194
Practical Practical Oral Oral Medicine 2 Medicine 2 Ahmed A. Abdelazim

Practical oral medicine 2

Embed Size (px)

Citation preview

Page 1: Practical oral medicine 2

Practical Oral Practical Oral Medicine 2Medicine 2

Ahmed A. Abdelazim

Page 2: Practical oral medicine 2

10 Marks over the following:1-Cardiovascular diseases2-Endocrine diseases3-Infectious diseases:a)AIDSb)Hepatitis4-Oro-facial pain5-Tongue diseases

Page 3: Practical oral medicine 2

1- 1- Cardiovascular Cardiovascular

diseasesdiseases

Page 4: Practical oral medicine 2

Case 1 A 62-year-old male came to your clinic he is

smoker with medical history of type 2 diabetes mellitus ,hypertension and with a history of

exertional chest pain radiated to left shoulder, arm, side of neck and mandible. This patient complained of pain related to upper molars on examination you noticed a generalized gingival

enlargement 1-Dental Management.

2-Cause of generalized gingival enlargement

Page 5: Practical oral medicine 2
Page 6: Practical oral medicine 2
Page 7: Practical oral medicine 2
Page 8: Practical oral medicine 2
Page 9: Practical oral medicine 2

A 59-year-old man came to your clinic .He had a history of placing a pacemaker and a 90-minute severe crushing chest pain He was taking aspirin daily . He asked for Scaling and fixed prosthesis.

How to manage this patient in your clinic ??

Case no 2 :

Page 10: Practical oral medicine 2

60 years old patient presented to your clinic with history of prosthetic valve on examination you found that his upper third molar should be extracted How to mange this patient ??

Case no 3 :

Page 11: Practical oral medicine 2

A cyanotic patient with clubbing fingers and edema of his extremities what would you suspect

and How to deal with this patient ??

Case no 4 :

Page 12: Practical oral medicine 2

Case 1This 65-year-old male This 65-year-old male

patient suffers during patient suffers during the dental treatment the dental treatment from Pain in the left from Pain in the left arm and shoulder, he arm and shoulder, he also gave a history of also gave a history of previous attacks that previous attacks that resolved resolved spontaneously spontaneously

1- Diagnosis ?1- Diagnosis ?

2- Management ?2- Management ?

Page 13: Practical oral medicine 2

Case 2A patient presented to A patient presented to Your clinic giving a history Your clinic giving a history Of taking this drugOf taking this drug

1- What is the 1- What is the Scientific name ofScientific name ofThis drug ?This drug ?

2- Its Uses ?2- Its Uses ?

3- Common side 3- Common side Effect of this drugEffect of this drug

Page 14: Practical oral medicine 2

Case 370-year-old patient gave70-year-old patient gaveA history of severe chestA history of severe chestPain and a heart attack thatPain and a heart attack thatOccurred 2 years agoOccurred 2 years agoAnd he was taken to theAnd he was taken to theHospital for pain reliefHospital for pain relief

1- Diagnosis1- Diagnosis

2- Is elective dental treatment possible ?2- Is elective dental treatment possible ?

3- What is the drug that relieves pain in such attacks ?3- What is the drug that relieves pain in such attacks ?

Page 15: Practical oral medicine 2

Case 4A female patient admitted to your clinic gave a history

of anginal attacks that were relieved by nitroglycerine tablets. You noticed that after treatment when she started to stand up from the dental chair, Symptoms of dizziness and loss of consciousness started to appear.

1- Explain what happened to the patient

2- How to prevent this from occurring again ?

Page 16: Practical oral medicine 2

Case 5

Mention Uses ofThis drug

Page 17: Practical oral medicine 2

Case 6Case 6During extraction of the lower third molar of a 55-

year-old female patient, Severe bleeding occurred.Upon questioning the patient she gave a history of a

past heart attack (Myocardial infarction) and that she was admitted to the hospital for relief of pain.

1- Explain the cause of bleeding ?

2- What are the tests needed for MI patients before dental procedures ?

