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Hi,

1. Why cysts in maxillary sinus appear radiopaque.

2. How you screen to rule out cancer in 90 sec.

Hi Karthi

These are what I can think of now:

1- Because maxillary sinus is full of air so anything eles, even a cyst full of liquid

would look radio-opaque in comparison to the air.

2- In which area? Extra oral (head and neck) or intra oral?Normally we say a wound that does not heal within 14 days should be suspected

for a malignant lesion and inflation of the borders, history ( individual and

familial) and there is some neat technique called vizilite . the results are not

100% but it is a cute little machine that is fun to work with.

Please correct me if I am wrong. Thank you all.

after all it was my humble two cents

cheers

In perio. If the patient has generalized gingival recession due to mechanical. CAL

is 3-4mm.Probing depth is 1-2mm. BOP in 2teeth. How to give a diagnosis.

I think the patient only has localized marginal gingivitis

No periodontistis there.

Since there is loss of periodontal tissues i think we should still give a diagnosis as

periodontal disease.

Just now i spoke to a periodontist in India.

this is a point that should be discussed .

In australia they just see the pocket depth and diagnose the case -thats -what i

presume. nobody is sure about this.if there is no active disease you can term it as

loss of periodontium rather than periodontitis .

Even me too suffered a lot from this i did a diagnosis of severe periodontitis in a

case where there was average pocket depth of 3-5 mm plus 2 mm gingival

recession.

In the opg there was almost 60 % bone loss.in 80% of the areas.

I didnt give a diagnosis of gingivitis along with periodontitis as -my idea was justto give the the more advanced diagnosis.

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in fact i couldnt pass CD2 becoz of these reasons as discussed in the post exam

counselling-my diagnosis was not right it was generalised moderate

periodontitis according to the examiners.i overdiagnosed the case and i did miss

an ulcerative lesion on gingiva-diagnosis of ulcerative ginigvitis.

.they are very stringent about some ideas.they dont look at CALat all-thats what

my knowledge is .If anybody can give a clear idea of whats needed it would

highly appreciated.

hello all!

this is a point that should be discussed .Dear tom,

I really understand what u mean. Believe me , I struggled too.

In australia they just see the pocket depth and diagnose the case ( For Ivan

Darby, the head of perio dept in melbourne uni, it is all about probing depth. He

says , if there is probing depth there is perio and if there is no probing depth

there is no perio)-thats -what i presume. nobody is sure about this.if there is no

active disease( From the recent articles , only a examination on a patient at two

points of time, can say about the activity of the disease or the examination of a

patient at alongitudinal point of time or taking a radiogrpaph at two points of

time)can term it as loss of periodontium rather than periodontitis .

Even me too suffered a lot from this i did a diagnosis of severe periodontitis in a

case where there was average pocket depth of 3-5 mm plus 2 mm gingivalrecession.

In the opg there was almost 60 % bone loss.in 80% of the areas.

I didnt give a diagnosis of gingivitis along with periodontitis as -my idea was just

to give the the more advanced diagnosis.( I feel you had to give gingivitis because

a perio case comes only after the stage of gingivitis even we know that not all

cases of gingivitis proceeds to perio) (Your diagnosis is absolutely fine because

articles maintain the stand that CAL is still the gold standard of diagnosis of perio

because CAL indicates destrucution of perio tissues inspite of the etiology and

the best indicator for future loss of attachment in the same pace irrespective of

the ettiology. So your diagnosis is right. But at the end of the day if it is an

examiner who is not related to perio coming on that day what can we do? This

happened to me. The lady was an CD1 examiner in my first appearance who

came for my CD2 exam in the second appearance and it was hard to convince her

just because they are not willing to change their stance for us and we be the

vicitms. So this how this exam becomes a slight unpredictable. But keep up the

spirit and we.re in the right direction.)

in fact i couldnt pass CD2 becoz of these reasons as discussed in the post exam

counselling-my diagnosis was not right it was generalised moderate

periodontitis according to the examiners.i overdiagnosed the case and i did miss

an ulcerative lesion on gingiva-diagnosis of ulcerative ginigvitis.(Yeaah, it wouldbe better not to miss any obvious lesions which adds up the salt )

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.they are very stringent about some ideas.they dont look at CALat all-thats what

my knowledge .If anybody can give a clear idea of whats needed it would highly

appreciated.

Regards

Tom

Hi Karthi

Regarding your Perio case ,there is no probing depth beyond 3mm , so we can't

diagnose the condition as periodontitis.I thinklocalized gingivitis is a correct

diagnosis.

presence of periodontal tissue loss (recession) is not enough to making Dx. it

maybe related to past perio dx which is stable& non progressive now or due to

other causes such as occlusal trauma.

Regards

MD

yes,pocket is current indication of periodontitis..where as recession with no

pocket or else healty is indication of previous desease..not current..this is very

important to consider for diagnosis

All the best

Farida

Hello all,

Just a bit curious.( for a polite and healthy discussionn)

a) Is there a reference to quote about, when we see a patient on the first visit

whether the disease is stable or active?

The epidemology chapter in Lindhe clearly states about the uniqueness of

periodontal infections. or why periodondidits is diffferent from other infections

in the body and the similarities it shares with other infections. One of the

uniqueness of periodonditis is we cannot say whether the disease is stable or

active at one point of time. There need to be two reference points to be

compared with ,to say whether a disease is in active state or stable.

