Oromaxillofacial Diagnosis……..-Juniper publishers
JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF HEAD NECK & SPINE SURGERY
Opinion
“Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone canyou become an expert.”
Sir William Osler
Diagnosis is the bridge between the study of disease
and the treatment of illness. Making a distinction between disease and
illness appears redundant because the words frequently are used
interchangeably. However, diseases of the oral cavity and related
structures may have profound physical and emotional effects on a
patient, and a holistic approach to patient care makes this distinction
significant. In oral pathology one studies disease; in clinical
dentistry one treats illness. For example, necrotizing ulcerative
gingivitis may be defined with special emphasis on the microbiological
aspects of the disease, or one may speak of an inflammatory reaction
featuring “punched-out” erosions of the inter dental papillae. However,
necrotizing ulcerative gingivitis is more complex. It is the totality of
symptoms (subjective feelings) and signs (objective findings) that
together characterize a single patient’s reaction-not merely a tissue
response-to infection by spirochetes. While disease is an abstraction,
illness is a process.
Similarly, clinicians must recognize that systemic
disease may affect the oral health of patients and to treat dental
disease as anentity in itself is to practice a rigid pseudoscience that
is more comforting to the clinician than to the patient. The diagnosis
and treatment of advanced carious lesions afford little support to the
patient if one over looks obvious physical findings suggesting that the
extensive restorative needs were precipitated by qualitative and
quantitative changes in the flow of saliva secondary to an undiagnosed
or uncontrolled systemic problem, or anticholinergic pharmacotherapy.
The clinician with a balanced view of dentistry will recognizethat
caries is only a sign of disease and preventive and therapeutic
strategies will have to be based on many patient-specific factors.
It is axiomatic that while dentists are the
recognized experts on oral health, they must also learn of systemic
diseases. Such an obligationis tempered only by the extent towhich
systemic diseases relate to the dental profession’s anatomic field of
responsibility,the extent to which illnesses require modification of
dental therapy or alter prognoses, and the extent to which the presence
of certain conditions (infectious diseases) may affect care givers.
Consequently, clinicians should not treat oral diseases as isolated
entities. They should recall that physical signsand symptoms are
produced by physical causes. Since physical problems are the
determinants of physical signs and symptoms, these signs and symptoms
must be recognized before the physical problems can be diagnosed and
treated.
It is through the clinical process that clinical
judgment is applied and, with experience, matures. Clinical judgment
does not comeearly or easily to most clinicians. It is forged from long
hours of clinical experience and a life-long commitment to the
disciplined studyof diseases and illnesses. Clinician’s should study
books to understand disease, studypatients to learn of human nature and
illness, and model mentors to develop clinical judgment. Ultimately, the
experienced clinician will merge the science of understanding disease
and the art of managing illness. These activities should be fostered by
the clinician’s sincere desire to minimize patient discomfort, both
physical and emotional, and to maximize the opportunities to provide
optimal care.
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