Page 18: Practical oral medicine 2

Case 7During the dental

treatment of this patient, he suffered from severe chest pain

The dentist gave him 3 tablets of sublingual nitroglycerine that proved not effective in relieving pain

1- Diagnosis1- Diagnosis2- Management ?2- Management ?

Page 19: Practical oral medicine 2

Case 8This patient presented toYou suffering from persistentSevere headache, and also Reported the presence ofDental pain without thePresence of caries orPeriodontal disease(Odontalgia)

1- Possible DiagnosisAnd how to confirm ?

2- Write 3 drugs taken by these patients

Page 20: Practical oral medicine 2

Case 9After 2 months from dental extraction, a patient started to

suffer from fever, tiredness and mild clubbing of his fingers. The patient has a history of a congenital heart disease. The patient was admitted to the hospital for management.

1- Possible Diagnosis ?

2- What would you do for similar patients before extraction ?

Page 21: Practical oral medicine 2

Case 10

1- Diagnosis2- Describe it and mention 2 diseases

associated with it ?

Page 22: Practical oral medicine 2

Note

Page 23: Practical oral medicine 2

Clubbing of fingers

Page 24: Practical oral medicine 2

35-Clubbing finger

Page 25: Practical oral medicine 2

Case 10Female patient who is allergic to Penicillin came to your

clinic for the extraction of her lower second molar.She gave a history of a previous cardiac surgery involving

implanting a prosthetic valve.

1- Dental Management

2- What complications can happen to her if the proper drug wasn’t administered ?

Page 26: Practical oral medicine 2

Case 11This patient presented withBluish discoloration of his handsAnd bilateral lower limb edemaTogether with distention of The neck veins. He wanted toExtract his lower incisors

1- Diagnosis

2- Discuss emergencySituations possible withThis patient and theirmanagement

Page 27: Practical oral medicine 2

Note

Digoxin (Digitalis) is usedBy heart failure patients

Side effects Gag reflex

Page 28: Practical oral medicine 2

Note

Nifidepine (Calcium antagonist) cause generalized gingival enlargement

Page 29: Practical oral medicine 2

2- Endocrine diseases

Page 30: Practical oral medicine 2

Case 1This patient presents withChronic fatigue, tiredness andHypotension and melanin Hyperpigmented macules onThe skin and vermilion border

1- Diagnosis

2- Explain the reason of hyperpigmentations ?

Page 31: Practical oral medicine 2

NoteMoon’s face in Cushing

Page 32: Practical oral medicine 2
Page 33: Practical oral medicine 2
Page 34: Practical oral medicine 2

Buffalo hump

Page 35: Practical oral medicine 2
Page 36: Practical oral medicine 2

Case 2A 55-year-old female patient was taking 60 mg cortisone daily

for the treatment of her auto-immune disease.She stopped taking cortisone abruptly, after which she suffered

from severe hypotension, hypoglycemia then she fainted and was taken to the hospital.

1- Diagnosis

2- Explain what happened to the patient ?

3- How to avoid that ?

Page 37: Practical oral medicine 2

Case 3A patient came to your clinic suffering from badly broken down

upper right first molar that requires extractionIn history taking: the patient admitted taking prednisone for 6

years in treating rheumatoid arthritis

1- Dental Management of this patient

2- Explain why ?

Page 38: Practical oral medicine 2

Case 4This female patient who is taking Daily steroid for several years lostHer consciousness with a rapidDrop in blood pressure. She alsoBecame mentally confused andNot responsive to the dentist

1- Diagnosis ?

2- Dental Management ?

Page 39: Practical oral medicine 2

Case 550 years old patient came to your clinic for operative

restoration of his mandibular second molar toothHistory revealed taking daily steroid (6 mg prednisone) for 3

months

How to avoid the occurrence of adrenal Crisis in this patient ?

Page 40: Practical oral medicine 2

Case 6During the history taking of a patient admitted for

extraction of his wisdom tooth, He gave a history of stopping prednisone tablets 3 weeks ago. He reported taking the drug for 10 years.

Dental Management for this patient ?

Page 41: Practical oral medicine 2

Case 7This patient presents with severeAphthous ulcers on his lips andOral mucosa. You decided to startA steroid therapy taken orallyFor the management of theOral ulcers.

