1. INTRODUCTION BASIS FOR CLINICAL DIFFERENTIAL DIAGNOSIS Dr. Shahzadi Tayyaba Hashmi shahzadi@inaya.edu.sa

2. DEFINITION The art or process of identifying the nature and cause of a disease or injury through evaluation of patient history, examination and review of Labortary data DIFFERENTIAL DIAGNOSIS DEFINITION The process of differentiating between two or more conditions / diseases which share similar signs and symptoms DEFINITION The art or process of identifying the nature and cause of a disease or injury through evaluation of patient history, examination and review of Labortary data DIFFERENTIAL DIAGNOSIS DEFINITION The process of differentiating between two or more conditions / diseases which share similar signs and symptoms DIAGNOSIS

3. Diagnosing lesions of oral mucosa is necessary for the proper management of patients Clinical differential diagnosis is the cognitive process of applying logic and knowledge, in a series of step-by- step decisions to create a list of possible diagnosis It is helpful for clinicians to organize their knowledge of oral pathology using a system that stimulates the clinical appearance of lesions Diagnosing lesions of oral mucosa is necessary for the proper management of patients Clinical differential diagnosis is the cognitive process of applying logic and knowledge, in a series of step-by- step decisions to create a list of possible diagnosis It is helpful for clinicians to organize their knowledge of oral pathology using a system that stimulates the clinical appearance of lesions Introduction to clinical differential diagnosis in dentistry

4. Decision tree for oral mucosa lesions Clinical Impressions Surface Lesions of Oral Mucosa Soft tissue Enlargements Soft tissue Enlargements White Pigmented Ulcerative Reactive Tumour neoplasm Tumour neoplasm

5. The first decision to make when using decision tree is whether the lesion is a surface lesion or soft tissue enlargement SURFACE LESIONS o Consist of lesions that involve the epithelium and superficial connective tissue of skin and mucosa o Do not exceed 2-3mm in thickness o Divided into three categories based on their clinical appearance  White  Pigmented  Vesicular-ulcerated The first decision to make when using decision tree is whether the lesion is a surface lesion or soft tissue enlargement SURFACE LESIONS o Consist of lesions that involve the epithelium and superficial connective tissue of skin and mucosa o Do not exceed 2-3mm in thickness o Divided into three categories based on their clinical appearance  White  Pigmented  Vesicular-ulcerated HOW TO USE A DECISION TREE

6. WHITE LESIONS White Lesions Hairy tongue Leukoedema Lichen planus Geographic tongue Hairy Leukoplakia

7. PIGMENTED LESIONS Kaposi’s Sarcoma Melanoma White spongy nevus Hemangioma

8. Ulcerative lesions Ulcerative Erythmatous lesions Herpes Simplex Herpes Zoster Apthous Ulcers Hand, foot and mouth disease Hand, foot and mouth disease Infectious Mononucleosis

9. Swellings or masses that are divided into two categories 1.Reactive 2.Tumors The term tumor is used for enlargement clinically Reactive enlargements are painful and have a more rapid growth than tumors Swellings or masses that are divided into two categories 1.Reactive 2.Tumors The term tumor is used for enlargement clinically Reactive enlargements are painful and have a more rapid growth than tumors SOFT TISSUE ENLARGEMENTS

10. Soft tissue enlargements Tumors or Neoplasms Benign Tumors Benign Tumors Cysts Malignant Hemangioma Neurofibroma Fibroma Gingival cyst Thyroglossal cyst Sarcoma Melanoma Squamous Cell carcinoma Squamous Cell carcinoma Papiiloma