4th BDS Year SYLLABUS
 
   SYLLABUS
 
  Oral Medicine & Radiology
Paediatric & Preventive Dentistry
  Orthodontics & Dentofacial Orthopaedics
  Periodontology
   
Oral Medicine & Radiology
     

Paper No. –I : Oral Medicine & Radiology

Teaching Scheme

Examination Scheme

Total Marks

Hours Per year

Lectures Clinical
65 200

265 Hrs

Theory Marks

Final Viva Voce Internal
70 20 10

100

Practical Marks
Final Internal
90 10

100

200
     
  ORAL MEDICINE AND RADIOLOGY
     
  AIMS
  (1)

To train the students to diagnose the common disorders of Orofacial region by clinical examination and with the help of such investigations as may be required and medical management of oro-facial disorders with drugs and physical agents.

  (2)

To train the students about the importance, role, use and technics of radiographs and other imaging methods in diagnosis.

  (3)

The principles of the clinical and radiographic aspects of Forensic Odontology.

     
 

The syllabus in ORAL MEDICINE & RADIOLOGY is divided into two main parts. (I) Diagnosis, Diagnostic methods and Oral Medicine (II) Oral Radiology. Again the part ONE is subdivided into three sections. (A) Diagnostic methods (B) Diagnosis and differential diagnosis (C) Oral Medicine & Therapeutics.

     
  COURSE CONTENT
     
  (1)

Emphasis should be laid on oral manifestations of systemic diseases and ill-effects of oral sepsis on general health.

  (2)

To avoid confusion regarding which lesion and to what extent the student should learn and know, this elaborate syllabus is prepared. As certain lesions come under more than one group, there is repetition.

     
 

Part-I ORAL MEDICINE AND DIAGNOSTIC AIDS

  SECTION (A) – DIAGNOSTIC METHODS.
     
  (1) Definition and importance of Diagnosis and various types of diagnosis
  (2) Method of clinical examinations.
   
(a) General Physical examination by inspection.
(b) Oro-facial region by inspection, palpation and other means
(c)

To train the students about the importance, role, use of saliva and techniques of diagnosis of saliva as part of oral disease

(d)

Examination of lesions like swellings, ulcers, erosions, sinus, fistula, growths, pigmented lesions, white and red patches

(e) Examination of lymph nodes
(f)

Forensic examination – Procedures for post-mortem dental examination; maintaining dental records and their use in dental practice and post-mortem identification; jurisprudence and ethics.

  (3) Investigations
   
(a) Biopsy and exfoliative cytology
(b)

Hematological, Microbiological and other tests and investigations necessary for diagnosis and prognosis

     
  SECTION (B) – DIAGNOSIS, DIFFERENTIAL DIAGNOSIS
     
 

While learning the following chapters, emphasis shall be given only on diagnostic aspects including differential diagnosis

     
  (1)

Teeth: Developmental abnormalities, causes of destruction of teeth and their sequelae and discoloration of teeth

  (2)

Diseases of bone and Osteodystrophies: Development disorders: Anomalies, Exostosis and tori, infantile cortical hyperostosis, osteogenisis imperfecta, Marfans syndrome, osteopetrosis. Inflamation – Injury, infection and sperad of infection,fascial space infections, osteoradionecrosis.

     
    Metabolic disorders – Histiocytosis
    Endocrine – Acro-megaly and hyperparathyroidism
   

Miscellaneous – Paget’s disease, Mono and polyostotic fibrous dysplasia, Cherubism.

  (3)

Temparomandibular joint: Developmental abnormalities of the condyle. Rheumatoid arthritis, Osteoarthritis, Sub-luxation and luxation.

  (4) Common cysts and Tumors:
    CYSTS: Cysts of soft tissue: Mucocele and Ranula
    Cysts of bone: Odontogenic and nonodontogenic.
    TUMORS:
   
  Soft Tissue:
   
  Epithelial: Papilloma, Carcinoma, Melanoma
  Connective tissue: Fibroma, Lipoma, Fibrosarcoma
  Vascular: Haemangioma, Lymphangioma
  Nerve Tissue: Neurofibroma, Traumatic Neuroma, Neurofibromatosis
  Salivary Glands: Pleomorphic adenoma, Adenocarcinoma, Warthin’s Tumor, Adenoid cystic, carcinoma.
   