1- What will you do to minimize the risk of occurrence of adrenal insufficiency ?

2- Which is better to start with: Topical or systemic steroids ? And why ?

Page 42: Practical oral medicine 2

Case 855-year diabetic female

complaining of burning sensation of his tongue.

On examination, Diagnosis of Pseudo membranous candidiasis was done.

Her last random blood glucose level was 350 mg/dl

1- What is the normal value of random blood glucose level ?

2- What is the proper treatment ?

Page 43: Practical oral medicine 2

Case 9During the dental treatment of a 33 years old Type

1 diabetic female patient, she appeared to be sweating heavily with the increase in heart rate. Minutes later, she began to be mentally confused and started to faint gradually.

1- Name this condition ?

2- Mention 3 causes for this problem ?

3- How will you manage this ?

Page 44: Practical oral medicine 2

Case 104 days after the onset of a severe odontogenic infection, this

diabetic patient started to feel tired and confused with heavy urination and acetone breath. His skin started to be dry and he showed signs of increased rate of respiration. After that the patient was comatosed.

The most probable diagnosis is:The most probable diagnosis is:

1- The patient developed hypoglycemic coma

2- The patient developed hyperglycemic coma

3- Signs and symptoms of odontogenic infection

4- Respiratory diseases associated with Diabetes

Page 45: Practical oral medicine 2

Case 11Female patient with exophthalmia of her eyes came to your

clinic requiring the extraction of her teeth. During the baseline recording of vital signs you noticed that her blood pressure is 220/130 mmHg. She also complained of irregularity in her heart beats. She was nervous and anxious and felt restless during dental treatment.

The patient began to be very worried, her skin was very hot and her BP began to be very high when she felt pain during the extraction of her badly decayed lower molar

1- Diagnosis of the patient’s disease

2- Why did she suffer from these symptoms during the dental treatment ?

3- What is your dental management ?

Page 46: Practical oral medicine 2

Case 121- Name ThisEye phenomenon

2- It occurs with …………………..

Page 47: Practical oral medicine 2

Exophthalamus in Hyperthyroidism

Page 48: Practical oral medicine 2

Case 13This patient presented withPuffiness of his face andLips also macroglossia wasSeen intra-orally.The patient is very tired andObese and shows signs of edemaallover his body.His skin is cold and very dry

1- Diagnosis ?2- How to confirm it ?3- Possible complication during dental treatment

Page 49: Practical oral medicine 2

3-Infectious 3-Infectious diseasesdiseases

Page 50: Practical oral medicine 2

AIDSAcquired immune

deficiency syndrome

Page 51: Practical oral medicine 2

Important to Know

Page 52: Practical oral medicine 2
Page 53: Practical oral medicine 2
Page 54: Practical oral medicine 2
Page 55: Practical oral medicine 2
Page 56: Practical oral medicine 2
Page 57: Practical oral medicine 2
Page 58: Practical oral medicine 2
Page 59: Practical oral medicine 2
Page 60: Practical oral medicine 2
Page 61: Practical oral medicine 2

Atrophic Candidiasis

Page 62: Practical oral medicine 2
Page 63: Practical oral medicine 2
Page 64: Practical oral medicine 2
Page 65: Practical oral medicine 2
Page 66: Practical oral medicine 2
Page 67: Practical oral medicine 2
Page 68: Practical oral medicine 2
Page 69: Practical oral medicine 2
Page 70: Practical oral medicine 2
Page 71: Practical oral medicine 2
Page 72: Practical oral medicine 2
Page 73: Practical oral medicine 2
Page 74: Practical oral medicine 2
Page 75: Practical oral medicine 2
Page 76: Practical oral medicine 2
Page 77: Practical oral medicine 2
Page 78: Practical oral medicine 2
Page 79: Practical oral medicine 2
Page 80: Practical oral medicine 2
Page 81: Practical oral medicine 2
Page 82: Practical oral medicine 2
Page 83: Practical oral medicine 2
Page 84: Practical oral medicine 2

Chronic Herpes Simplex infection with lesions on tongue and lips.