Having said so ,I clearly agree with the relevance of probing depths in diagnosis

but I politely disagree if probing depth is the sole mode of diagnosing and if it is

the means of saying that disease is active or not.

I believe we have to corelate the paramneters , (all the parameters ) with the

given patient and come to a diagnosis which is appropriate for the patient. The

reason being by no means a patient should miss the benefit of a maintenance

protocol for an affected dentition or in other words we dont want to give an

inappropriate diagnosis for the patient in the first visit.

When I mention parameters above, let uus consider Karthi's scenario with the

patient having very mid generalised bone loss (an example of a parameter), whatwould be the diagnosis? I think the diagnosis should be mild perio instead of

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gingivitis. Does occlusal trauma cause generalised bone loss? The main reason

for occlusl trauma would be excessive loading on some teeth due to various

factors. So I feel we should see a widening of periodontal space before bone loss.

Now if bone loss happens due to occlusal trauma then the patient had a previous

periodondidits which gets aggrevated upon. Even I dont believe that tooth brush

trauma causes generalized bone loss.Past periodonditis is one of the best predictors for having future breakdown.or

in other words it is a risk indicator. So the pateint will have to be seen in once in

three months. Then appropriately we can change the diagnosis. My point is ,it

would not be appropriate to give diagnosis as gingivitis superimposed ona

healthy periodontium in the first visit just becuase we are seeing the patient for

the first time .

And the AAP articles clearly states that CAL is the gold standard for diagnosis.

I think , melbourne uni supports probing depths because it eliminates so much of

confusion. And it is easy for us too. At the end of the day we have to defend the

case in whichever means it is and make them know that we know about what

we,re defending about.

Please consider from a discusion point of view,

Regards

Bishop

hello

i totally agree with you Bishop.Periodontitis is a disease of bone too.the disease

activity is not just limited to the pocket. for eg-if given an opg if there is 50%

bone loss in the opg the case qualifies for being clasified as severe

periododntitis.here if the pocket depth is 3mm would youclasify it just asgngivitis???

But if we go according to the pocket depth -better we should clasify this as loss of

periodontium.may thats what the examiner needs.

the strange thing i felt was when we say the diagnosis ,even if its not tallying

with that of examiner .atleast they should ask how we come to the

diagnosis??instead they just laugh at you they- dont express their dissatisfaction

and believe you dont have any idea about periodontal diagnosis.I think it all

depends on the examiner ,its high time they give guidelines for the candidates.

here i attach a manual of perio from a reputed university on how they asess the

perio examination.

may be this is irrelevant for the -ADC examination sake -you got to follow what

the examiner believes.

but just for the discusion!!!!!!!!!just go through page 11.

It would be nice if somebody could come with the final picture of whats needed??

here i am assuming things as a part of of my post examination analysis.

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regards

tom

Hi Karthi,

If the patient has no active periodontal disease, we should not diagnose as such.

If the patient had periodontal disease in the past, it is a past history of

periodontal disease.

In the scenaio you mentioned, there is no probing depth beyond 3mm (probing

on depth 1-2mm), so there is no sign of periodontis. however there is BOP in 2

teeth that should be investigated. It must be due to very inflamed gingiva, hard to

think on periodontis with 1-2mm PD....

The Attachment loss, recession is not very important when making diagnosis, at

least here in Australia. They say , basically for 2 reasons:

1st, AL is regarded as a sign that there was disease in the past, they use the

metaphor of an amalgam filling....when you do find an amalgam filling in a tooth,

it means that there was a disease in the past (caries) , but you would not say

caries when seeing an amalgam...get it?.

2nd, Attachment loss could be caused not only by periodontal disease, but also

by occlusal trauma , traumatic toothbrushing, etc

Why do you people think?

hi all,The answer to How you screen to rule out cancer in 90 sec.: BrushBiopsy (very similar to PAP smear for detecting cervical cancer and isused as a routine in-office procedure for detecting those suspiciouscancerous lesions which are not yet sinister looking) . For further detailsu can easily google it. Most importantly u do not need to anesthetize thearea to perform the brush biopsy.

All the bestmadan

hi karthi

all theory questions were clinicaaly oriented.all had

accompanying photos and radiographs.

in perio they had given a full set of PAs and charting. tabular

columns were given with each teeth number. we were asked to

fill in relevant details for each tooth. i found it a bit difficult.

prostho was like usual.

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cd3 pics of radiographs were given and we were asked to mark

all relevant things in it.

pics were provided in oral med. where we had to give DD and

reasons.

in cd1 they asked different options of replacing a missing

premolar and what all factors we will consider before

replacing.few more questions were there.

Hi Madan,

Brush biopsy cannot be done in 90 sec. As Macula densa said ithink it should be Vizilite.

It can also be node detection bcos node canbe fixed ipsilateral or

contralateral. but i am not sure about my opinion.

Previously they used a stain called toludine blue. This stain

willtake uo the site which is dysplastic.

The FDA has approved a device to detect oral cancer called a

VELscope. The VELscope is non-invasive and uses a bright

blue light to emphasize any changes in the mouth that a dentist

or hygienist could not normally see.

Dr. Kenneth Magid, a professor at New York University

College of Dentistry, states on the Oral Cancer Foundation

website, "The problem, for the most part, is that early oralcancer looks like everything else. It looks like a million other

injuries and changes in the tissue in the mouth. It's a red spot or

a white spot. We see them all the time." But using the

VELscope to detect oral cancer can make abnormalities stand

out like sore thumbs.