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Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director of Oral Medicine University of Minnesota

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Page 1: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Physical Evaluation of the Dental Patient

Dr. Nelson L. RhodusDiplomate, American Board of Oral

Medicine

Morse Alumni Distinguished Professor

Director of Oral Medicine

University of Minnesota

Page 2: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 3: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Relevant to dentistry Indications

• Signs and symptoms of disease• High risk groups• Confirm clinical diagnosis

Categories of lab tests• Diagnostic• Screening

Page 4: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

THE DIAGNOSTIC PROCESS

Page 5: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS

CBC( complete blood count)• Hemoglobin• Hematocrit• RBC, WBC• Differential WBC

Page 6: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS

Bleeding studies• PT( INR): Prothrombin Time• PTT ( INR): Partial Thromboplastin Time• BT: Bleeding time• Platelet count

Page 7: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS Fasting blood glucose

( 126 mg %)Hb A 1 C

Infectious diseases:HBV, HCV, HIV, other

Page 8: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS

DDS should have a working concept of WNL( range)

Errors in testing Clinical scenario MOST IMPORTANT! May need to repeat test in light of clinical

impression

Page 9: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Lab tests used frequently by DDS CBC : RBC 4.6 - 6.2 million /cc- male 4.2 - 5.4 million/cc- female Erythrocytopenia=Decrease= Anemias

Fe, B-12, folate, pernicious, sickle cell Erythrocytosis= Increase= Polycythemia

dehydration, infection-fever

Page 10: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS CBC : Hemoglobin ( Hb) Oxygen-carrying capacity 13.5- 18.0 g/100cc - males 11.5- 16.4 g/100cc - females

Page 11: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS CBC : Hematocrit ( Hct) Volume of RBCs per 100 cc of blood 40 - 52 % - males 35- 47 % - females

Page 12: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS CBC : mean corpuscular hemoglobin

( MCH) Average Hb content of each RBC 27-32 pg

Page 13: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

Lab tests used frequently by DDS CBC : erythrocyte sedimentation rate

( ESR)= aggregated RBCs WNL < 20 mm/hr. Inflammation Increase= tissue destruction

Page 14: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Lab tests used frequently by DDS CBC : WBC 5,000 - 10,000 / cc Leukocytosis= increased WBC

infection, RF, allergies, necrosis, exercise, pregnancy, stress, drugs, LEUKEMIA

Leukopenia= decreased WBChypovolemia, early leukemia, drugs, radiation, blood dyscrasias

Page 15: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Lab tests used frequently by DDS CBC : differential WBC Neutrophils( segmented) = 50-70%

Neutrophils( band) = 0- 5% Lymphocytes = 25-40% Monocytes = 4-8% Eosinophils = 1- 4% Basophils = 0- 1%

Page 16: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Lab tests used frequently by DDS CBC : differential WBC LEUKEMIAS Acute lymphocytic( lymphoblastic) leukemia Acute myelogenous leukemia Chronic lymphocytic( lymphoblastic)

leukemia Chronic myelogenous leukemia

Page 17: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Lab tests used frequently by DDS CBC : differential WBC LYMPHOMAS Hodgkin’s, non- Hodgkin’s, Burkitt’s

Page 18: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing Neutrophilic leukocytosis: bacterial

infections, inflammatory disorders, drug reactions, leukemia

Lymphocytosis: bacterial infections, viral infections,

leukemia Eosinophilic leukocytosis:

allergic reactions

Page 19: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 20: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

BLOOD CHEMISTRY SMA-12/60

Page 21: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 22: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing

BLOOD CHEMISTRY BONE METABOLISM Calcium, Phosphorous, Alkaline

phosphatase

Page 23: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 24: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY BONE METABOLISM Calcium, Phosphorous, Alkaline

phosphatase Hyperparathyroidism, Multiple myeloma Paget’s disease, fibrous dysplasia Osteoporosis , Cancer