Page 85: Practical oral medicine 2

Herpetic whitlow

Page 86: Practical oral medicine 2
Page 87: Practical oral medicine 2
Page 88: Practical oral medicine 2
Page 89: Practical oral medicine 2
Page 90: Practical oral medicine 2
Page 91: Practical oral medicine 2
Page 92: Practical oral medicine 2
Page 93: Practical oral medicine 2
Page 94: Practical oral medicine 2
Page 95: Practical oral medicine 2
Page 96: Practical oral medicine 2
Page 97: Practical oral medicine 2
Page 98: Practical oral medicine 2
Page 99: Practical oral medicine 2

Linear gingival erythema

Page 100: Practical oral medicine 2

Linear Gingival erythema

- Mild pain- Responds poorlyTo conventionalTreatmentHIV periodontal Triad:1- HIV associated gingivitis1- HIV associated gingivitis2- HIV associated periodontitis2- HIV associated periodontitis3- HIV associated Necrotizing gingivitis & 3- HIV associated Necrotizing gingivitis &

periodontitis periodontitis

Page 101: Practical oral medicine 2
Page 102: Practical oral medicine 2
Page 103: Practical oral medicine 2
Page 104: Practical oral medicine 2

Linear gingival erythema

Page 105: Practical oral medicine 2

Linear gingival erythema

Page 106: Practical oral medicine 2

Linear Gingival Erythema

Page 107: Practical oral medicine 2

Necrotizing Ulcerative Periodontitis

Page 108: Practical oral medicine 2
Page 109: Practical oral medicine 2

Squamous cell papilloma

Page 110: Practical oral medicine 2

Squamous cell papilloma

Page 111: Practical oral medicine 2
Page 112: Practical oral medicine 2
Page 113: Practical oral medicine 2
Page 114: Practical oral medicine 2
Page 115: Practical oral medicine 2
Page 116: Practical oral medicine 2
Page 117: Practical oral medicine 2
Page 118: Practical oral medicine 2

(3)

Haemoglobin 11.5 g/dl WBS 6.1 X 103/ml Neutrophils 5.2 X 103/ml Lymphocytes 0.2 X 103/ml Monocytes 0.6 X 103/ml CD 4 210 cells /ml HIV antibody positive HIV viral load undetectable

Page 119: Practical oral medicine 2

(4) CD 4 20 cells / ml HIV viral load 120.000 copies/ ml

Page 120: Practical oral medicine 2

(5)

Hb 14.5 g/dl Reticulocyte 0.68% (N: 0.5-2.4%) Platelets 266.000 Bilirubin 45 mg/dl (N: 0.3-1.0 mg/dl) AST 136 IU/L (N: 10-40 U/L) ALT 240 IU/L (N: 9-60U/L)

Page 121: Practical oral medicine 2

(6)Hb 14.5 g/dl Reticulocyte 0.68% (N: 0.5-2.4%) Platelets 266.000 Bilirubin 55 mg/dl (N: 0.3-1.0 mg/dl) AST 136 IU/L (N: 10-40 U/L) ALT 640 IU/L (N: 9-60U/L) HBsAg positive HBeAg positive Anti-HCV negative

Page 122: Practical oral medicine 2

(7) Platelets 100.000 Prothrombin time 20 sec (control 11.5-15.5) Serum bilirubin 75 mg/dl (N: 0.3-1.0 mg/dl) AST 101 IU/L (N: 10-40 U/L) ALT 38 IU/L (N: 9-60U/L) HBsAg positive

Page 123: Practical oral medicine 2

(8)

Platelets 130.000 Prothrombin time 20 sec (control 11.5-15.5) Serum bilirubin 45 mg/dl (N: 0.3-1.0 mg/dl) AST 101 IU/L (N: 10-40 U/L) ALT 38 IU/L (N: 9-60U/L) HBsAg positive Anti HBs negative HBe Ag positive Anti-HBe negative

Page 124: Practical oral medicine 2

Case 1This HIV + patient presented to theOral Medicine department sufferingFrom asymptomatic corrugated White lesion on the lateral borderOf the tongue.The patients says he feels gagging Because of the lesion and complainedOf its bad appearance.

