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JADA Continuing Education

History-taking and the diagnostic phase of management

Background. Comprehensive patient evaluation begins with an accurate analysis of all factors of the patient’s history before the physical examination is performed. Risk factor identification is particularly important in most cases of oral mucosal dysplasia and carcinoma, as it alerts the clinician to an increased susceptibility for such alterations. The armamentarium of the dentist, which ranges from noninvasive indicators to a scalpel biopsy, permits a thorough evaluation of any observed mucosal changes. Newer additions to this armamentarium have been developed and are emerging that aid in the process of characterizing lesions, thereby facilitating appropriate management.

Methods. The author presents methods of assessing and analyzing a patient’s oral health status. He discusses carcinogens and cofactors, as well as dietary considerations, in the development of oral mucosal pre-cancer and cancer. He also presents details of the clinical evaluation, which can lead the clinician to possible further evaluation and analysis by an expanding array of diagnostic tools.

Results. The article identifies the factors a clinician should consider when evaluating the dental patient, from initial presentation and risk factor identification to the use of traditional assessment parameters. New and evolving diagnostic tools, coupled with cell and tissue characterization by an oral and maxillofacial pathologist, remain critical in terms of patient management and in maintaining optimum standards of care.

Conclusions and Clinical Implications. A comprehensive oral examination must include integration of each patient’s in-depth health history and the physical findings. Appreciation of subtle surface changes as a possible harbinger of pathology and the traditional process of observation combined with new and emerging tools now allow for earlier diagnosis that will translate into improved outcomes.

This article has been cited by other articles:

				D. E. Morse, W. J. Psoter, T. De La Torre Feliciano, G. Cruz, and N. Figueroa Detection of Very Early Oral Cancers in Puerto Rico Am J Public Health, July 1, 2008; 98(7): 1200 - 1202. [Abstract] [Full Text] [PDF]