  Hard Tissue:
   
  Non Odontogenic: Osteoma, Osteosarcoma, Osteoclastoma, Chondroma, Chandrosarcoma,
  Central giant cell rumor, and Central haemangioma
  Odontogenic: Enameloma, Ameloblastoma, Calcifying Epithelial Odontogenic tumor, Adenomatoid Odontogenic tumor, Periapical cemental dysphasia and odontomas
  (5)

Periodontal diseases: Gingival hyperplasia, gingivitis, periodontitis, pyogenic granuloma

  (6)

Granulomatous diseases: Tuberculosis, Sarcoidosis, Midline lethal granuloma, Crohn’s Disease and Histiocytosis X

  (7)

Miscellaneous Disorders: Burkitt lymphoma, sturge – Weber syndrome, CREST syndrome, rendu-osler-weber disease

     
  SECTION (C): ORAL MEDICINE AND THERAPEUTICS.
     
 

The following chapters shall be studied in detail including the eiology, pathogenesis, clinical features, investigations, differential diagnosis, management and prevention

     
  (1) Infections of oral and paraoral structures:
   

Bacterial: Streptococcal, tuberculosis, syphillis, vincents, leprosy, actinomycosis, diphtheria and tetanus

    Fungal: Candida albicans
   

Virus: Herpes simplex, herpes zoster, ramsay hunt syndrome, measles, herpangina, mumps, infectious mononucleosis, AIDS and hepatitis-B

  (2) Important common mucosal lesions:
   

White lesions: Chemical burns, leukodema, leukoplakia, fordyce spots, stomatitis nicotina palatinus, white sponge nevus, candidiasis, lichenplanus, discoid lupus erythematosis

   

Veiculo-bullous lesions: Herpes simplex, herpes zoster, herpangina, bullous lichen planus, pemphigus, cicatricial pemphigoid erythema multiforme.

    Ulcers: Acute and chronic ulcers
    Pigmented lesions: Exogenous and endogenous
   

Red lesions: Erythroplakia, stomatitis venenata and medicamentosa, erosive lesions and denture sore mouth.

  (3) Cervico-facial lymphadenopathy
  (4) Facial pain:
   
(i)

Organic pain: Pain arising from the diseases of orofacial tissues like teeth, pulp, gingival, periodontal tissue, mucosa, tongue, muscles, blood vessels, lymph tissue, bone, paranasal sinus, salivary glands etc.,

(ii) Pain arising due to C.N.S. diseases:
 
(a)

Pain due to intracranial and extracranial involvement of cranial nerves. (Multiple sclerosis, cerebrovascular diseases, trotter’s syndrome etc.)

(b)

Neuralgic pain due to unknown causes: Trigeminal neuralgia, glossopharyngeal neuralgia, sphenopalatine ganglion neuralgia, periodic migrainous neuralgia and atypical facial pain

(iii) Referred pain: Pain arising from distant tissues like heart, spine etc.,
  (5) Altered sensations: Cacogeusia, halitosis
  (6)

Tongue in local and systemic disorders: (Aglossia, ankyloglossia, bifid tongue, fissured tongue, scrotal tongue, macroglossia, microglossia, geographic tongue, median rhomboid glossitis, depapillation of tongue, hairy tongue, atrophic tongue, reactive lymphoid hyperplasia, glossodynia, glossopyrosis, ulcers, white and red patches etc.)