1- Diagnosis ?

2- What is the causative organism ?

3- Mention other diseases showing the same lesion?

Page 125: Practical oral medicine 2

Case 2This 66-year-old AIDS patients presented to yourClinic suffering from extremely painful ulcers,Erosions and crusts on his face, cheeks and ears

The patient reported the presence of the lesionsFor 3 months now

1- Diagnosis ?

2- Causative organism ?

3- Management ?

Page 126: Practical oral medicine 2

Case 3A 28-year-old black male presented with numerous nodules on the face, and with multifocal, purple-red, maculo-papular lesions on the gingivae, and on the hard palate . The patient said that the facial and intra-oral lesions had appeared three months prior to our examination.

1- Diagnosis ?

2- What is the causativeOrganism ?

Page 127: Practical oral medicine 2

Case 4This 40-year-old patient Who gave a history ofIV drug abuse for severalYears, presented with manyDeep painful ulcers on Her upper and lowerLip that aren’t healingAnd are chronic

1- Diagnosis ?

2- What underlying disease you suspect ?3- Management ?

Page 128: Practical oral medicine 2
Page 129: Practical oral medicine 2

Case 1This patient suffers from drop

of the angle of the mouth & inability to close his eyes. He reported that these manifestations had a rapid onset. The facial muscles tend to be deviated to one side of the face.

1-What is your diagnosis ?

2-What is the treatment ?

3-What are the causes ?

Page 130: Practical oral medicine 2

Case 250-year old female patient came to the dental clinic

suffering from a very tender area on her upper lip. She said that when she touches this specific area, an

attach of electric shock like pain occurs. This pain attack last for 5 minutes.

1-What is your diagnosis ?

2-How can you confirm your diagnosis ?

3-What is the possible treatment ?

Page 131: Practical oral medicine 2

Case 3This patient suffers from loss of

taste sensation, inability to whistle and inability to close the eyes.

Ears showed multiple vesicles, ulcers and crusts on the external ear.

1-What is the diagnosis ?

2-What are the lesions A & B ?

Page 132: Practical oral medicine 2

Case 4This male patient suffered

from severe pain in front of the ear that is worst upon awakening and radiates to the neck.

On clinical examination, Wear facets were noticed on the mandibular posterior teeth

1-What is the diagnosis ?

2-What is the treatment

Page 133: Practical oral medicine 2

Management of MFPDS1. Elimination of cause e.g.:

high filling occlusal adjustments.

2. Occlusal splints (Bite raiser – night guard) if no local factor can be detected.

3. Patient reassurance .

Page 134: Practical oral medicine 2
Page 135: Practical oral medicine 2
Page 136: Practical oral medicine 2
Page 137: Practical oral medicine 2

Case 5A 45-year-old female patient suffering from depression

and anxiety from several years. She was suffering from chronic dull aching pain allover her head that doesn’t respond to analgesics

1-What is the diagnosis ?

2-What is the management ?

Page 138: Practical oral medicine 2
Page 139: Practical oral medicine 2

Tongue diseases Tongue diseases and disordersand disorders

Page 140: Practical oral medicine 2
Page 141: Practical oral medicine 2

ExaminationExaminationInspectionInspection

Page 142: Practical oral medicine 2

B- Palpation B- Palpation BidigitalBidigital Consistency Consistency

C- Function evaluationC- Function evaluation

Tongue Tie

Tongue deviation

Page 143: Practical oral medicine 2

Disorders of Tongue

• Glossodynia (burning mouth syndrome)- spontaneous burning, discomfort, pain, irritation, or rawness of the tongue, has no identifiable etiology most of the time

Page 144: Practical oral medicine 2

Etiology of Glossodynia

• Neurologic– Peripheral nerve

damage– Diabetic neuropathy – Trigeminal neuralgia

• psychiatric– Depression– Anxiety– Cancerophobia

• Systemic disorders– Anemia (iron deficiency,

pernicious)– Nutritional deficiency – Gastroesophageal reflux

disease– Sjogren syndrome– Hypothyroidism– Acquired

immunodeficiency syndrome

Page 145: Practical oral medicine 2

Treatment

• Tricyclic antidepressant

Page 146: Practical oral medicine 2

Disorders of Tongue…• Glossitis- presents as pain, irritation or burning,

hypogeusia, or dysgeusia

• Atrophic glossitis– Due to filiform de-papillation– Mild patchy erythema to a completely smooth,

atrophic, beefy-red surface

– Etiology - pernicious anemia, protein and other nutritional deficiencies, chemical irritants, drug reactions,, vesiculobullous diseases, oral candidiasis and systemic infections

