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Physical signs for the general dental practitioner

From Volume 39, Issue 8, October 2012 | Page 601

Authors

Steve Bain

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

Articles by Steve Bain

Ritu Nirula

F1, ABMU Health Board, Wales Singleton Hospital, Swansea

Articles by Ritu Nirula

Article

Steve Bain
Dr Ritu Nirula

‘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 middle-aged woman from the West Indies has been having pain and swelling of her fingers for the last 6 months. She has a long-standing ‘inflammatory’ condition which has been causing lethargy, breathlessness and skin rashes.

  • What does this photo show?
  • Which disease is this woman likely to be suffering from?
  • What other features can be present with this disease?
  • What management options are there for this disease?

    • Answers: Case 98

  • This photo shows dactylitis, which is painful inflammation affecting the finger, leading to a sausage-like shape.
  • The disease is sarcoidosis. It is a multisystem inflammatory condition, which characteristically involves the formation of non-caseating granulomas (unlike that of tuberculosis, which has caseating granulomas). Lupus pernio, a rash consisting of bluish-purple, plaque-like lesions over her nose and cheeks, is pathognomonic of sarcoidosis.
  • Lethargy is common and the lungs are affected in >90% of cases, presenting with features of interstitial lung disease – dry cough, fever and breathlessness. Other common features are those affecting the skin, including erythema nodosum (tender, red nodules over both shins). Commonly, patients may be asymptomatic and are diagnosed by a routine CXR showing bilateral hilar lymphadenopathy.
  • Treatment is mainly symptomatic, with corticosteroids being the mainstay treatment option for pulmonary disease. Immunosuppressant drugs are being investigated regarding their benefit in managing the disease. Skin manifestations of the disease generally respond well to the use of NSAIDs within weeks. However, systemic steroids are used to treat lupus pernio.