A Pragmatic Approach to Oral and Maxillofacial Differential Diagnosis: The Clinical Examination Plan

Journal Article

Ekram, Mohamed . 2006

• Magazine \ Newspaper: Ain Shams Dental Journal
• Issue Number: 1
• Volume Number: 9
• Pages: 93-99

Publication Abstract

A horizontal study was carried out on 3243 adult patients in a trial to avoid the mis-diagnosis of cases as well as the time consumption brought about by recording unreal abnormalities or expectations told by the patients. The study included a simple questionnaire about the subjective chief complaint followed by its inspection. The chief complaint was also reexamined during the sequence of differential diagnosis. The study revealed that, the chief complaints told by the patients coincided with reality only in 61% of cases, expressed as an expectation in 11%, as a notation about the patient in 5%, and did not coincide with reality in 23% of cases. This brings us to conclude that, taking the case history and performing the physical examination should not be carried out independently in a strict sequence but, rather the chief complaint should be inspected following its subjective recording then the rest of the history is recorded. The chief complaint should be re-examined during the sequence of differential diagnosis. The study has introduced a number of factors that can shape the chief complaints and also a new plan for differential diagnosis with a pragmatic orientation of the examination items.