Investigations in oral medicine

Prepared by: Jamal Q AhmedSupervised by: Prof.Dr.Ali Al

Zubaidi

Blood testing Indications in oral medicine

1. Patients with recurrent aphthous stomatitis2. Patients with a persistently sore or dry mouth3. Patients with oral lesions with an atypical history or

unusually resistant to treatment4. Patients complaining of a sore mouth or dry mouth

despite no mucosal changes can be seen5. All patients with orofacial candidosis6. Patients following abnormalities following an initial

screening Full blood count and film examination

From this anemia are demonstrated by a change in red cell morphology and lowered hemoglobin concentration

contd Erythrocyte sedimentation test it increase in

Tuberculosis/acute hepatitis/acute myocardial infarction/rheumatic fever/rheumatoid arthritis/malignancies/multiple myeloma/temporal arteritis

Heamatinics Ferritin increase in leukemia, some liver

disease,hemachromatosis Decrease in iron deficiency anemia Iron/iron deficiency anemia Folate and vitB12 in megaloblastic and

pernicious anemia transferin

contd Red cell indices

MCV/ normocytic ,microcytic (iron deficiency anemia) or macrocytic(megaloblastic anemia)

MCHC normochromic, hypochromic(iron deficiency anemia) hyperchromic (pernicious anemia)

Blood grouping and cross match

Serology for detection of antibodies in serum, either in infectious diseases like syphlysis,gonorrhea,tuberclosis,or in autoimmune disease SLE,rheumatoid artheritis,ceolic disease,sjogren syndrome

Skin testes

Patch test Prick test Scratch test

Clinical chemistry

Glucose: increase in diabetes mellitus, cushing’s syndrome

Decrease in diabetic patients in excessive use of insulin, in sever liver diseases

Urea: increase in dehydration, renal failure Creatinine: increase in renal failure Electrolytes

Sodium: raised in dehydration, low in cardiac failure Potassium: raised in renal failure, diabetic

ketoacidosis, low in diuretic use Calcium: high in hyperparathyroidism, malignancy,

vitaminD excess low in rickets, osteomalatia, hypoparathyroidism

Phosphate: high in renal failure, low in rickets, osteomalatia

contd

Alkaline phosphatase: raise in paget’s disease, rickets, osteomamalatia ,cholestasis

Total protein: raise in dehydration, liver diseases,myeloma,sarcoidosis,connective tissue diseases low in overhydration,renal failure,enteropathy

Liver enzymes: disturbed in liver diseases, some drug therapies like carbamazepine, phenytoin,phenobarbitone

Immunological tests

Auto antibodies Coelic disease (anti gliadin ,anti endomysal,anti

reticulin antibody), lupus erythematous (anti nuclear antibodies) sjogren syndrome (SS-A,SS-B), pemphigus (antibody against desmosomes) pemohigoid (antibody against basement membrane)

Viral antibodies:AIDS,EBV C-reactive protein increase in inflammatory

conditions and malignancies Direct and indirect immune fluorescence Complement tests: C1 esterase inhibitor

deficiency

Endocrine function

Importance in oral medicine Diagnosis of diabetes Orofacial disorders due to poorly

controlled hormonal imbalances Hormonal imbalance due to therapy of

orofacial disorders Managment may influenced by

endocrine disease or hormone replacement therapy

Urinalysis Glycosuria: diabetes mellitus Ketonuria: diabetic ketoacidosis, starvation Bilirobin or urobilinogen: hemolytic anemia Proteinuria

Infections/vascular/drugs/autoimmune diseases Heamaturia

Infection/antibodies/inherited hemolytic diseases/mechanical causes/chemicals

Microbiological investigations

Microbiological investigation done for detection of:

Viable organism/microbiological products/antibody detection

Bacteriology: culture and sensitivity test,

Mycology: swab, smear ,oral rinse

Virology: tissue culture, antigen detection, identification of genetic material (PCR,FISH)

Biopsy

Indications: Lesions which have neoplastic or

premalignant features Lesions of uncertain etiology Persistant lesions failing to respond

treatment Confirmation of clinical diagnosis

Types of biopsy

Excisional Incisional FNA Frozen section Oral brush biopsy

Investigation of specific medical problems Anemia

Haemoglobin concentration A full blood film Red cell indices White cell count and differential

Deficiency anemia Iron deficiency anemia/ folate deficiency/vitamin

B12/multiple heamatinic deficiencies Sickle cell anemia

Full blood picture Simple solubility test Heamoglobin electrophoresis

contd Bleeding tendencies

Platelete count: increase in1. Myeloproliferative diseases2. Malignancies specially disseminated one3. Chronic inflammation like in RA, inflammatory bowel disease,

collagen diseases thrombocytopenia

1. Decreased Platelete production like in aplastic anemia,radiotherapy,nutritional deficiencies, drug effects like alcohol ,chemotherapy,

2. Antiplatelete antibodies like in autoimmune thrombocytopenia, SLE, acute leukemia

3. Drugs like heparin, quinine4. Increased Platelete consumption like septecemia,massive blood

loss5. Hypersplenism like cirrhosis, after massive transfusion, renal

insufficiency

APTT, PT and INR prolonged in inadequate vitaminK in

diet Premature infants Poor fat absorption( obstructive

jaundice,coelic disease,fistulas,colitis) Sever liver damage Drugs (warfarin, heparin) Bleeding time

Adrenocortical function testing Blood pressure: hypotension in addison’s

disease, hypertension in cushing’s syndrome

Plasma cortisol level :in addison’s disease decrease, in cushing’s syndrome increase

Synacthen test Serum antibodies Electrolytes: sodium decreases and

potassium increases in addison’s disease

contd

Diabetes RBS more than 11mmol/l or FBS more

than 7mmol/l hyperparathyroidism