1. Dr. Dhruvi Shah
PG-1,
Oral Medicine & Radiology.

2. DEFINITION:
● It is an extension of physical examination in which tissue,
blood, urine or other specimens are obtained from patient &
are subjected to microscopic, biochemical, microbiological
& immunological examination.
● This investigations help us in identifying nature of disease.

3. Classification:
Chair side Investigations Laboratory Investigations
Acts as a precursor to laboratory
investigations.
Significantly higher sensitivity and
specificity.
Eg: Electric Pulp testing for tooth
vitality, Glucometer, Measuring
Blood pressure.
Eg: Complete Blood Count.
1. Based on where investigations are done:

4. 2. Based on specificity/sensitivity:
Screening Tests Diagnostic Tests
An ideal screening test is 100%
sensitive.
An ideal diagnostic test is 100%
specific.
Useful in a large sample size at risk;
typically cheaper
Useful in symptomatic individuals
to establish diagnosis or
asymptomatic individuals with
+ve screening test; expensive
Eg: Rapid antigen test. Egs: RTPCR.

5. Clinical Surgical
3. Based on clinical/ surgical:
Use of excretory fluids like blood, urine, saliva
for investigation.
Taking cells, tissues from the site of lesion
representing a part or whole of it for
investigation.
Readily accessible.
Non- invasive (except blood retrieval).
Particular site is chosen for the procedure to
perform.
Invasive procedure.
No such test are required.
Inexpensive.
Blood reports test are required before following
the procedure.
Expensive.
Ex- blood assay, urine analysis, saliva
biochemistry test.
Ex- Biopsy, cytology.

7. ● Laboratory investigations includes:
1. Serological test
2. Blood test
Serological investigation:
● Serology is the diagnostic identification of antibodies in the serum and other body
fluids obtained from supernatant fluid after coagulation of fibrin.
● Antibodies are typically formed in response to an infection, against other foreign
proteins (mismatched blood transfusion), or to one's own proteins (autoimmune
disease).
● Several methods can be used to detect antibodies and antigens:
ELISA,
Agglutination,
Precipitation,
Complement-fixation,
Fluorescent antibodies,
Chemiluminescence.

8. Importance of BLOOD in lab investiagtions:
● Blood tests are one of the most basic and common tests in clinical practice, which
could provide clinicians with the scientific basis for the diagnosis, treatment, and
prognostic evaluation of many diseases
● Simplicity, speed, small incision, and low cost, shorter testing time, as well as the
indirect reduction of other unnecessary index tests.
● It is a routine procedure in developed countries.
● To investigate the patient’s infections most often a blood sample is taken not only
for the analysis of blood parameters but also for pathogen detection mostly by PCR
or for testing the presence of specific antibodies.
● Blood can be cultured to detect and identify bacteria or other cultivable micro-
organisms.

9. Blood collection methods include:
1. venipuncture (penetrating a vein with a needle) with an
evacuated tube system, syringe method, or butterfly infusion
set containing anticoagulant.
2. Capillary blood system- the skin puncture is done with the
use of a lancet.
3 most commonly used anticoagulants are:
• Tripotassium or trisodium salts of
ethylenediaminetetraacetic acid (EDTA),
• Trisodium citrate,
• Heparin.
Anticoagulated blood is stored at 4°C for a 24-hour period
without significantly altering cell counts or cellular
morphology. However, it is preferable to perform hematologic
analysis as soon as possible after the blood is obtained.

10. SITE FOR COLLECTION OF BLOOD
•By pricking the finger, ear lobe or
ankle pad.
•Eg: RBS (Random Blood Sugar).
•Directly from antecubital vein.
•Eg: CBC (Complete Blood Count).
Directly from radial artery.
•Eg: ABG (Arterial Blood Gas).
CAPILLARY
VENOUS
ARTERIAL

12. Complete blood cell counts generally are
performed using manual cell-counting
techniques, although automated methods
have been used for red blood cell (RBC)
counts.

