Diagnostic Tests for Gingivostomatitis
Gingivostomatitis Tests: Book Excerpts
Gingivostomatitis Diagnosis: Book Excerpts
Diagnostic Tests for Gingivostomatitis: Online Medical Books
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Stomatitis:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Head, eyes, ears, nose, and throat (HEENT). Based on the history, a focused physical examination of the HEENT is necessary. Look for signs of trauma. Examine the conjunctiva and nasal mucosa for inflammatory changes or ulcerations. Evaluate the patient for coexisting upper respiratory signs and symptoms such as rhinorrhea, sinus tenderness to palpation, and otitis media. Inspect facial skin for vesicles from HSV or varicella-zoster or other lesions such as echymoses, malar rash, or viral exantham. Look for facial asymmetry. Varicella-zoster can cause facial nerve paralysis, called the “Ramsay Hunt syndrome.” Evaluate preauricular, postauricular, and cervical lymph node chains. Finally, evaluate the oral cavity, documenting the size, location, and appearance of the lesion.
B. Additional physical examination. Based on findings from the HEENT examination, additional physical examination might include (a) pulmonary examination for viral pneumonitis or pulmonary findings in autoimmune diseases; (b) abdominal and rectal examination for Crohn’s disease or ulcerative colitis; (c) genitourinary examination for mucosal ulcers in Behçet’s disease and Stevens–Johnson syndrome, and for signs of syphilis or gonorrhea; (d) a general skin examination looking for viral exanthemas, drug eruptions, lichen planus, pemphigus, pemphigoid, and SLE; and (e) a musculoskeletal examination for signs of SLE, Reiter’s syndrome, or other autoimmune diseases (3).
Testing
A. Clinical laboratory testing should be guided by history and physical findings. A potassium hydroxide wet mount is useful in the diagnosis of candidiasis. Viral and bacterial cultures can be obtained from swabs of oral lesions, but viral cultures are usually more helpful than bacterial cultures. Darkfield microscopy can be performed from swabs of syphilis chancres or plaques. Cytologic scrapings of premalignant or malignant lesions, prepared in a manner similar to a Pap smear, are not a substitute for biopsy of suspected oral neoplasia (2,4).
B. Diagnostic imaging is indicated only in selected cases such as coexisting sinus disease [“mini” sinus computed tomogram (CT)], coexisting neck mass or lymphadenopathy suggestive of malignant disease (head and neck CT), suspected metastatic disease (chest x-ray study; CT of the head, abdomen, and chest), or trauma (cervical spine series; cranial CT; dental Panorex films). If HSV is suspected, cranial magnetic resonance imaging (MRI) may be useful to evaluate the temporal lobes. A chest x-ray study is also indicated in suspected lower respiratory tract disease such as viral or autoimmune pneumonitis or secondary bacterial pneumonia. If a severe lip laceration has occurred, plain films can help to rule out mandibular condylar fractures or tooth fractures.
Diagnostic assessment
The diagnosis of stomatitis depends on synthesis of the aforementioned key historical, physical examination, laboratory, and imaging elements. All oral ulcers that do not heal, as well as white or reddish-white lesions that do not resolve in 2 weeks, need biopsy to rule out malignancy (2,4).
References
1. Yeatts D, Burns JC. Common oral mucosal lesions in adults. Am Fam Physician 1991;44:2043–2050.
2. Silverman S. Oral cancer, 4th ed. Hamilton, Ontario: BC Decker, 1998.
3. Salisbury PL, Jorizzo JL. Oral ulcers and erosions. Adv Dermatol 1993;8:31–79.
4. Mashberg A, Samit A. Early diagnosis of asymptomatic oral and oropharyngeal squamous cell cancer. CA Cancer J Clin 1995;45:328–351.
5. Laskaris G. Oral manifestations of infectious diseases. Dent Clin N Am 1996;40:
395–423.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
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