Chapple / Hamburger Periodontal Medicine - A Window on the Body

1. Auflage 2019
ISBN: 978-1-85097-307-2
Verlag: Quintessenz Verlag
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 43, 250 Seiten

Reihe: QuintEssentials of Dental Practice

Periodontal Medicine is a sub-discipline of Periodontology which deals with non-plaque-induced conditions/lesions of the periodontal tissues, including the periodontal manifestations of systemic diseases and syndromes. It reminds us of the often forgotten and frequently ignored medical aspects of a traditionally surgical discipline. This heavily illustrated text attempts to guide the reader through over 100 conditions using their clinical presentation as the guiding principle to categorization.

Autoren/Hrsg.

Chapple, Iain L. C.

Hamburger, John

Leseproben

Chapter 1
Establishing a Differential Diagnosis for Periodontal Manifestations of Systemic Diseases
Aim
This chapter aims to provide the reader with a step-by-step guide to history-taking, examination and further investigation of non-plaque-induced lesions that arise withithe periodontal tissues, including the free and/or attached gingiva and associated oral mucosa, to help establish a differential diagnosis. Outcome
Having read this chapter the reader should appreciate the need for a forensic and systematic approach to establish differential diagnoses for oral and medical conditions that manifest within the periodontal and associated tissues. Terminology
A variety of clinical, procedural and pathological terms and descriptors are used throughout this chapter, and Table 1-1 defines these by category. Table 1-1 Terminology Used in Periodontal and Oral Medicine/Pathology Context Terminology Definition Clinical presentation or procedure Symptom Something the patient is experiencing or complaining of as a consequence of their condition. Sign Something the clinician detects (visual, tactile or olfactory) that may help inform the diagnosis. Biopsy Acquisition of human cells or tissues to aid diagnosis. Incisional biopsy A biopsy involving partial removal of the lesion. This may be performed when malignancy is suspected and complete excision of the lesion would result in loss of key surgical landmarks. Excisional biopsy A biopsy involving complete removal of the lesion. Fine needle biopsy /aspirate Cells acquired using a fine cutting biopsy needle to obtain diagnostic material from within a lesion whose location or nature is such that surgical management should be delayed until microscopic diagnostic information is available. Broad needle biopsy Tissue acquired using a broad cutting biopsy needle. The purpose is to acquire diagnostic material from within a lesion whose location or nature is such that surgical management should be delayed until microscopic diagnostic information is available. In addition, it is believed that acquisition of small numbers of cells may be of limited/no benefit to the pathologist. Swab Use of a soft material (e.g. cotton pellet) to obtain infective material for culture and subsequent identification and testing (e.g. for antibiotic sensitivity) following culture. Smear Use of a solid/sharp instrument to scrape away cells for microscopic examination. Cytology Examination of individual cells (human or microbial) by microscopy, with or without special stains. Differential diagnosis A list of possible diagnoses, ranked in order of the most likely to the least likely. Presumptive (working) diagnosis A clinical diagnosis made in the absence of confirmatory information from additional clinical investigations and upon which therapy is based. Definitive diagnosis The working and most likely diagnosis upon which therapeutic strategies are based. Lesions and lesion descriptors Ulcer A breach in the epithelium to expose the underlying connective tissue. Erosion Apartial breach in the continuity of an epithelial surface, which does not expose underlying connective tissue. Fissure A narrow crack or slit (usually describes an ulcer shape). Vesicle A small (<0.5cm) fluid filled lesion (not pus) Bulla A larger (>0.5cm) fluid filled swelling (not pus) Blister A fluid filled swelling (not pus) Papule Raised lesion (<1.0cm diameter) Macule Flat lesion (< 1.0cm diameter) Nodule Raised lesion (>1.0cm diameter) Pedunculated Lesion is borne/carried on a stalk/stem Sessile Lesion is borne on a broad/flat base Sinus A hole communicating a body cavity with the external environment Sinus tract An epithelial lined tunnel linking an internal body cavity with the external environment Fistula A communication between two body cavities Tumour A neoplasm is an abnormal mass of tissue, the growth of which is uncoordinated with that of normal tissues, and that persists in the same excessive manner after the cessation of the stimulus which evoked the change Granuloma A well-defined accumulation of modified macrophages (epithelioid cells), surrounded by lymphocytes and often with multinucleated giant cells. Epulis A benign localised swelling of the gingiva usually affecting the interdental papilla Cyst A pathological fluid filled (not pus) cavity. Pathological terms or descriptors Atrophic Thinning of a tissue. Hyperplasia An increase in the size of a tissue due to an increase in the number of its constituent cells. Hypertrophy An increase in the size of a tissue due to an increase in the size of its constituent cells. Overgrowth An increase in the size of a tissue due to an increase in the size and/or number of constituent cells and/or extracellular matrix components. Dysplasia Disturbance in the normal maturation of a tissue. Anaplasia Lack of differentiation of a tissue, characteristic of some tumour cells. Acantholysis Separation of epithelial cells within the stratum spinosum. Acanthosis An increase in thickness of the stratum spinosum. Leukoplakia An adherent white patch or plaque that cannot be characterised clinically or pathologically as any other lesion (WHO). Erythroplakia A bright red velvety plaque that cannot be characterised clinically or pathologically as any other recognisable condition (WHO). Hyperkeratosis Excess deposition/formation of keratin within the stratum corneum of epithelium. Oedema The collection of inflammatory fluid exudate within a tissue or body cavity. Angioedema A diffuse oedematous swelling that may develop rapidly often involving the facial tissues and frequently, but not universally, results from a hypersensitivity reaction. Guiding Principles Behind Establishing a Diagnosis
The sub-headings used in the following section are those classically recommended for use in clinical practice and thus are standard procedures. In periodontal medicine, the ‘history’ has a unique temporal relationship with the other diagnostic stages, because it should continue throughout the consultation process, i.e. never hesitate to return to and refine the history in the light of each new piece of information gathered. The Diagnostic Pathway
The Complaint
The complaint is information that must be provided by and recorded in the patient’s own words. It is important when the complaint involves a symptom such as ‘pain’ or ‘soreness’ to clarify the exact details of that complaint, e.g.: Character? Intensity/severity? Location? Spread? Associated signs or symptoms? Similar lesions elsewhere on the body? The History of the Complaint
The history of the complaint often holds the key to its diagnosis. For example, the appearance of the lesion or symptoms may be subsequent to the patient commencing new medication, implying a potential aetiological role for that medication. For an abscess that is of pulpal origin, any swelling may present after an episode of dental pain, whereas with an abscess of periodontal origin the swelling often precedes the development of pain; temporal issues are important. Other key issues to explore...