13. PERIPHERAL BLOOD SMEAR:
● Blood smear is often used as a follow-up test to abnormal
results on a complete blood count (CBC) . It help diagnose
and/or monitor numerous conditions that affect blood cell
populations.
● The smears are stained with Wright or May-Grünwald-
Giemsa stains. Both stains are modifications of the
Romanowsky procedure
● It indicates the presence of atypical, abnormal, or
immature cells, or condition affecting blood cell production
or lifespan.
● Ex: Giemsa-stained peripheral blood smear is the standard
test for the diagnosis of Malarial infection. Classic ring-
shaped/ headphone-shaped trophozoites are seen in case
of Plasmodium falciparum infection.

14. CBC: COMPLETE BLOOD COUNT
WBC
WBC or Leukocyte count
WBC Differential count
PLATELET
Most commonly ordered blood test where calculation of the
cellular (formed elements) of blood are done. It includes:
Platelet count

15. ● RBC or Erythrocyte count.
● Haemoglobin estimation (Hbg).
● Hematocrit (Hct).
● ESR (Erythrocyte Sedimentation Rate).
● RBC indices-
➢ Mean Corpuscular Haemoglobin (MCH).
➢ Mean Corpuscular Volume (MCV).
➢ Mean Corpuscular Haemoglobin concentration
(MCHC).
RBC

17. TOTAL RBC/ ERYTHROCYTE COUNT
● RBC count is the number of RBCs contained in a sample of blood, usually expressed as millions of
cells per 100ml(cells/100ml).
● Formation of matured RBC is called ERYTHROPOIESIS.
● These cells are formed in the bone marrow and released into the bloodstream as they mature.
● They lack a cell nucleus and organelles, to accommodate maximum space for protein hemoglobin
which carries oxygen from the lungs to all parts of the body.
● Life span of 100- 120 days.
● Normal range of RBC is:
Male: 4.7 to 6.1 million cells/ 100 ml
Female: 4.2 to 5.4 million cells/ 100 ml.

19. POLYCYTHEMIA (Increase in RBC)
● It can be linked to secondary causes- chronic hypoxia.
● Polycythemia vera is a chronic myeloproliferative disease
characterized by a predominant proliferation of the erythroid.
● Common symptoms: itching (pruritus), severe burning pain, reddish or
blue coloration of skin, gouty arthritis etc.
● Smokers have high number of RBCs compared to non smokers.

20. Bleeding from the gingiva
Purplish red discoloration
reddish or blue coloration of skin

21. ANEMIA (DECREASED RBC COUNT)
● Nutritional deficiency- deficiency of B12, Folic acid, Iron, Protein.
● Decreased production of mature RBC seen in bone marrow
suppression.
● Improper maturation as in hemolytic anemia.
● Destruction of RBC as in long standing Hemorrhage.

23. HEMOGLOBIN CONCENTRATION:
● Haemoglobin concentration is expressed in gm/ dl.
● Haemoglobin is a protein molecule within RBC that carries oxygen and
because of this blood has its red colour.
● Change in its concentration is directly proportional to change in RBC’s conc.
● Normal range: Male 13-18 gm/ dl.
Female 12-16 gm/ dl.

25. Methods to estimate HB
Manual Sahli’s Acid Hematin Method Automated Cyanmethemoglobin Method

26. HEMATOCRIT (Hct)/ PACKED CELL VOLUME
● It is the volume percentage (vol%) of packed red blood cells to that of whole
blood.
● The measurement depends on the number and size of red blood cells.
● An abnormally low hematocrit may suggest anemia, a decrease in the total
amount of red blood cells, while an abnormally high hematocrit is
called polycythemia.
● Normal range: Male 40- 54%
Female 37- 47%

28. ESR- ERYTHROCYTE SEDIMENTATION RATE
● Rate at which RBC in anticoagulated whole blood descend in a standardized tube
over a period of one hour.
● It is a common hematology test, and is a non-specific measure of inflammation.
● To perform the test, anticoagulated blood is placed in an upright tube, known as a
Westergren tube, and the distance which the RBC fall is measured and reported
in mm at the end of one hour.
● Normal range:
0 to 22 mm/hr for men
0 to 29 mm/hr for women.

