ORALM 630

Clinical Diagnosis and Oral Medicine

Karen Manookin

1 Credit Per Quarter, 4 Credits Total / Quarters 9-12 (Autumn-Summer, Third Year)

Course Description

This is a clinical course series for the third year dental student that includes history-taking and physical examination, radiology, diagnosis and emergency dental care. Additionally, the course includes rotations to the Oral Medicine Clinical Services Faculty Practice, the DECOD Clinic (for dental care for the developmentally disabled patient) and the off-site Provail Clinic (for treatment of patients with cerebral palsy). Rotations to two geriatric facilities are also possible. The initial focus of clinical activity is on the complete assessment of patients seeking comprehensive care at the School of Dentistry. As the student progresses through this 4-quarter course, there is increasing emphasis on the assessment and care of patients with emergency dental needs and with developmental or acquired disabilities.

Educational Objectives

The objectives for this course are for the student to develop the following skills:

  1. Communication with patients that establishes rapport and facilitates gathering of subjective data.
  2. Complete and accurate medical history taking and understanding of the role between medical and psychosocial problems to oral health and delivery of care.
  3. Identification, through general survey, vital signs and complete physical examination of the head and neck, of signs of diseases or conditions that affect the oral health of the patient or delivery of care.
  4. Development of differential diagnoses for signs and symptoms identified during the examination.
  5. Formation of problem lists for the patients that include pertinent health issues, patient’s desires for treatment, urgent care needs and diseases of the soft and hard tissues of the oral cavity and associated structures.
  6. Determination of radiographic needs of the patient, development of radiograph-taking skills and interpretation of radiographic findings.
  7. Communication with other health care providers in the form of referrals to physicians, dental specialists or other clinics within the school when indicated.
  8. Assessment and treatment of emergency urgent problems that includes determination, sequencing, delivery and follow-up of the correct treatment for urgent dental problems.
  9. Dental care of patients with developmental disabilities.
  10. Diagnosis and management of patients with chronic orofacial pain, mucosal abnormalities, diseases of the salivary glands, chemosensory disorders and halitosis.
  11. Appropriate use of pharmacological agents for pain, infection and anxiety management.

Course Outline

The student attends one clinic session (2.5-3 hours each) every week during her/his third year. During the Summer Quarter (#12), the student attends two sessions per week. In total, each student attends approximately fifty clinical sessions during the four quarters of this course. For each session, the student is assigned to one of the following activities:

  1. Medical history interview, physical examination, and problem list formation for a patient who has been accepted for comprehensive care at the School of Dentistry. The evaluation also includes radiographic survey of the patient. The radiographic examination, which is overseen by Oral Radiology Faculty, occurs in the Radiology Clinic. It includes evaluation of image quality, determination of need for supplementary radiographs, interpretation of radiographs and a written radiographic report. Initiation of referrals and consult requests are also performed, if indicated.
  2. Medical and problem history interview of one or more patients with emergency dental problems. Physical examination, radiographic evaluation and appropriate diagnostic testing are conducted to determine the diagnosis. The diagnosis and treatment options are confirmed with the attending faculty, followed by delivery of the appropriate treatment of the patient’s emergency.
  3. Rotations to either of two clinics specializing in dental care for the developmentally disabled patient. The student will conduct exams and deliver care under the supervision of faculty with expertise in the treatment of these patients.
  4. Rotation to the Oral Medicine Clinical Services Faculty Practice, where students will observe the evaluation and management of patients with chronic orofacial pain, mucosal disorders, chemosensory disorders and salivary gland diseases.

Course Expectations

To successfully meet the requirements of this course, the student must attend assigned clinic sessions, exhibit professional conduct, and demonstrate her/his clinical skills by participation in the activities (1-4) listed above.

Daily assessment of clinical skills is obtained through review by the attending faculty of standardized forms completed by the student for collection of historical and physical examination data. The student presents this information and the diagnosis(es) (and in the case of urgent care patients, the treatment plan) to the attending faculty. In the case of initial assessment of entering patients, the attending faculty confirms historical and physical findings, problem identification, and determination of radiographic needs by the student. The student and patient continue assessment in the Radiology Clinic. In the case of urgent care dental patients, the protocol is the same, with the addition of treatment plan approval and assessment of completed treatment by the faculty. The attending faculty completes a form with clinical performance criteria for each student at the end of each session. At the end of each quarter, the assessments are summarized by the attending faculty on a form designed for this purpose.

Effective Winter Quarter 2007, completion of on-line course evaluation is a requirement of this course. Failure to comply will result in an “Incomplete” grade being assigned.

Competences Addressed:

  • UWSOD Competency 1: Examine a patient using contemporary diagnostic methods to evaluate the head and neck region and to reach a diagnosis of the patient’s oral and craniofacial health status.
  • UWSOD Competency 3: Formulate a comprehensive treatment plan based on diagnostic findings, then implement treatment in a safe, properly sequenced and timely manner.
  • UWSOD Competency 5: Recognize the limits of their expertise and seek consultation with other health care providers to facilitate patient care.
  • UWSOD Competency 6: Manage acute and chronic orofacial and dental pain.
  • UWSOD Competency 7: Manage pulpal and periradicular disease.
  • UWSOD Competency 8: Manage dental emergencies.
  • UWSOD Competency 10: Prescribe and administer pharmacological agents for patient care.
  • UWSOD Competency 11: Diagnose and manage hard and soft tissue lesions and diseases of the orofacial complex.
  • UWSOD Competency 14: Manage periodontal diseases.
  • UWSOD Competency 15: Assess the teeth and supporting structures and provide preventive services.
  • UWSOD Competency 22: Utilize critical thinking in assessing technical and scientific information for use in identifying patient needs and treatments.
  • UWSOD Competency 23: Apply the principles of behavioral science that pertain to patient-centered oral health care.
  • UWSOD Competency 25: Manage a diverse patient population and have the interpersonal and communication skills to function successfully in a multicultural work environment.

Media

  • Oral Radiology, Principles and Interpretation, White and Pharoah, 4th ed. or later, Mosby
  • Student’s choice of drug reference manuals

*last updated: 11/28/2011

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