Page 25: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 26: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY BONE METABOLISM Calcium 9.0-10.5 mg% Hypocalcemia: hypoparathyroidism, Vit. D

deficicency, preganancy, diuretics

Page 27: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY BONE METABOLISM Phosphorus 3.0- 4.5 mg% Hyperphosphatemia: hypoparathyroidism, renal

disease, hyperthyroidism, hypervitaminoisis D Hypophosphatemia: hyperparathyroidism,

malabsorption, Vit. D deficiency

Page 28: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY BONE METABOLISM Alkaline phosphatase 25 - 115 Units/L Elevated: hyperparathyroidism, Paget’s,

sarcomas, metastatic carcinoma, growth

Page 29: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY RENAL FUNCTION TESTS BUN ( blood urea nitrogen) Uric Acid Creatinine

Page 30: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY RENAL FUNCTION TESTS BUN ( blood urea nitrogen) 8-18 mg% Uric acid 2.4-7.5 mg % Increased: Chronic renal failure, chemo-Tx,

lymphoproliferative disease, gout , acidosis

Page 31: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY RENAL FUNCTION TESTS Creatinine 0.6-1.2 mg% Increased: Chronic renal failure, CHF,

acromegaly, dehydration, diabetes, shock

Page 32: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY LIVER FUNCTION TESTS LDH: lactate dehydrogenase AST: aspartate aminotransferase ALT: alanine aminotransferase( SGPT) Alkaline phosphatase Bilirubin, Protein, Albumin

Page 33: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY LIVER FUNCTION TESTS LDH: lactate dehydrogenase 50-240 Units/L ALT 0-40 Units/L

Page 34: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY LIVER FUNCTION TESTS LDH and ALT increased: MI, liver disease, mononucleosis, renal

disease, anemia, pancreatitis, skeletal muscle damage

Page 35: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY LIVER FUNCTION TESTS Bilirubin 02.-1.5 mg % liver disease: hepatitis, cirrhosis, drug

toxicities

Page 36: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY LIVER FUNCTION TESTS Total protein 5.6-8.4 g % Albumin= 3.4- 5.4 g % Globulins= 2.2-3.0 g % liver disease: cirrhosis, chronic infections, Multiple myeloma

Page 37: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY BLOOD GLUCOSE 70-100 mg % Fasting > 126 mg % = diabetes Increased : corticosteroids, catecholamines,

growth hormone, CHF, diuretics

Page 38: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Clinical laboratory testing BLOOD CHEMISTRY SERUM CHOLESTEROL <200 mg % Elevated : hypercholesterolemia risk for

ASCVD( MI)

Page 39: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 40: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Normal control of bleeding Vascular phase Platelet phase Coagulation phase

Page 41: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

bleeding problems Inherited Acquired Drug therapy

Page 42: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Detection of the patient with bleeding problems Prothrombin time( PT ) or

International Normalized Ratio (INR) Partial thromboplastin time (PTT) Thrombin time (TT) Bleeding time (BT) Platelet count

Page 43: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Prothrombin time (PT) activated by tissue thromboplastin tests

extrinsic and common pathways run with a control ( variable with lab :

therefore: INR) normal= 11-15 seconds prolonged time = abnormal

( significant for dentistry > 2.5, 3.0, 3.5...)

Page 44: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Activated partial thromboplastin time (PTT)

Contact activator( kaolin) tests the intrinsic and common pathways run with a control normal= 25-35 seconds prolonged ( 2.5, 3.0, 3.5...)= abnormal

Page 45: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Thrombin time(TT) activated by thrombin tests the ability to form a solid clot run with a control normal= 9-13 seconds prolonged( 2.5, 3.0, 3.5,...) = abnormal

Page 46: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Ivy bleeding time (IBT) tests vascular and platelet status Immediate factors in control of bleeding normal = 1-6 minutes abnormal = prolonged time