29. INCREASED ESR DECREASED ESR
• Inflammation OR infections,
• pregnancy,
• anemia,
• autoimmune disorders (such
as rheumatoid
arthritis and lupus),
• Kidney diseases
• cancers (such
as lymphoma and multiple
myeloma).
• polycythemia,
• Hyper viscosity,
• Sickle cell anemia,
• leukemia,
• chronic fatigue syndrome,
• low plasma protein (due to liver
or kidney disease),
• congestive heart failure.

31. ● RED BLOOD INDICES are blood test that provide information about the Hb
content and size of RBC.
● Abnormal value indicate the presence and type of Anemia.
MCH : Mean Corpuscular Haemoglobin.
MCHC: Mean Corpuscular Haemoglobin Concentration.
MCV : Mean Corpuscular Volume.
MCH MCV
MCHC

32. MCV:
Measures the average size of your red
blood cells.
MCH:
Quantifies the amount (mean) of
hemoglobin per red blood cell.
MCHC:
It is the measure of the concentration of
hemoglobin in a given volume of packed
red blood cell.

33. ● Erythrocytes indices generally evaluate the nature of anemia,
assistance is obtained by calculating standard indices relating to the
size of RBCs.

36. QUALITATIVE TEST
● Size of RBC
● Shape of RBC
● Staining of RBC
● Inclusions in RBC

37. SIZE OF RBC
Diameter of RBC ranges from about 7- 8 µm.
Thickness is about 2.5 µm.
Smaller cells are called Microcytic.
Larger cells are called Macrocytic.

38. CAUSE OF MACROCYTES: CAUSE OF MICROCYTES:
Megaloblastic anaemia Iron deficiency anaemia
Chronic liver disease Haemolytic anaemia
Thalassemia

39. SHAPE OF RBC
● The shape of the human red blood cell (RBC)
is known to be a Biconcave disc.
● This shape increases their surface area
for the diffusion of oxygen across their surfaces.

42. STAINING OF RBC
Red blood cell Inclusion Bodies are pieces of stainable material within red blood cells, mainly due to
retained remnants of cellular components.

44. WBC / LEUKOCYTE COUNT
● It is the count of no. of white blood cells in volume of blood.
● The cells of the immune system that are involved in protecting the body against
both infectious disease and foreign invaders.
● All WBC are produced and derived from multipotent cells in the bone marrow known
as hematopoietic stem cells and are Nucleated.
● Leukocytes are found throughout the body, including the blood and lymphatic system.
● Normal range: 4,000-11,000 cells/mm3 of blood.
● There are Quantitative & Qualitative changes seen in WBC.
Following will be QUANTITATIVE CHANGES—

46. LEUKOCYTOSIS (INCREASED WBC)
● Infection (acute or chronic)
● Leukaemia
● Polycythemia (elevated red blood cell count due to tumour or hypoxia)
● Trauma
● Exercise, stress, anxiety
● General anaesthesia
● Drugs such as corticosteroids and epinephrine
● Rheumatoid arthritis
● Smokinga

47. LEUKOPENIA (DECREASED WBC)
● HIV, influenza, dengue infection, respiratory tract infection
● Bone marrow depression
● Radio therapy
● Shock

48. WBC: DIFFERENTIAL COUNT

49. Functions of WBC cells:

50. CLINICAL IMPORTANCE: NEUTROPHILS
● Stress ● Aplastic anaemia
● Pregnancy ● CYCLIC neutropenia(abnormally
low levels of neutrophils)
● Infection ● Malignancy
● Excitement, exercise
● Inflammation
Increase Decrease

51. EOSINOPHILS
● Parasitic infection ● Immune deficiency
● SCARLET fever(strep throat) ● Aplastic anaemia
● Allergic reaction ● Acute stress
● Hypersensitive reaction ● Typhoid
Increase Decrease

