5. GI: Oral/Dental Considerations Flashcards
1
Q
GI Review of Systems
- Changes in ____
- Food intolerance
- ____
- Indigestion and relief
- ____
- Abdominal pain
- Radiation of ____
- Nausea and vomiting
- ____
- Cramping
- Stool color / odor
- ____
- Diarrhea
- ____
- Mucus in stools
- Blood in stools• Patient may report as indicators of undiagnosed GI disease, or symptoms of known disorders
• Already templated in ____ already
○ Most are prepopulated as a ____ response as well
A
appetite
belching
hiccups
pain
hematemsis
flatulence
constipation
EHR
negatives
2
Q
GERD – Oral / Dental Manifestations
- Dental ____
- Thermal sensitivity of dentition
- ____
- Halitosis
- ____
- Altered oral sensation
- Mucosal ____ / atrophy• Moderate-severe reflux > stomach contents into mouth > ____ of enamel/dentin
○ Patients also have sensitivity to hot/cold as a result
• Dysgeusia - altered ____
• Halitosis in more severe cases
• Glossodynia - ____ sensations of the tongue
• Oral sensation alteration
○ “teeth feel hairy” or “coating of slime in mouth”
A
erosion
dysgeusia
glossodynia
erythema
erosion
taste
burning
3
Q
GERD – Dental Management
- Thorough baseline ____ history
- Diagnosis / management of condition to date
- Review of systems
- ____ of diagnosed disease
- Recognition of ____ disease
- Need for medical consultation / referral
- Update ____ at each visit
- Chair ____
- Angle to minimize gastric retrograde flow• Applies to any disorder
• Reflux for a few months > PPI and asymptomatic > good!
○ Chronic reflux > unstable
• Keep patient at 45 degree angle to restrict gastric flow
A
medical stability undiagnosed medical history positioning
4
Q
- Example of erosion
- ____ surfaces > higher rate of erosion due to exposure to gastric contents
- Occlusal surfaces > pitting feature
A
lingual/palatal
5
Q
GERD
- Dysgeusia
- ____
- Dental considerations
- Topical ____ application with occlusal tray
- Restorative needs
- Medications
- Drug – drug interactions
- Side effects• Mouth rinses can be helpful for dysgeusia > patient should stay away from ____-based rinses (can dry the mucous), or bicarbonate can help as well
• Occlusal tray to ____ tooth surfaces > can reduce the frequency of erosion
○ Resins in high frequency with stomach content? May need more ____ materials
A
mouthrinses fluoride alcohol protect durable
6
Q
- Vinyl tray > not used for ____ habits
* Can be used with ____ or just as a protective device fro acidic contents
A
parafunctional
fluoride
7
Q
PUD – Oral / Dental Manifestations
- Dental ____
- Lip ____ malformations
- Medication-induced manifestations
- ____
- Dysgeusia
- ____
- Erythema multiforme
- Anemia-related manifestations
- Atrophic ____
- Angular ____
• Higher frequency of fungal infection > candidiasis > pseudomembranous • Immune mediated inflam syndrome > EM • Higher risk of developing anemia ○ Glossitis > affects the \_\_\_\_ ○ Cheilitis > affects the \_\_\_\_
A
erosion vascular candidiasis xerostomia glossitis cheilitis
tongue
commissures
8
Q
PUD
* Lip vascular malformations * One lesion spontaneously \_\_\_\_
• \_\_\_\_ ○ Most common type you'll encounter ○ Plaques § Can affect any \_\_\_\_ § Pathognomonic
• A lot of tests to confirm > can see it and just treat it with \_\_\_\_
A
bled
pseudomembranous colitis
surface
antifungal
9
Q
PUD
* Xerostomia * Look at floor of mouth > see no \_\_\_\_ pooling > classic sign of dry mouth * Take mirror and against buccal mucosa > if sticks they're \_\_\_\_ * Mucosal tissue looks \_\_\_\_> doesn't look dull bc of no saliva in this person's mouth * End stage of severe dry mouth * Radiation for H/N therapy from cancer * Rampant dental \_\_\_\_, and high rates of infection * Extracting teeth * High chance of developing \_\_\_\_ infections?
