6. 5 Gy 2 years ago cirrhosis and prolonged bleeding time, previously diagnosed hyperglycemia, to be rule out

Definitive dx cannot always be made Informed patient’s diagnoses and results of the various examination and tests Explain to the patient the nature, significance, and treatment of any diseases that has been clearly diagnosed There are diseases that therapies. The therapy for one disease may be

Establishing the diagnosis Reviewing the patien’s history and physical, radiograph, and laboratory examination data 2. Listing those items that either indicate an abnormality or that suggest the possibility of a significant health problem requiring further evaluations 1. 3. Grouping these items into primary versus secondary symptoms, acute versus chronic problems, and high versus low priority for treatment 4. Categorizing and labeling these grouped items according to a standardized system for the classification of disease

Information gathering 1. patient history 2. radiographic examination 3. clinical examination, diagnostic aids 4. laboratory data Evaluation of the finding Significant findings Diagnosis Problem list

Diagnostic summary Usually a patient has more than one problem Whenever the cause of the particular problems can be identified, it should be included in the diagnosis summary The information should be permanent part of the record Put the though into words, and this forces rethinking and reevaluation of the clinical finding to date

Essential information during therapy and at recall Help for evaluation of the success therapy In time, the accuracy of the original diagnosis can be determined

For example 1. 2. 3. 4. Gingivitis associated with plaque only, (Periodontitis): localized moderate periodontitis 13 previously treated tooth, adequate ro (Endodontics): canal filling; 21 pulp necrosis with symptomatic apical periodontitis 14 O, 15 O, 16 O initial caries; 21 M, D, 11 D, (Operative): 22 Dcavitated caries; 24 MOD, 34 OD seconda caries (Crown & Bridge): 46 crown fracture 5. (Surgery): 6. (Prosthodontics): 46 nonrestorable tooth 18 impacted tooth 36, 37, 47 missing 16 supraeruption

Diagnosis 1. 2. 3. 4. 5. 6. 7. Gingivitis associated with plaque only, localized moderate periodontitis 21 pulp necrosis with symptomatic apical periodontitis 14 O, 15 O, 16 O initial caries; 21 M, D, 11 D, 22 Dcavitated caries; 24 MOD, 34 OD secondary caries 13 previously treated tooth, adequate root canal filling 46 crown fracture, nonrestorable tooth 18 impacted tooth 36, 37, 47 missing; 16 supraeruption

Further reading Colemean GC: Referrals and consultations. In , Coleman GC, Nelson JF, editors: Principles of oral diagnosis, ed 1, St Louis, 2002, Mosby-Year book. Lockhart PB: Dental emergencies. In, Dental care of the medially complex patient, ed 5, Edinburgh, 2004, Wright, 200209. Lockhart PB: Medical emergencies. In, Dental care of the medially complex patient, ed 5, Edinburgh, 2004, Wright, 200209, 263 -292. Stefanac SJ. Treatment planning in dentistry, ed 2, Missouri, Mosby Elsevier, 2007. Navarro CM, Onofre MA, Sposto M: Referral letters in oral medicine: an approach for the general practicioner. Int J Oral Maxillofac Surg 2001; 30: 448 -51.

Learning objectives Know how to take history and examine of pain, a swelling, an ulcer, pain of dental origin, pain of nondental origin Know how to diagnosis of common oral symptoms