52. BASOPHILS
● Chronic leukaemia ● Acute infection
● Polycythemia ● Trauma injury
● Myelofibrosis
Increase Decrease

53. LYMPOCYTES
● Mumps ● Aplastic Anemia
● Chronic infection
● Whooping cough
Increase Decrease

54. MONOCYTES
● MALARIA ● Aplastic Anemia
● INFECTIOUS MONONUCLEOSIS
(Epstein–Barr virus)
● Tuberculosis
● SABE (Subacute Bacterial
Endocarditis)
● HODGKIN'S DISEASE
Increase Decrease

55. QUALITATIVE CHANGES
● Variation in morphology of neutrophils
● Variation in cytoplasm of neutrophils
● Variation in lymphocytes
● Variation in morphology of macrophages.

56. VARIATION IN MORPHOLOGY OF NEUTROPHILS:
● It is detected under peripheral blood smear.
● Variation in lobes is seen from 1- 5 lobes.
● Arnett Count: Based on variation in degree of lobulation depending upon
age and maturation of cell.
● In mature neutrophil there are 4- 5 lobed nucleus.

57. VARIATION IN CYTOPLASM OF NEUTROPHILS
● Cytoplasm of neutrophils have 2 types of granules.
Primary granules stains strongly by Romanowsky stains.
Secondary granules stains weakly by Romanowsky stains.
Variations:
● Toxic granules: Increases in the number & staining density of secondary granules.
● Auer Rods: Abnormally large elongated primary granules seen in acute myeloid
leukaemia.
● Large granules: Seen in autosomal recessive immunodeficiency disorder
characterized by partial ocular albinism, easy bruisability and bleeding i.e. Chediak-
Higashi syndrome.

58. VARIATION IN LYMPHOCYTES
● Reactive lymphocytes: They are lymphocytes with slightly larger nucleus
with open chromatin and abundant cytoplasm which is irregular.

59. VARIATION IN MORPHOLOGY OF MACROPHAGES:
• Giant cells are formed by fusion of various cells such as macrophage, epithelioid cells,
monocytes etc. These are multi-nucleated, large in size, and present at the site of chronic
inflammation and other granulomatous conditions.
TYPES:
1. Langhans’ giant cells:
Tubercular granuloma
Leprosy (TT Type mainly)
Late Syphilis
Deep fungal infection
2. Foreign body giant cells (FBGCs).
3. Touton giant cells: Xanthelasmatic giant cells.

61. PLATELET/ THROMBOCYTE COUNT
● Platelets have no cell nucleus, they are fragments of cytoplasm that are derived from
the megakaryocytes of the bone marrow or lung, which then enter the circulation.
● Circulating inactivated platelets are biconvex discoid (lens-shaped) structures, 2–
3 µm in greatest diameter.
● Activated platelets have cell membrane projections covering their surface.
● Platelets are found only in mammals, whereas in
other vertebrates (e.g. birds, amphibians), thrombocytes circulate as
intact mononuclear cells.

62. ● Normal Range: 1,50,000- 4,50,000/mm3
● When the count is low bleeding time is expected to be prolonged.
● Platelet count >50,000- 60,000/mm3,
spontaneous bleeding may occur followed
by Petechial.

63. QUALITATIVE- THROMBOCYTOPATHY:
● Blood disorders characterized by dysfunctional platelets (thrombocytes).
● Result in prolonged bleeding time, defective clot formation, and a tendency
to hemorrhage.
● Inherited thrombocytopathies:
Von Willebrand disease
Down syndrome
Wiskott- Aldrich syndrome (an immune disorder).

64. ● Acquired thrombocytopathy:
cirrhosis
leukemia,
pernicious anemia,
scurvy,
uremia.
● Temporary platelet dysfunction is induced by drugs:
Antihistamines
Aspirin,
Indomethacin,
Phenothiazines,
Phenylbutazone, and
Tricyclic antidepressants.