Page 147: Practical oral medicine 2

Disorders of taste dysgeusia

• Viral infections• Candidiasis• Malnutrition• Neoplasms• Xerostomia• Metabolic disturbance• Drugs• Radiation• Zinc deficiency

Page 148: Practical oral medicine 2

COMMON LESIONS

Page 149: Practical oral medicine 2

Normal variations

Page 150: Practical oral medicine 2

Varicosities

Page 151: Practical oral medicine 2
Page 152: Practical oral medicine 2

Foliate papillae

Page 153: Practical oral medicine 2

They are occasionally mistaken fortumors or inflammatory disease

Page 154: Practical oral medicine 2

Developmental lesions

Page 155: Practical oral medicine 2

Fissured tongue

• normal variant seen in 5-11% individuals

• Numerous small irregular fissures oriented laterally on the dorsal tongue

• Also seen in - Melkersson-Rosenthal syndrome, psoriasis, Down syndrome, acromegaly, Sjogren syndrome

Page 156: Practical oral medicine 2

Macroglossia• Congenital or acquired process, tongue is

disproportionately large relative to the patient’s jaw size• Difficulty with mastication and speech and accidental

tongue biting are common• Differential- Down syndrome, hypothyroidism,

haemangioma, neurofibromatosis, infection by mycobacteria, or deep fungus, amyloidosis………

Page 157: Practical oral medicine 2

MicroglossiaMacroglossia\Fissured tongue

Page 158: Practical oral medicine 2

Hairy tongue• Hypertrophy of filiform papillae

resembling hair-like projections• Associated with - heavy tobacco

use, mouth breathing, antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of antacids.

• White, yellow green, brown, or black color is due to chromogenic bacteria or staining from exogenous sources

Page 159: Practical oral medicine 2

Black hairy tongue

Page 160: Practical oral medicine 2

Brown hairy tongue

TREATMENT: Treatment consists of brushing the tongue with a soft bristle toothbrush . Surgical scraping.

Page 161: Practical oral medicine 2

1. What is the clinical diagnosis

2. What are the predisposing factors?

3. What is the treatment?

Page 162: Practical oral medicine 2

Geographic tongue• Geographic tongue- benign

inflammatory condition, due to loss of filiform papillae

• Erythematous plaques with well demarcated white border

• Etiology- idiopathic, psoriasis, Reiter syndrome, atopic dermatitis, idiopathic

Page 163: Practical oral medicine 2
Page 164: Practical oral medicine 2
Page 165: Practical oral medicine 2

Hemangioma of the lateral aspect of the tongue

Page 166: Practical oral medicine 2
Page 167: Practical oral medicine 2

Lingual thyroid

Page 168: Practical oral medicine 2

Other lesions

Page 169: Practical oral medicine 2

OraI hairy leukoplakia• Caused by Epstein-Barr

virus.• Presents as

asymptomatic, corrugated, white plaques with accentuation of vertical folds along the lateral borders of tongue

• Predominantly seen in HIV infection, organ transplant recipients and patients on chemotherapy

Page 170: Practical oral medicine 2

OraI hairy leukoplakia, Diagnosis

•DNA in situ hybridization•Biopsy

Page 171: Practical oral medicine 2

CandidiasisPseudomembranous

• Etiology• Predisposing factors• Classification• Treatment

Page 172: Practical oral medicine 2

Median rhomboid glossitis• Median rhomboid

glossitis - atrophic disorder of the tongue secondary to chronic candidiasis

Page 173: Practical oral medicine 2
Page 174: Practical oral medicine 2

Atrophic (erythematous) candidiasis

Page 175: Practical oral medicine 2

Squamous cell carcinoma• Early carcinoma may

clinically appear as leukoplakia or erythroplasia.

