Diagnostic Approach for gingival enlargement.pptx

diagnostic approach for gingival enlargement. epulids

1. DIAGNOSTIC APPROACH GINGIVAL ENLARGEMENT

2. STEP 1: COLLECTION Information is collected through thorough history taking SOCRATES Med Hx Family Hx Social Hx

3. STEP 1: COLLECTION Clinical examination

4. STEP 2: CLASSIFICATION Oral lesions are categorized based upon: Colour change (white, red, blue, pigmented or combined) Loss of integrity of the mucous membrane (erosion, fissure, or ulcer, which may be primary or secondary) Growth or swelling Lesions involves tooth and/or bone, either alone or combined with other soft tissue lesions Syndrome

5. STEP 3: COMPARISON

6. STEP 4: CLINICAL IMPRESSION A dental clinician must correlate with history, age, gender, clinical characteristics (appearance, site, location, signs and symptoms), radiological appearance and other possible causes before arriving to a definite diagnosis.

7. STEP 5: CONFIRMATION For some lesions even though the dental clinician are definite about clinical diagnosis, confirmation is necessary. Radiographs (PARG, OPG, CT, MRI) Laboratory investigations (HIV testing, serum Ca and alkaline phosphatase levels, haemoglobin estimation) Exfoliative cytology Biopsy

8. ORAL LESIONS SUITABLE FOR BIOPSY BY A GENERAL DENTIST

9. STEP 6: CONCLUSION Earlier diagnosis depends upon the history and clinical features. The dental clinician should concentrate several causative factors and possible diagnostic factors – where clinician may require collection of more information and in-depth clinical examination. At certain times, when there is no correlation between clinical diagnosis and etiological factors or the laboratory results or radiological investigations, the pathology (biopsy report) issues the final diagnosis.

10. Gingival swelling Localized - Epulis Generalized

11. Localized gingival swelling (epulis) Acute Chronic Assoc with NVT Assoc with VT Assoc with pericoronal flap Pericoronal abscess Periapical abscess/ Endo- perio lesion Near margin/papilla Diffuse/attached ging . Gingival abscess Periodontal abscess

12. Localized gingival swelling (epulis) Chronic Pink/Pale Firm: Fibroma Soft/compressible: Lipoma Fibro-lipoma Mucocele Cyst Warty: Papilloma Reddish/ Bluish Anterior Posterior Non-specific Peripheral giant cell granuloma H/o pregnancy: Pregnancy epulis No relevant h/o: Pyogenic granuloma Compressible and soft: Hemangioma Firm: Inflammatory

13. Recall

14. Differential Diagnosis of Gingival Enlargements Interactive Case Study [Your Name] [Presentation Date]

15. Introduction to Gingival Enlargements Gingival enlargements can be classified into isolated reactive lesions (epulis) and regional/generalized enlargements. Accurate diagnosis is crucial for effective treatment.

16. Isolated Reactive Lesions (Epulis) Chronic Lesions: - Pink/Pale: Firm (e.g., Fibroma) - Soft/Compressible: Lipoma, Fibrolipoma , Mucocele, Cyst - Warty: Papilloma Reddish/Bluish: - Associated with vital teeth: Gingival abscess - Near margin/papilla: Peripheral Giant Cell Granuloma - Anterior: Pregnancy epulis - Posterior: Pyogenic granuloma Acute Lesions: - Associated with non-vital teeth: Periapical abscess/endodontic-periodontal lesion - Associated with pericoronal flap: Pericoronal abscess - Diffuse/Attached gingiva: Periodontal abscess - Compressible and soft: Hemangioma - Firm: Inflammatory Interactive Element: Ask students to recall characteristics of chronic vs. acute lesions.

17. Regional/Generalized Enlargements Pink/Firm/Resilient: - Papillary: History of drugs causing enlargement (e.g., DIGO) - Diffuse: - With systemic involvement (+ve): Syndrome associated with hereditary gingival fibromatosis, lysosomal storage disease - Without systemic involvement (-ve): Hereditary gingival fibromatosis as isolated entity, false enlargement - Non-Specific Reddish/Edematous: - Significant local irritants: Inflammatory enlargement - Scanty local irritants: History of contributory systemic disease (e.g., pregnancy, puberty, diet history, incompetent lips, allergy) - No appreciable local irritants: Based on associated systemic manifestations (e.g., leukemia, diabetes mellitus, Wegener's granulomatosis, sarcoidosis, tuberculosis, Sturge-Weber syndrome) Interactive Element: Ask students about potential causes of regional/generalized enlargements.

18. Case Presentation Case Scenario: - Patient Age: 45 - Medical History: Non-contributory - Clinical Presentation: Localized swelling in the anterior maxillary gingiva, firm and pink in color Interactive Element: Ask students to list potential diagnoses based on the information provided.

19. Step 1: Initial Observation Is the lesion: - Chronic or Acute? - Pink/Pale or Reddish/Bluish? Interactive Element: Provide clickable options for students to choose the characteristics of the lesion.

20. Step 2: Further Investigation For Chronic and Pink/Pale Lesions: - Consider Firm (Fibroma) or Soft/Compressible (Lipoma, Fibrolipoma, Mucocele, Cyst) For Chronic and Reddish/Bluish Lesions: - Consider associated conditions such as Gingival Abscess or Peripheral Giant Cell Granuloma Interactive Element: Use clickable options to guide students through the decision-making process.

21. Step 3: Specific Diagnosis For Firm Lesions: - Consider Fibroma if pink/pale - Consider Hemangioma if compressible and soft - Consider Inflammatory if firm Interactive Element: Allow students to choose from different characteristics to reach a final diagnosis.

22. Confirming the Diagnosis Histopathological confirmation is essential for accurate diagnosis. Types of histopathological findings: - Fibroma: Fibrous tissue proliferation - Lipoma: Adipose tissue - Mucocele: Mucin-filled cyst - Peripheral Giant Cell Granuloma: Multinucleated giant cells Interactive Element: Ask students to discuss the types of histopathological findings that might be expected.

23. Case Resolution Diagnosis: Fibroma Reasoning: The lesion was firm and pink/pale, consistent with the characteristics of a fibroma. Additional Tests/Treatments: Histopathological examination confirmed fibrous tissue proliferation. Interactive Element: Allow students to compare their diagnosis with the actual diagnosis and discuss any discrepancies.

24. Summary and Takeaways Importance of differential diagnosis in gingival enlargements. Steps involved in using the decision tree for accurate diagnosis. Key points: Observe characteristics, use the decision tree, confirm with histopathology. Interactive Element: Encourage students to ask questions and discuss any points of confusion.

25. Questions and Answers Open the floor for questions from students. Encourage active participation and address any questions or concerns.