65. ● Polycythemia vera
● Haemolytic anaemia
● Chronic leukaemia
● Acute rheumatic fever
● Post partum phase
● Thrombocytopenic purpura
● Aplastic anaemia
● Haemolytic Jaundice
● Gaucher’s disease
● Dengue fever
THROMBOCYTOSIS:
Increase Platelet Count
THROMBOCYTOPENIA:
Decrease Platelet Count
QUANTITATIVE

66. Purplish- red infiltrates at
interphalangeal joints
Hyperkeratosis
Melanonychia Tongue
hyperpigmentation
Thrombocytosis

67. Gaucher’s disease
Thrombocytopenic purpura
Thrombocytopenia

69. It includes:
1. Bleeding time
2. Clotting time
3. Capillary Fragility test
4. Tourniquet test
5. Prothrombin time
6. Partial Thromboplastin Time
7. INR- International Normalized Ratio.

70. Haemostasis:
● The cessation of bleeding following trauma to blood vessels results from 3
processes:
1. Vasoconstriction of blood vessels
2. Formation of platelet plug- Platelet plug is formed by: adhesion, activation, &
aggregation.
3. Formation of fibrin clot.
● The clot forms within & around the platelet aggregates forming firm haemostatic
plug which includes various clotting factors following extrinsic and intrinsic
pathway.

72. BLEEDING TIME
● It measures the time required for haemostatic plug to form.
● Platelet abnormality or in its function will prolong the bleeding time.
● It is used to screen disorders of platelet functions and thrombocytopenia
● Normal bleeding time : 2- 6 minutes.
● Methods are:
Dukes method (7-8 minutes)
Ivy’s method (5-6 minutes)

73. Interpretation of Bleeding time:
It is usually the result of abnormalities in the structure abilities of
capillaries to contract, platelet number or abnormality in functional
integrity.
Prolonged in:
● Thrombocytopenia
● Acute leukaemia
● Aplastic anaemia
● Liver diseases
● Von-Willebrand’s disease

74. CLOTTING TIME
● Time required for coagulation to occur in a sample of whole blood outside the
body is known as Clotting Time.
● Normal time 3-7 minutes.
● Methods are:
Capillary tube method.
Le and Whites test tube method.

75. Interpretation of Clotting time
It is usually prolonged in diseases affecting stages of coagulation.
Prolonged in:
● Liver cirrhosis.
● Hemophilia A and B
● Factor xi deficiency.
● Hypofibrinogenemia
● Heparin & Dicumarol therapy

76. CAPILLARY FRAGILITY TEST
● It is the ability of superficial capillaries of skin of forearm and hands to withstand an
increased intraluminal pressure and a certain degree of hypoxia.
● It is done by occluding the upper veins of the upper arm with blood pressure cuff for
five minutes
● Also known as Tourniquet test or Rumpel Leede test.
Indications:
● Bleeding abnormality
● Petechiae in oral cavity
● Scurvy
Positive results: Unequivocal petechiae seen distal to cuff.
(15-20/ 6.5 cm2 or 1”).

77. PROTHROMBIN TIME:
● It is the time in seconds that is required for development of a clot in citrated
or oxalated plasma where known amount of tissue thromboplastin and
calcium are added.
● It detects the abnormality of coagulation factors involved in Extrinsic
pathway (factor F7) and Common Pathway factor (F5, F10,
prothrombin, fibrinogen).
● Normal range: 11- 13.5 seconds.
● Method: Quicks method.

78. Prolonged time (>3) indicates a hemorrhagic tendency.
It gets prolonged when plasma level of any factor is below 10% of its
normal value.
Increased Prothrombin time:
● Disseminated Intravascular Coagulation
● Patients on Warfarin Therapy
● Vit K deficiency
● Early & End stage Liver failure.

