Know your patient

Know your patient and diagnostic tools

When identifying oral lesions it is important to keeping in mind that a patient is more than a mouth. To become good at oral pathology the hygienist must know their patient. Knowing a patient includes knowing their medical and dental history, psychosocial traits, habits and lifestyle. Much of this information can be found in the medical history but, nothing can replace building a relationship with your patients. Remember you patient is a whole person. For more information on the professional relationship refer back to "The Professional Relationship" found in DH 310.

As a licensed oral health professional you have a legal and ethical responsibility to identify, document and follow-up on all lesions found in your patients oral cavity and surrounding tissues. If you and your clinical faculty decide not to refer a patient to an oral surgeon it is your responsibly to observe the lesion, with a faculty person, in fourteen days and document your findings .

WHAT TO DO WHEN YOU FIND A LESION?

1. Gather all the pertinent information.

Review the medical history again, looking for information including:

History

Name
Age
Sex
Race or ethnic background
Occupation
Lifestyle
Habits
Chief Complaint
Symptoms

Onset
Course
Previous treatment
Present Illness
Medical history
Chronic systemic disease
Acute systemic disease

Family history
Social History
Occupation
Habits
Medication

2. Interview the patient to gather additional information to complete the assessment.

3.Complete a physical examination of the lesion.

Visual examination
Palpation
Percussion
Auscultation

4. Document the lesion in the patient chart. (See describing a lesion)

4. Determine with a faculty member if:

the patient should be referred for a biopsy
a chair side diagnostic tool should be used or
the patient should return in two weeks for further evaluation

4. Document in the patient chart what you said and did with the patient.

DIAGNOSTIC and SCREENING TOOLS

The only diagnostic technique that is 100% accurate is the biopsy. Biopsy requires the removal of deep cells from the suspect lesion to determine the true nature of the cells. There a patients that require a referral for an immediate biopsy to determine what cells are present in the lesion. An example of a patient you may want to refer immediately for biopsy is one who chews tobacco and presents with a white corrugated lesion on the buccal mucous.

A screening tool that can be used in the clinic is the Toluidine blue. This is not a biopsy! It is a screening tool. It is important that the patient knows that this is not a biopsy and it may or may not be accurate. The toluidine blue identifies rapidly multiplying cells present at the surface of the lesion. If there are rapidly multiplying cells it is recommended that the patient be referred for a biopsy.

The Brush Biopsy@ is another tool that I will refer to as a screening tool because it only evaluated the surface cells of a lesion. Remember that a biopsy must examine the cells from deep within the lesion. The Brush Biopsy uses a spiral brush much like a proxy brush to gather surface cells from the lesion. This procedure can be done chair-side by a dentist or hygienist. The cells are sent to a lab for evaluation, upon completion a report is returned to the clinician. It is easy and does not require an incision, but may not be accurate.

MORE INFORMATION

Because there are some many oral disease and systemic disease that have oral manifestations this class does not have all the information on oral pathology. I have provided you with some links that you can explore for more on oral pathology. Any time you have a question in this class these sites provide sound scientific information.