Page 47: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 48: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 49: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Platelet count tests numbers of platelets present to form

clot normal= 140,000 to 400,000 / cc bleeding problems < 50,000/cc

Page 50: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Thrombocytopenia platelet count ~ 50,000 ( with or without

platelet replacement) < 50,000 = bleeding problem

Page 51: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Bleeding disorders Nonthrombocytopenic purpuras

• vascular wall alterations• platelet function disorder

Thrombocytopenic purpuras• Primary ( genetic)• secondary( acquired: drugs, diseases)

Disorders of coagulation• inherited, acquired

Page 52: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Microbiological exam Sample collection ( bacterial, fungal, etc.) Lesion Transport media Clinical information: site, nature, differential

diagnosis ID organism Antimicrobial sensitivity : long-term Rx, diabetes,

immunosuppressed, refractory to Tx Closely follow course of TX

Page 53: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Diabetes mellitus Detection and management

Dr. Nelson L. Rhodus

Director of Oral Medicine

University of Minnesota

Page 54: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 55: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 56: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 57: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Cytology

Exfoliative cytology ( Oral CDx)= “brush biopsy”…….. PAP smear

Scrape off surface of lesion to BM if possible

Useful for : HSV, Candidiasis, pemphigus, some bacteria, cellular atypia

Page 58: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 59: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 60: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

QuickTime™ and a decompressor

are needed to see this picture.

Page 61: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Exfoliative cytology

Oral CDx ® ( “brush biopsy”) some, limited clinical diagnostic

value( decide to Bx) irregular epilthelial cells (not flat) enlarged, irregular size and shape of

nuclei hyperchromatic nuclei

Page 62: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 63: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

ORAL CANCERDETECTION

CLINICAL vs. DEFINITIVE DIAGNOSIS

HISTOPATHOLOGY ..MUST !! lesion with MODERATE DEGREE of

clinical suspicion ...BIOPSY lesion with HIGH DEGREE of clinical

suspicion...REFER

Page 64: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 65: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 66: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Leukoplakia to SCCA

mean age 63; F = M time to transformation = 7.2 years precedent dysplasia= 17% 17 % WITH Bx-proven dysplasia >>>

SCCA in 3 yrs.

Page 67: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Biopsy

Excisional- entire lesion is removed Incisional- portion of large lesion Punch Fine-needle aspiration Oral pathologist Clinical information to pathologist

Page 68: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 69: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 70: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 71: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 72: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 73: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 74: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 75: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 76: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Toludine blue

Ora-scan® binds to DNA 93 % accurate = adjunct uptake= high yield + margins false + ves

Page 77: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 78: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 79: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Candida speciesCandida species

several common species in oral cavity Candida may proliferate with

immunosuppression increase in Candida counts with decreased

salivary flow associated with diabetes, hematologic

abnormalities and several other disorders including Sjogren’s syndrome

Page 80: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 81: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 82: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 83: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Diascopy

Detects blood in a blisterform lesion Press on lesion with a glass microscope

slide If color blanches= blood-filled Oxidized vs. reduced blood

Page 84: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 85: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

FNA

salivary glands lymph nodes 22 gauge needle + 10 - 20 ml

syringe cytology

Page 86: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 87: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 88: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 89: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Asdvanced laboratory techniques DNA testing( microarray, RT-pcr, etc.) Cytogenetics, chromosomal Viral testing ELISA, enzyme assays Immunofluorescence Antibodies Salivary scintigraphy MRI, CT , etc.

Page 90: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 91: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director
Page 92: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

QuickTime™ and a decompressor

are needed to see this picture.

Page 93: Physical Evaluation of the Dental Patient Dr. Nelson L. Rhodus Diplomate, American Board of Oral Medicine Morse Alumni Distinguished Professor Director

Candidiasis

53% in SCCA ; 31 % in WNL chronic fungi : epithelial adhesion immunoincompetence higher correlation with leukoplakias to

SCCA transformation (61%)


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