79. PARTIAL THROMBOPLASTIN TIME:
● It is time in seconds that is required for development of a clot in
citrated or oxalated plasma, where known amount of tissue
thromboplastin and calcium are added.
● It detects the abnormality of coagulation factors involved in Intrinsic
pathway (factor F8, 9, 11, 12) and Common Pathway factor (F5,
F10, prothrombin, fibrinogen).
● Normal range: 25- 35 seconds.
(If PTT is prolonged it indicates deficiency of factor 8 & 10).

80. INTERNATIONAL NORMALIZED RATIO:
● It is a laboratory measurement of how long blood takes to form clot. It is used to
determine the effects of anticoagulants on the clotting system.
● It is the ratio of Patient’s Prothrombin Time to that of normal Prothrombin time.
INR = Patient`s PT
Normal PT
● INR is used to monitor anticoagulant therapy and NOT be used as coagulation
screening test.
● Normal range: 0.8- 1.2 (no anticoagulant therapy)
02- 03 ( anticoagulant therapy required).

81. INR <3
INR <2
INR <1.5
Infiltration anesthesia , scaling and root
planing
Major surgery
Block anesthesia , minor surgery ,
extraction

83. ● The biochemical profile is a series of blood tests used to
evaluate the functional capacity of several critical organs and
systems, such as the liver and kidneys.
● These tests can be done on an empty stomach or not, and are
usually accompanied by a complete blood count (CBC).

84. Specilazed tests done in dentistry:
1. Minerals:
● Serum Iron and Total Iron Binding Capacity.
● Serum Fluorine.
● Serum Calcium, Serum Posphorus
2. Solutes:
● Serum Alkaline Phosphatase, and Serum Acid Phosphatase.
● Serum Glucose, Glucose Tolerance test, HbA1c.
3. Vitamins:
● Vit C,
● Vit D3,
● Vit B12.
4. Hormones:
● Serum T4 and T3, TSH.
● Serum PTH.

85. Serum Iron and Total Iron Binding Capacity:
● Iron deficiency is usually detected on the basis of the amount of iron bound to
transferrin (90%) and Ferritin (10%) in the plasma i.e. serum iron and the total
amount of iron that can be bound to the plasma transferrin.
● Normal values : Serum Iron: 80 - 180 µg/dl.
TIBC: 250 - 370 µg/dl.
Significance:
● In iron deficiency anaemia, serum iron level falls but TIBC rises.
● In anaemia of chronic infections and malignancy, serum iron rises and TIBC falls.

86. SERUM FLUORINE:
● Fluoride is one of the most abundant elements found in nature. Water is the major
dietary source of fluoride.
● Anticariogenic and antimicrobial properties helps in topical effects in the prevention
or treatment of dental caries and tooth decay.
● In bone and teeth, fluoride can displace hydroxyl ions from hydroxyapatite to produce
fluorapatite or fluorohydroxyapatite. About 99% of total body fluoride is contained in
bones and teeth, and the amount steadily increases during life.
● Fluoride concentrations can be measured in either serum or urine.
● Blood plasma, saliva, soft tissues maintain a constant resting level 0.14ppm-
0.19ppm.

87. FLUOROSIS:
● Can be- Dental, Skeletal, Systemic.
● Acute exposure to hydrogen fluoride or fluorine by inhalation, or
through the skin, leads to severe burning and systemic toxicity with
marked reductions in plasma calcium and magnesium
concentrations.
● Chronic exposure leads to osteofluorosis with sclerosis of the bones
and ligaments.
● Occurs where the fluoride content of water is high (>3-5), mottling of
permanent teeth is common. The enamel losses its luster and became
rough.
● Symptoms may range from tiny white streaks to dark brown strains
and rough, pitted enamel. Incisors of the upper jaw are more affected.
● High fluoride level may also interfere with iodine Metabolism, causing
hypothyroidism. The hormones of bone Metabolism like Parathyroid
and growth hormone level in serum are elevated.
● The estimated lethal dose is 5-10 g (32-64 mg/kg) in adults and 500
mg in small children.

