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Physical signs for the general dental practitioner

From Volume 39, Issue 10, December 2012 | Page 745

Authors

Steve Bain

Professor of Medicine (Diabetes), University of Wales, Swansea

Articles by Steve Bain

Pranav Kumar

Specialist Registrar, Singleton Hospital, Swansea

Articles by Pranav Kumar

Article

Steve Bain
Dr Pranav Kumar

‘Physical Signs for the General Dental Practitioner’ aims:

  • To increase awareness of the value of identifying general clinical signs.
  • To enable the interpretation of selected clinical signs that are visible in the clothed patient.
  • To indicate the potential relevance of these clinical signs to the dental management of the patient.
    • The series will contribute to non-verifiable CPD requirements.

    This patient with type 2 diabetes complains of pain in his right greater toe.

  • What is the likely cause of this appearance?
  • What features differentiate this diagnosis from others in a person with diabetes?
  • What is the cause of the pain?
  • What medical therapies are available for this condition?

    • Answers: Case 100

  • This image shows areas of skin ulceration which are ischaemic in origin.
  • The major causes of ulceration in the diabetic foot are ischaemia (poor blood circulation)and neuropathy (nerve damage leading to sensory loss). Ischaemic ulcers are typically seen on the margins of the foot, on a background of poor quality skin (in this case extremely dry and fissured). This contrasts with neuropathic ulcers, located underlying pressure points (eg the ‘balls’ of the feet) with marked skin overgrowth (callous) and which are typically painless.
  • Lack of blood supply (and hence oxygenation) causes pain which is usually worse at night when the feet are elevated in bed.
  • There are none. Revascularization by angioplasty or bypass surgery is indicated, otherwise amputation will follow.