Diagnosis is a determination and

judgement of variations from the normal

Diagnosis means through knowledge

and entails collection of data about the
patient and their complaint .
Following history taking and
examination, investigation may be
required to help confirm the diagnosis
or to include some diagnosis

Why important?

Diagnosis made at an early stage can

be life changing event for a patient .
Wrong diagnosis will lead to wrong
treatment which is not desirable for both
the clinician and the patient.

Right approach

Appropriate diagnosis can be made

with the help of signs,symptoms and
investigations

 Provisional diagnosis

Hematological diagnosis

Laboratory diagnosis

Therapeutic diagnosis

Radiographic diagnosis

Emergency diagnosis

Differential diagnosis
Pathological diagnosis

Diagnosis by exclusion
Remote diagnosis
Final diagnosis

Serological diagnosis

Direct diagnosis

Diagnosis made on the basis of medical

signs and patient reported symptoms

Patients chief complaint should be given

priority

Actual or definitive diagnosis is

uncertain and can be only given after
necessary investigations

A diagnosis significantly based on laboratory

report or test results.

A laboratory test interpreted in conjugation with

informations from history and physical
examination will confirm a diagnostic impression

Diagnosis established after taking

appropriate radiograph is called
radiographic diagnosis

It can be intraoral periapical

radiograph or highly informative like
CT and MRI

Developing differential diagnosis

involves rearranging the list of possible
diagnosis

Order them according by rank according

to several criteria

A common criteria used in listing a

differential diagnosis is frequency of
occurrence, with most probable
diagnosis at the top and least at the

Age ,sex ,race and other associated

factors are concerned

Defintive diagnosis is confirmed after

necessary investigation

 These types of diagnosis are made from pathology

results
Mostly histopathological diagnosis
will be the final diagnosis

Diagnosis confirmed with the help of

serological test
Eg. investigations for HIV and hepatitis

 A type of telemedicine that diagnose a

patient without being physically in same
room as physician

Made by observing pathognomonic

features

Eg abnormally translucent brownish

teeth are characteristic for
dentinogenesis imperfecta.

Diagnosis established by
haematological tests
Eg .sickle cell anemia.

Diagnosis arrived after benefial effects

of therapy

Diagnosis made on situations such as

accidents, injuries is called emergency
diagnosis

Diagnosis is made without waiting for

detailed examination

Identification of disease by excluding all

possible causes

Final diagnosis is made after critical

evaluation of information obtained from
patient history,physical examination,
radiologic and laboratory investigation.

After determining significant findings a

list of diagnosis and problem is listed

Treatment objective has to be created

with patient assistance

Good treatment objective articulate clear

goal from both dentist and patient
perspective

Before creating any treatment plan

dentist must determine patients own
desire

The most important goal is to resolve

the chief complaint

Determining patient goals begin during

initial interview

Avoid leading questions about treatment

Treatment goals frequently influenced by the

patients attributes are referred as patient
modifiers

Positive modifiers
Interest in oral health
Ability to afford treatment
H/o regular dental care

Negative modifiers

Time and financial

constraints
Fear of dental
treatment
Poor oral and general
health
Destructive oral habits

Knowledge

dentist level of knowledge and

experience can influence the selection
of goals and objective

Technical skill

in addition to knowledge the dentist

must have technical ability to provide
treatment

Visioning

Identifying the key tooth

Phasing procedure

Experienced practioner will develop a

vision of what patient mouth look like
when treatment is complete

Experienced practioner construct and

deconstruct various plans mentally

First step in treatment planning is

identifying the key tooth that can be
salvaged

Retaining the key tooth improves and

loss of key tooth can limit the treatment
options available

Key tooth must be periodontlly stable

Canine - anterior tooth
Molar
- posterior tooth
Key tooth are usually favorably
positioned in the arch
Key teeth that are decayed or broken
should be restorable

While treating patient with complex

needs its advantageous to braek
treatment plans into phases or
segments

Systemic phase
Acute phase
Disease control phase
Definitive treatment phase
Maintenance care phase

Through evaluation of health

Procedures necessary to manage

patient patients general and
psychological health before dental
treatment

Consultation with physician

Antibiotic prophylaxis

To resolve any symptomatic problem

that patient present with
Acute phase treatment
Extraction
Endodontic therapy
Initial periodontal therapy
Placement of provisional /permanent
restorations
Repair of prosthesis
Medication to control pain and infection

To control active oral disease and

infection

Stop occlusal and esthetic detiortaion

Manage any risk factor

Oral hygiene instruction

Scaling and root planning

Caries risk assesment and prevention

Endodontic therapy

Extraction of hopeless tooth

Disease control phase is valuable if the

dentist is uncertain about-

Disease severity

Patient commitment to treatment

Treatment option

Success or failure of disease control

phase is evaluated with post treatment
assessment examination before
proceeding to definitive treatment

To rehabilitate the patient oral condition

and includes procedure that improves
appearance and function
Additional periodontal treatment

Orthodontic treatment and occlusal

therapy

Oral surgery (elective extraction ,

preprosthetic surgery and orthognathic
surgery)

Elective endodontic procedure

Single tooth restoration

Replacement of missing tooth with fixed

or removable prosthesis including
implant

Cosmetic and esthetic procedure

Constitute of highly personalised plan

that strives to maintain the patient in
optimum health.

Periodic examinations
Periodontal maintenance treatment
Application of fluoride
Oral hygiene instructions

After the formulation of the treatment

plan patient has to sign the case record

This is the informed consent that patient

is willing for the treatment

Informed consent is very important for

medicolegal purposes

Prognosis is a prediction of the

probable course,duration and outcome
of a disease based on a general
knowledge of the pathogenesis of the
disease and presence of risk factor

Prognosis can be

Excellent
Very good
Good
Fair
Poor

When the prognosis is one step below fair

and one step above poor it is called guarded
prognosis

The patients desires and capabilities

Systemic health

The status of the supporting structures

Condition of teeth

Matching treatment plan with patient desire

Gathering information about the patient often

requires more time than any other aspect of
treatment planning .To prevent missing
important findings the dentist should gather
data in an organized systematic manner

Each practitioner must develop a consistent and

standardized mechanism for gathering
historical information about the patient
,obtaining radiographs and performing clinical
examination .

It is essential that any data gathered be both

complete and accurate. If differences occur in
either completeness or accuracy the validity of
the final treatment may be suspected.

Oral medicine diagnosis and treatment planning burket,s9th and 11th edition
Oral diagnosis, Oral medicine and Treatment planning
Steven L Bricker,Robert P Langlais,Craig S Millar 2nd
edition
Diagnosis and treatment planning Stefnac and Nesbit
Textbook of oral medicine SR prabhu
Clinical manual for oral medicine and radiology
Ravikiran ongole 1st edition
Oral and maxillofacial medicine Crispan scully 1st
edition
Practical medicine for students and practitioners P.J
Mehta
Oral Diagnosis the clinicians guide Warren birnbaum ,
Stephen M Dunne 1st edition
Color atlas of common oral diseases Robert P.
Langlais,Craig S. Miller 2nd edition