88. ORAL MANIFESTATIONS: Uses
● Fluoride in the developing enamel form Fluorapatite – it increases
resistance to demineralisation and thus prevent caries.
● Enhancement of remineralization.
● Lowering of critical pH for demineralisation of enamel.
● Inhibition of bacterial growth and metabolism.
● Inhibition of acid formation.

89. SERUM CALCIUM, PHOSPHORUS:
● The conc. of Serum Ca varies inversely with serum P.
● S. Calcium: 9- 11 mg/dl.
● S. Phosphorus: 2- 5 mg/dl.
● At levels less than 7 mg/dl Serum Ca, signs of tetany (neuro muscular
junction excitability, +ve chvostek’s sign) may appear.

90. SERUM ALKALINE & ACID PHOSPHATASE:
● Alkaline phosphatase activity is found in the cytoplasm of neutrophils, osteoblasts,
vascular endothelial cells, and some lymphocytes.
● Its screening test to differentiate chronic myeloid leukemia from leukemoid
reactions and other myeloproliferative disorders.
● Its level in the plasma is a reflection of bone cell activity.
● Acid phosphatase is found in all hematopoietic cells, but the highest levels are
found in macrophages and osteoclasts
● S. Alkaline phosphatase: 3-13 ku/dl (kings unit/dl)
● S. Acid phosphatase:1-3 ka(katal) u/ml.

93. This test is generally used to detect diabetes mellitus or
hyperglycaemia in patients for dental procedures or to physician for
symptomatic management.
• High values are seen in Diabetes Mellitus, Cushing’s disease,
Pheochromocytoma, in patients taking corticosteroids.
• Low values seen in insulin secreting tumors, Addison’s, Pituitary
hypo function.
Oral Glucose Tolerance Test:
Glucose is given and blood samples taken afterward to determine
how quickly it is cleared from the blood. The test is usually used to
test for diabetes, insulin resistance, impaired beta cell function.
Glycated Haemoglobin (HbA1C):
Form of hemoglobin (Hb) that is chemically linked to a sugar
through a process of glycation.
HbA1C fraction is abnormally elevated in diabetic patients with
chronic hyperglycemia, an average of 4 months.
Serum Glucose, Glucose Tolerance test, HbA1c:

94. Oral Manifestations:
● Mucosal conditions include oral dysesthesia, burning mouth,
● Altered wound healing,
● Increased incidence of candidal infections (acute pseudomembranous
candidiasis of the tongue, buccal mucosa, and gingiva).
● Xerostomia and bilateral generalized salivary gland enlargement or sialadenitis
(in the parotid glands) can occur, related to poor glycemic control.
● Higher dental caries incidence.
● Dry mucosal surfaces.
● Gingivitis and periodontitis.

95. SERUM VITAMIN C:
● Useful for formation of collagen, in bone formation, as an antioxidant, for
iron and hemoglobin synthesis, antibody synthesis.
● Normal value: 60- 70 mg/day.
● Lingual vitamin C test- application of a blue dye (dichloroindophenol sodium
salt) on the tongue and then timing how long it takes the dye to disappear.
● Other testing options include the examination of blood, urine, and feces.

96. ORAL MANIFESTATIONS:
● Detected as early as 60 days to 90 days on a vitamin C-deficient diet.
● Petechia, follicular hyperkeratosis, dryness of the mouth, loss of teeth,
periodontal diseases, and disintegrating restorations are frequently noted.
● Spongy gums with fetor and bleeding- scorbutic gingivitis.
● Decreased ability to heal wounds
● Bruise easily
● Nosebleeds
● Weakened tooth enamel
● Swollen and painful joints
● Anemia

97. SERUM VITAMIN D3:
● Maintains normal blood levels of Calcium and Phosphorus.
● Promotes bone mineralization.
● Prevents Ricketts in children and Osteomalacia in adults.
● The standard test for vitamin D is blood level measurements of 25(OH)D, with a level
below 20 ng/ml considered a deficiency.
● Normal values: 20 and 40 ng/mL

98. ORAL MANIFESTATIONS:
● Involvement of alveolar bone.
● Enamel hypoplasia (incomplete mineralization of
teeth)
● Susceptibility to dental caries
● Pulp calcification
● Spontaneous dental and gingival abscess
● MANDIBULAR MANTLE in infants.
Radiographic Features:
● large pulp chamber.
● short root.
● Poorly defined Lamina dura and Hypoplastic alveolar
ridge.

