Oral Medicine Investigations Short Essays

Oral Medicine Investigations Important Notes

1. Oral Medicine Investigations Biopsy:

• It is the removal of part of tissue for the purpose of histological examination And Analysis

Oral Medicine Investigations Types:

• Punch Biopsy.
• Incisional Biopsy.
• Excisional Biopsy.
• Needle Biopsy.

2. Oral Medicine Investigations Tests and their uses:

• Schilling test
  • It is done to detect vitamin B12 deficiency as well as to distinguish and detect lack of intrinsic factor and malabsorption
  • The test is performed in three stages
    • Stage 1 – without intrinsic factor
    • Stage 2 – with intrinsic factor
    • Stage 3 – test for malabsorption of vitamin B12
• Paget’s test
  • It is used to examine the swelling
  • Finger pressure is applied over the swelling
• Lugol’s iodine test
  • It is used as an aid to the diagnosis of malignant lesions
  • It contains iodine, potassium iodide, and distilled water
  • Normal cells- stained brown black
  • Inflammatory tissue- stained dark brown
• Schimmertest
  • It is a diagnostic test for Sjogren’s syndrome
  • A strip of filter paper is placed in between the eye And eyelid to determine the degree of tears measured in mm
  • If it is < 5 mm in 5 min, it is positive
• Tzanck test
  • Tzanck smear shows acantholysis of cells
• Patch test
  • It is used to evaluate drug allergy
  • The suspected allergen is placed on normal non-hairy skin i.e. on the upper portion of the back
• Paul Bunnel test
  • It is a diagnostic test for infectious mononucleosis
  • The normal titer is 1:8
  • Butin the diseased person’s titer becomes 1:4096

3. Oral Medicine Investigations Bence Jones proteins:

• It is an unusual protein which coagulates when urine is heated to 40-60 degrees C and disappears when urine is boiled
• It reappears when urine is cooled
• It is also seen in patients with diseases such as
  • Leukemia
  • Polycythemia vera
  • Multiple myeloma
  • Solitary myeloma

Oral Medicine Investigations Short Essays

Question 1. Endocarditis prophylaxis regimen for dental procedures.

Answer:

1. Standard Prophylaxis:

• Amoxycillin
• Dose= Adult -2 gm
• Child- 50 mg 1 hour before surgery

2. Patient unable to take orally:

• Ampicillin
• Dose: Adult – 2 gm IM/4
• Child- 50 mg 1 hour before surgery

3. Patient allergic to penicillin:

• Clindamycin
• Dose: Adult – 600 mg
• Child- 300 mg 1 hour before surgery

Dental Procedures Requiring Prophylaxis:

• Dental extractions
• Periodontal surgeries
• Implant placement
• Endodontic procedures beyond the apex
• Subgingival placement of fibers
• Intraligamentary LA injections

Read And Learn More: Oral Medicine Question and Answers

That Donot Require:

• Nonintraligamentary injections
• Intracanal endo treatment
• Placement of rubber dam
• Suture removal
• Placement of the removable prosthesis
• Making impressions
• Fluoride treatments
• Shedding of primary teeth

Question 2. Biopsy.

Answer:

Biopsy

It is the removal of part of tissue for the purpose of histological examination And Analysis

Biopsy Types:

1. Punch Biopsy:

The sample is obtained with the help of a punch

Biopsy Indications:

• Mucosal lesions
• Inaccessible areas

2. Incisional Biopsy:

• Indication: large lesions
  • Tumours: Edge biopsy is taken where the tumour cells can be compared with the normal cells

3. Excisional Biopsy:

• Indication: Small lesions
• The entire lesion is excised in a single sitting and sent for histological examination

4. Needle Biopsy:

• FNAC
  • Indication: Cystic cavity:
  • 23-26 gauge needle is used to aspirate the contents of the lesion

Question 3. Exfoliative cytology.

Answer:

Exfoliative cytology

Introduced by Papanicolaou And Traunt

Exfoliative cytology Technique:

Scrap the surface of the lesion
↓
Collect it with the help of a wooden spatula
↓
Prepare a smear
↓
Stain it
↓
Observe under microscope Results:
↓
Class 1: Normal
↓
Class 2: atypical
↓
Class 3: Intermediate
↓
Class 4: Suggestive of cancer
↓
Class 5: Positive of cancer

Question 4. Aspiration biopsy.

Answer:

Aspiration biopsy

• Needle Biopsy: technique
• FNAC:
  • 23-26 gauge needle is inserted into the tissues
    • Aspirate the needle
    • Cystic fluid is collected in it
    • Examine the fluid
• Indication: cystic cavity:
• OKC:

Question 5. Schilling test.

Answer:

Schilling test

It is done to detect vitamin B12 deficiency as well as to distinguish and detect a lack of intrinsic factors and malabsorption The test is performed in three stages

Schilling test Stage 1:

• Without intrinsic factor (IF)
• An oral dose of 0.5-1 pg of radioactively labeled vitamin B12 is administered orally
• After 2 hours a large dose(4 mg) of unlabelled vitamin B12 is given parenterally
• In normal individuals, more than 7% of 1 pg of an oral dose is excreted in a 24-hour urinary sample
• Patients with intrinsic factor deficiency excrete a lower quantity of it

Schilling test Stage 2 (WITH IF):

• If the 24-hour urinary excretion of vitamin B12 is low, the test is repeated using the same procedure but with the addition of a high oral dose of IF is administered
• If the 24-hour urinary output is now normal the low value in the first test was due to IF deficiency
• Patients with pernicious anemia have abnormal tests even after treatment with vitamins due to IF defi¬ciency