• The tongue and floor of the mouth are the most common areas

• PROGNOSIS: The overall five year survival rate is about 50%. Early diagnosis increases the chance of survival.

Page 176: Practical oral medicine 2

Leukoplakia

unilateral indurated white patch related to the lateral surface of the tongue.

Page 177: Practical oral medicine 2

EARLY SQUAMOUS-CELL CARCINOMA OF THE LATERAL

BORDER OF THE TONGUEEARLY SQUAMOUS-CELL

CARCINOMA OF THE FLOOR OF THE MOUTH

Page 178: Practical oral medicine 2

SQUAMOUS-CELL CARCINOMA PRESENTING AS EXOPHYTIC ULCERATED TUMOR OF THE

LATERAL BORDER OF THE TONGUE..

LATE SQUAMOUS-CELL CARCINOMA ON THE DORSUM

OF THE TONGUE.

Page 179: Practical oral medicine 2
Page 180: Practical oral medicine 2

• DIFFERENTIAL DIAGNOSIS: All ulcerations present for more than 2-3 weeks in which there is no apparent cause should be biopsied to rule out carcinoma, especially in adults whose lesions are in high risk areas.

Page 181: Practical oral medicine 2

Traumatic ulcerSource of trauma should be identified

Page 182: Practical oral medicine 2

Case 11-What is the clinical diagnosis ?2-What are the predisposing factors ?

Page 183: Practical oral medicine 2

Case 2

A 22-year-old male that has been diagnosed as AIDS, has noticed this whitish lesion on both sides of his tongue.1-What is the most likely diagnosis ?2-Causative organism ?3- How to confirm your diagnosis ?

Page 184: Practical oral medicine 2

Case 3

A 55 diabetic male complaining of burning sensation in his tongue.He was on systemic antibiotic therapy (Penicillin) for the last 2 weeks

due to a severe dento-alveolar abscess1-What is the most likely diagnosis ?2-How can you confirm your diagnosis clinically ?3-What is the appropriate treatment ?

Page 185: Practical oral medicine 2

Case 4A 67-year old smoker male

complains about this 4-week duration ulcer. No history of trauma or systemic illness has been reported.

1-What is the differential diagnosis ?

2-Is there lymphadenitis ? What are its characteristics ?

3-How can you confirm you diagnosis ?

Page 186: Practical oral medicine 2

Case 5

A 67 years old smoker presented to the dental clinic with a complain of unilateral indurated white patch related to the lateral surface of the tongue.

1-What is the differential diagnosis ?2-What is the proper management ?

Page 187: Practical oral medicine 2

Case 6These tongue changes were discovered accidentally during routine examination of the oral cavity. The patient reported that both his sons have the same lesions1-What is the most likely diagnosis ?

Page 188: Practical oral medicine 2

Case 7

This lesion was observed clinically, but with no pain

1-What is the diagnosis ?

Page 189: Practical oral medicine 2

Case 81) What is the differential diagnosis ?2) How can you confirm your diagnosis ?

Page 190: Practical oral medicine 2

Case 9A 58 years hypertensive female came to the dental clinic with a complain of burning sensation related to the dorsal surface of the tongue, she also reported a sense of dryness in her mouth over the last few months.1-What is the most likely diagnosis ?2-How can we confirm the diagnosis ?3-What is the proper treatment ?

Page 191: Practical oral medicine 2

Case 10

32 parenteral drug addict male came to the dental office with a complain of mild roughness and irritation related to both lateral surfaces of the tongue. He also reported a history of frequent attacks of respiratory tract and skin infections during the last 3 months

1-What condition is important to exclude?2-What is the causative organism ?

Page 192: Practical oral medicine 2

Case 11A 33 male presented with a painful unilateral ulcer of 2 weeks duration. He reported that one of his filled lower teeth fractured recently.

What is the most likely diagnosis ?

Page 193: Practical oral medicine 2

Case 12

This patient reported the presence of this lesion since early childhood

What is the Probable diagnosis ?

Page 194: Practical oral medicine 2

Good Luck