Oral Diagnosis, Oral Radiology, and Treatment Planning
A structured workup
History (chief complaint in the patient's own words, history of present illness, medical history, medications, allergies, social history), examination, differential diagnosis, and a treatment plan ordered by urgency. Distinguish a working diagnosis, a differential, and a definitive diagnosis requiring biopsy.
Imaging
- Intraoral periapical: highest resolution, best for periapical disease and endodontics.
- Bitewing: interproximal caries and crestal bone.
- Panoramic: broad survey of impacted teeth, jaw lesions, and trauma, with lower resolution and ghost images.
- Cone-beam CT: three-dimensional bone, canal anatomy, and implant planning; dose exceeds intraoral films but is far below medical CT.
- MRI for soft tissue, CT for bone detail, sialography and ultrasound for salivary glands.
- Apply ALARA: collimation, lead apron, and the smallest field of view that answers the question.
Radiographic interpretation
Describe location, size, shape, margins (well or ill defined), internal structure (radiolucent, radiopaque, mixed), and effect on adjacent structures. Ill-defined margins suggest aggressive or malignant processes; well-defined margins suggest benign or cystic lesions.
Treatment planning
Sequence emergency care, disease control, definitive care, then maintenance. Weigh medical risk (ASA class), prognosis of individual teeth, occlusion, cost, and patient values, and obtain informed consent for each phase.
Traps
Questions ask for the most likely diagnosis, not the biopsy-proven one. Remember that a lesion must lose roughly 30–50% of its mineral content before it becomes radiographically visible.
Rule of thumb
A lesion crossing the midline suggests a systemic or developmental cause; an ill-defined, rapidly growing lesion calls for biopsy rather than observation.