Schilling test Stage 3:

• Test for malabsorption of vitamin Bt:
• The same patient absorb vitamin HI2 in water as was stipulated in the original test
• In conditions causing malabsorption, the test is repeated after a course of treatment with antibiotics or anti-inflammatory drugs

Question 6. Types and indications of biopsy.
(or)
Question 6. Biopsy

Answer:

Biopsy

It is the removal of part of tissue for the purpose of histological examination and analysis

Biopsy Types:

1. Punch Biopsy:

The sample is obtained with the help of a punch

• Indications:
  • Mucosal lesions
  • Inaccessible areas

2. Incisional Biopsy:

• Indication: large lesions:
  • Tumours: Edge biopsy is taken where the tumour cells can be compared with the normal cells

3. Excisional Biopsy:

• Indication: small lesions:
  • The entire lesion is excised in a single sitting and sent for histological examination

4. Needle Biopsy:

• FNAC:
• Indication: Cystic cavity:
  • A 23-26 gauge needle is used to aspirate the contents of the lesion

Question 7. Paget’s test.

Answer:

Paget’s test

• It is used to examine the swelling
• Finger pressure is applied over the swelling
• It can be done for small swellings
• The center of the swelling becomes soft as it contains fluid
• While the periphery becomes hard

Question 8. Lugol’s Iodine test.

Answer:

Lugol’s Iodine test

It is used as an aid to the diagnosis of malignant lesions

Lugol’s Iodine test Action:

• It will hind to glycogen present in the normal epithe¬lium
• It retains in normal squamous epithelial cells
• Thus it differentiates it from the abnormal cells

Lugol’s Iodine test Contents:

• Iodine 2 gm
• Potassium iodide 4 gm
• Distilled water- 100 cc

Lugol’s Iodine test Effects:

• Normal cells- stained brown black
• Proliferating epithelium- inversely proportional to the degree of keratosis
• Inflammatory tissue- stained dark brown

Question 9. Investigation of oral cancer 

Answer:

Investigation of oral cancer – Clinical methods:

1. Toulidlne blue staining:

It is used as an aid to the diagnosis of oral cancer and potentially malignant lesions

Investigation of oral cancer Method of Use:

• Make the patient to rinse the mouth with water twice for 20 seconds each
• Next, rinse with 1% acetic acid for 20 seconds
• Dry the area with the help of a gauze piece
• Apply 1% toluidine blue solution with a cotton swab
• Rinse again with acetic acid and water
• Observe the staining if present

Investigation of oral cancer Advantages:

• Good sensitivity
• Very low false negative results
• It is effective in demonstrating dysplasia and early malignant lesion which is not clinically recognize able

2. Lugol’s iodine test:

• • It is used as an aid to diagnosis ol malignant lesions

Lugol’s iodine test Action:

• It will bind to glycogen present in the normal epithelium
• It retains in normal squamous epithelial cells
• Thus it differentiates it from the abnormal cells

3. Acridine binding test’

• In this method, the uptake of acriflavine by desquamated buccal cells is measured
• Since the DNA content of the dysplastic cells are more, they will stain more intensely than normal cells

Photodiagnosis:

1. Autofluorescence spectroscopy:

• It is a non-invasive method
• It is used for the detection of alteration in the struc¬tural and chemical composition of cells

2. Fluorescence photography:

• It shows reduction and diminution of positive fluorescence associated with cancer regression and vice versa

Histopathological methods:

1. Biopsy:

• It is the removal of part of tissue for the purpose of histological examination and  analysis

2. Exfoliative cytology:

Exfoliative cytology Technique:

Scrap the surface of the lesion
↓
Collect it with the help of a wooden spatula
↓
Prepare a smear
↓
Stain it
↓
Observe under microscope

Exfoliative cytology Results:

• Class 1: Normal
• Class 2: Atypical
• Class 3: Intermediate
• Class 4: Suggestive of cancer
• Class 5: Positive of cancer

Molecular methods:

1. Quantification of nuclear DNA content:

• Quantitative analysis of DNA content reflects the total chromosomal content

2. Tumour markers:

• Tumor markers may be produced by host in response to cancerous substances
• They can be seen in blood circulation, body cavity fluids, cell membrane, and cell cytoplasm

Question 10. Coomb’s test.

Answer:

Coomb’s test

Coomb’s test was devised by Coombs, Mourant, and Race in 1945.

Coomb’s test Method:

Coomb’s test Types:

• Direct Coomb test
• Indirect Coomb test

Coomb’s test Uses:

• Detects anti-Rh antibodies
• Demonstrates incomplete antibody

Question 11. Brush biopsy

Answer:

Brush biopsy

This biopsy method utilizes an improved brush to obtain a complete transepithelial biopsy specimen with cellular representation from each of the three layers of the lesion: the basal, intermediate, and superficial layers.

• When used properly and rubbed against an area of suspect tissue aggressively [to the point of minor bleeding] the biopsy brush penetrates to the basement membrane, removing tissue from all three epithelial layers of the oral mucosa
• The oral brush biopsy does not require topical or local anesthetic and causes minimal bleeding and pain.
• The brush biopsy instrument has two cutting surfaces, the flat end of the brush and the circular border of the brush.
• Either surface may be used to obtain the specimen.
• Brush biopsies are utilized routinely in the detection of precancer and cancer in other organ systems.