  (7) Oral manifestations of:
   
(i) Metabolic disordeers:
   
  (a) Porphyria
  (b) Haemochromatosis
  (c) Histocytosis X diseases
   
(ii) Endocrine disorders:
   
  (a) Pituitary: Gigantism, acromegaly, hypopitutarism
  (b) Adrenal cortex: Addison’s disease (Hypofuntion)
    Cushing’s syndrome (Hyperfunction)
  (c) Parathyroid glands: Hyperparathyroidism.
  (d) Thyroid gland: (Hypothyroidism) Cretinism, myxedema
  (e) Pancreas: Diabetes
   
(iii)

Nutritional deficiency: Vitamins: riboflavin, nicotinic acid, folic acid Vitamin B12, Vitamin C (Scurvy)

(iv) Blood disorders:
   
  (a) Red blood cell diseases
    Defficiency anemias: (Iron deficiency, plummer – vinson syndrome, pernicious anemia)
   

Haemolytic anemias: (Thalassemia, sickle cell anemia, erythroblastosis fetalis)

    Aplastic anemia
    Polycythemia
  (b) White Blood cell diseases
   

Neutropenia, cyclic neutropenia, agranulocytosis, infectious mononeucleosis and leukemias

  (c) Haemorrhagic disorders:
   

Thrombocytopenia, purpura, hemophillia, chrismas disease and von willebrand’s disease

  (8) Disease of salivary glands:
   
(i) Development distrubances: Aplasia, atresia and aberration
(ii) Functional disturbances:Xerostomia, ptyalism
(iii)

Inflammatory conditions: Nonspecific sialadenitis, mumps, sarcoidosis heerdfort’s syndrome (Uveoparotid fever), Necrotising sialometaplasia

(iv)

Cysts and tumors: Mucocele, ranula, pleomorphic adenoma, mucoepidermoid carcinoma

(v)

Miscellaneous: Sialolithiasis, sjogren’s syndrome, mikuliez’s disease and sialosis

  (9) Dermatological diseases with oral manifestations:
   
(a) Ectodermal dysplasia (b) Hyperkerotosis palmarplantaris with periodont0opathy
(c) Scleroderma (d) Lichen planus including ginspan’s syndrome
(e) Luplus erythematosus (f) Pemphigus
(g) Erythema multiforme (h) Psoriasis
  (10) Immunological diseases with oral manifestations
   
(a) Leukemia (b) Lymphomas
(c) Multiple mycloma (d) AIDS clinical manifestations, opportunistic infections, neoplasms
(e) Thrombcytopenia (f) Lupus erythematosus
(g) Scleroderma (h) dermatomyositis
(i) Submucous fibrosis (j) Rhemtoid arthritis
(k) Recurrent oral ulcerations including behcet’s syndrome and reiter’s syndrome    
  (11)

Allergy: Local allergic reactions, anaphylaxis, serum sickness (local and systemic allergic manifestations to food drugs and chemicals)

  (12) Foci of oral infection and their ill effects on general health
  (13) Management of dental problems in medically comrpomised persons:
   
(i) Physiological changes: Puberty, pregnancy and menopause
(ii)

The patients suffering with cardiac, respiratory, liver, kidney and bleeding disorders, hypertension, diabetes and AIDS. Post-irradiated patients.

  (14) Precancerous lesions and conditions
  (15) Nerve and muscle diseases:
   
(i) Nerves:
   

(a)

Neuropraxia
(b) Neurotemesis
(c) Neuritis
(d)

Facial nerve paralysis including Bell’s palsy, Heerfordt’s syndrome, Melkerson Rosenthel syndrome and ramsay hunt syndrome

(e) Neuroma
(f) Neurofibromatosis
(g) Frey’syndrome
   
(ii) Muscles:
   
(a) Myositis ossificans
(b) Myofascial pain dysfunction syndrome
(c) Trismus
  (16) Forensic odontology:
   
(a) Medicolegal aspects of orofacial injuries
(b) Identification of bite marks
(c) Determination of age and sex
(d)

Identification of cadavers by dental appliances, Restorations and tissue remnants

  (17)

Therapeutics: General therapeutic measures – drugs commonly used in oral medicine viz., antibiotics, chemotherapeutic agents, anti-inflammatory and analgesic drugs, astringents, mouth washes, styptics, demelucents, local surface anaesthetic, sialogogues, antisialogogues and drugs used in the treatment of malignancy

     
  PART – II BEHAVIOURAL SCIENCES AND ETHICS.
     