99. SERUM VITAMIN B12:
● Helps in formation of red blood cells and DNA.
● It is also a key player in the function and development of brain and nerve
cells.
● Vitamin B12 binds to the protein in the foods we eat.
● Normal values: 2.4 mcg.
● Blood or urine test can be done.

100. ORAL MANIFESTATIONS:
● Pernicious anemia- poor B12 absorption.
● Megaloblastic anemia, also called nutritional-
deficiency anemia, is a type of anemia caused by B12
or folate deficiency.
● Glossitis,
● Glossodynia,
● Recurrent ulcers,
● Cheilitis,
● Dysgeusia,
● Lingual paresthesia,
● Burning sensations, and pruritus.

101. SERUM T3 - T4, TSH:
● Thyroid function is currently measured either by uptake of radio isotope by the thyroid gland or by
direct measurement of thyroid hormones which are Triodothyronine (T3) and Thyroxine (T4).
● Thyroid Stimulating hormone (aka thyrotropin or thyrotrophin) is produced by the pituitary gland. It
masters production of T3 and T4 from its control center.
● When both T3 And T4 levels are increased with low TSH level- Hyperthyroidism.
● In Pregnancy : T3 is low but T4 is high.
● In Nephrosis: T3 is high but T4 is low.
Normal Value:
● Serum T4 5.3 - 14.5 mg/dl
● Serum T3 80 - 220 ng/dl
● Serum TSH 0.5 - 4.5 mU/dl

102. ORAL MANIFESTATIONS: HYPOTHYROIDISM
● Childhood hypothyroidism- Cretinism.
● Characterized by thick lips, large protruding tongue (macroglossia), malocclusion
and delayed eruption of teeth.
● Long-term effects of severe hypothyroidism on craniofacial growth and dental
development- impaction of the mandibular second molars caused by a dissociation
of ramus growth and failure of normal resorption of the internal aspect of the ramus,
resulting in insufficient space for proper eruption of these teeth.
● Dysgeusia, poor periodontal health, altered tooth morphology and delayed wound
healing (due to decreased metabolic activity in fibroblasts) along with increased risk
for infection are other manifestations.

103. HYPERTHYROIDISM:
● Increased susceptibility to caries, periodontal disease, enlargement of extra
glandular thyroid tissue (mainly in the lateral posterior tongue), maxillary or
mandibular osteoporosis, accelerated dental eruption, burning mouth
syndrome, Sjogren's syndrome.

104. SERUM PTH (PARATHORMONE):
● Maintains the ECF level of Ca+2.
● Normal range: 10- 60 pg/ml.
● It is regulated by negative feedback mechanism
Hypocalcemia- PTH
It increases the efficacy of calcium absorption in the intestine by stimulating
the productin of 1,25 (OH)2 D.

105. References:
● Burket 8th edition- Malcolm, Vernon, Greenberg.
● Sembulingam book of physiology.
● Burket’s oral medicine 11th edition- Greenberg, Glick, Ship.
● Lecture Notes Haematology 8th edition- Hugee & Jones, Wickramsinghe, C.S.R.
Hatton.
● Textbook of ORAL MEDICINE 2nd Edition - Anil Govindrao Ghom.
● Find the right sample: A study on the versatility of saliva and urine samples for the
diagnosis of emerging viruses- Matthias Niedrig et al.- review article, 29 dec, 2018.
● Investigation and analysis on the application of peripheral blood specimens for
routine blood testing by laboratory physicians Zeping Han et al.- Annals of Palliative
Medicine, Vol 10, No 9 September 2021