Oral medicine RED STAR

Patient history for new patient

Diagnose properly and formulate a treatment plan

Patient history with existing patient

Gain new information to support ongoing care

Patient history includes

All relevant information about a patient’s health

Different ways to guide patients to describe pain:

Aching, pulsating, itching, burning, dull/sharp

ABCDE’s of Melanoma

A= asymmetry

B= border irregularity

C= color (non-uniform)

D= Diameter >6mm

E=evolution (crusting, heaving, etc.)

Symblepharon clinical sign

A fiber band build-up in the eye, can be observe during dental exam

Sjogren’s syndrome symptoms

Itchy burning eyes (like sand in eyes), dry mouth and tongue

Pterygium clinical sign

Aka surfer’s eye, a result of lots of sun exposure

When you suspect an underlying condition you should:

Make a referral, and take initiative to do so. DON’T leave referral up to patient to do

Clinical evaluation main signs to look for:

• locations: uni or bi-lateral

• Consistency: firm, soft, rubbery, movable, fixed

• Size: ideally less than 1cm², >1cm²=RED FLAG

• Symptoms: tenderness, pain, non-tender

Unstimulated(resting) LOW salivary flow:

<0.1mL/mm

Unstimulated(resting) NORMAL salivary flow:

0.3-0.4 mL/min

Stimulated NORMAL salivary flow:

1-2 mL/min

Stimulated LOW salivary flow:

<0.7mL/min

Considerations when taking vital signs

• AV shunt- kidney dialysis

• Lymphedema- breast cancer

• Arms should be free of clothing (if AV shunt, use other arm)

• False(+) from recent coffee

Incisional vs excisional biospy

Incisional= take a portion of the lesion

Excisional= take the whole lesion

When do you order a biopsy?

When you suspect a tumor or something else, and need to refer to a physician

Direct immunofluorescence (DIF)

Microscopic/hematoxylin and eosin (H&E)

When do you refer as a dentist?

When there’s anything outside the scope of your practice and expertise. Like further evaluations, dental procedures, or biopsies.

Kidney dialysis consideration when taking vitals:

Use the arm without the AV shunt (if present)

Kidney dialysis consideration for scheduling:

Consider treatment on non-dialysis days. Dialysis uses Heparin which can cause excessive bleeding

Kidney dialysis consideration for recent labs:

Make sure to obtain patient’s permission prior to reaching out to physicians for recent labs

Pseudomembranous candidiasis/oral thrush

Oral manifestations of diabetes:

• opportunistic infections (bacterial, fungal, viral)

• hyposalivation

• oral burning sensation

• periodontal disease

• Sialosis= non-inflammatory swelling of parotid gland

• Orla ulcerations and trauma in setting of hyposalivation

Normal Mallampati classification

M1 and M2 ideal

Yellow in eye as a result of bilirubin not being properly removed from eyes

Cardiovascular symptoms

Chest pain, palpitation, peripheral edema, dyspnea on exertion

Gastrointestinal symptoms

Appetite changes, dysphagia, nausea, vomiting, diarrhea, constipation, heart burn

Hematologic symptoms

Easy bruising or bleeding, lymphadenopathy

Neurologic symptoms

Seizures, memory loss, loss of consciousness, paresthesia, paralysis