  PART – III -ORAL RADIOLOGY
     
  (1) Scope of the subject and history of origin
  (2) Physics of radiation:
   
(a) Nature and types of radiations
(b) Source of radiations
(c) Production of X-rays
(d) Properties of X-rays
(e) Compton effect
(f) Photoelectric effect
(g) Radiation measuring units
  (3) Biological effects of radiation
  (4) Radiation safety and protection measures
  (5) Principles of image production
  (6) Radiographic techniques:
   
(i) Intra-Oral:
   

(a)

Periapical radiographs (Bisecting and parallel technics)
(b) Bite wing radiographs
(c) Occlusal radiographs
   
(ii) Extra-oral:
   

(a)

Lateral projections of skull and jaw bones and paranasal sinuses
(b) Cephalograms
(c) Orthopantomograph
(e) Projections of temperomandibular joint and condyle of mandible
(f) Projections for Zygomatic arches
   
(iii) Specialised techniques:
   

(a)

Sialography
(b) Xeroradiography
(c) Tomography
  (7) Factors in production of good radiographs:
   
(a) K.V.P. and mA.of X-ray machine
(b) Filters
(c) Collimations
(d) Intensifying screens
(e) Grids
(f) X-ray films
(g) Exposure time
(h) Techniques
(i) Dark room
(j) Developer and fixer solutions
(k) Film processing
  (8) Radiographic normal anatomical landmarks
  (9) Faculty radiographs and artefacts in radiographs
  (10)

Interpretation of radiographs in various abnormalities of teeth, bones and other orofacial tissues

  (11)

Principles of radiotherapy of oro-facial malignancies and complications of radiotherapy

  (12) Cantrast radiography and basic knowledge of radio-active isotopes
  (13)

Radiography in Forensic Odontoloy - Radiographic age estimation and post-mortem radiographic methods

     
  PRACTICALS / CLINICALS:
     
  1.

Student is trained to arrive at proper diagnosis by following a scientific and systematic proceedure of history taking and examination of the orofacial region. Training is also imparted in management wherever possible. Training also shall be imparted on saliva diagnostic procedures. Training also shall be imparted in various radiographic proceedures and interpretation of radiographs.

  2.

In view of the above each student shall maintain a record of work done, which shall be evaluated for marks at the time of university examination

  3. The following is the minimum of prescribed work for recording
    (a) Recording of detailed case histories of interesting cases …… 10
    (b) Intra-oral radiographs (Periapical, bitewing, occlusal) ………… 25
    (c) Saliva diagnostic check as routine procedure
     
  BOOKS RECOMMENDED:
     
  a) Oral Diagnosis, Oral Medicine & Oral Pathology
   
1. Burkit – Oral Medicine – J.B. Lippincott Company
2. Coleman – Principles of Oral Diagnosis – Mosby Year Book
3. Jones – Oral Manifestations of Systemic Diseases – W.B. Saunders company
4. Mitchell – Oral Diagnosis & Oral Medicine
5. Kerr – Oral Diagnosis
6. Miller – Oral Diagnosis & Treatment
7. Hutchinson – clinical Methods
8. Oral Pathology – Shafers
9.

Sonis.S.T., Fazio.R.C. and Fang.L - Principles and practice of Oral Medicine

  b) Oral Radiology
   
1. White & Goaz – Oral Radiology – Mosby year Book
2. Weahrman – Dental Radiology – C.V. Mosby Company
3. Stafne – Oral Roentgenographic Diagnosis – W.B.Saunders Co.,
  c) Forensic Odontology
   
1.

Derek H.Clark – Practical Forensic Odontology - Butterworth-Heinemann (1992)

2.

C Michael Bowers, Gary Bell – Manual of Forensic Odontology - Forensic Pr (1995)

   
   
 
 
 
 
 
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