A
saliva
dry
shiny
caries
yeast
10
Q
PUD
EM • Intermittent episodes of peri/intraoral lesions around her \_\_\_\_ cycle ○ Can also be related to \_\_\_\_ • Crusty, \_\_\_\_ lip surfaces • Edema
* Severely ulcerated tissue causing a lot of \_\_\_\_ > impacting QoL * Doesn't look like anything else > can look non-\_\_\_\_ * Can have \_\_\_\_ lesions on cutaneous surfaces
A
menstrual
medications
hemorrhagic
pain
descript
target-like
11
Q
PUD
Atrophic glossitis
• Not erythematous, but ____ > lost all taste buds on tongue
• Looks abnormal in appearance but not in ____
• More typical pattern > ____ patches
• Tissue looks dry; patchy redness on different parts of tongue
Angular chielitis
• Located at ____
• Mixed with ____ and maybe some ____ as well
A
depapillated color erythematous commisures fungi bacteria
12
Q
PUD – Dental Management
- Thorough baseline medical history
- Diagnosis / management of condition to date
- Medications
- Use of ____
- Social history
- Use of ____
- Review of systems
- Stability of ____ disease
- Recognition of ____ disease
- Need for medical consultation / referral
- Update ____ at each visit
- Ability to tolerate care
• Symptoms associated with anemia • \_\_\_\_ / fatigue / SOB • \_\_\_\_ may be increased • \_\_\_\_ / angina • Monitor vital signs
* ASA/NSAIDs > physicians will say not to use them bc it will exacerbates symptoms * Alcohol > exacerbating factor for PUD
A
ASA / NSAIDs alcohol diagnosed undiagnosed medical history
weakness
cardiac output
palpitations
13
Q
PUD
- Maintenance of oral hygiene
- ____ in dental plaque
- Avoid ASA, NSAIDs
- Irritation of ____ lining
- Consider use of ____ or COX-2 inhibitor + ____
• Recognize potential for drug interactions
• Decreased efficacy of antibiotics with antacids containing ____,
magnesium or aluminum salts
- Antacids with bismuth
- ____• Better oral hygiene > less volume of H pylori in oral cavity
• Peptobismal in high frequency > bismuth > can cause brown-black hairy tongue
○ Solutions can be used to clean tongue > dilute ____ > daycon’s solution with a toothbrush to clean discoloration
A
H pylori
GI
acetaminophen
PPI
calcium
brown-black hairy tongue
bleach
14
Q
IBD – Oral / Dental Manifestations
- Aphthous ulcers (____)
- Major and minor
- Possible association with nutritional deficiencies
- Iron / folate / B12
- Pyostomatitis vegetans (____)
- Hairy leukoplakia (____)
- Deep, linear ulcerations in vestibular folds (____)
- Cobblestone lesions (____)
- Lip swelling (____)
- Oral lichenoid drug reactions (____)
A
UC/CD UC UC CD CD CD UC/CD
15
Q
IBD
* Minor aphtous ulcer > \_\_\_\_ in shape > \_\_\_\_ pseudomembrane * Multiple aphtous ulcers > can be \_\_\_\_ and affect oral intake * Major aphtous ulcer in a patient with UC * Topical \_\_\_\_ can be effective
A
symmetric
yellow-white
painful
CS
16
Q
IBD
• Pyostomatitis vegatans • \_\_\_\_ appearance to the gingiva • Consider doing a biopsy bc it's not that easy to spot ○ \_\_\_\_ in histology
A
pustular
granulomatous
17
Q
IBD
• Oral hairy leukoplakia • On biopsy > OHL ○ She was \_\_\_\_ patient > treated with an \_\_\_\_ ○ Not as common anymore; more common in immunodeficient patients
A
immunocompetent
antiviral
18
Q
IBD
* Had a RC therapy done on the molar bc of a lesion in the vestibular fold > never changed after the RCT > nothing stood out in the RoS * Have been seeing \_\_\_\_ in his stoool > likely it's Chron's disease > postivie for Chrons and oral biopsy to confirm digagnosis of chron's > topical \_\_\_\_ and healed • \_\_\_\_ appearance * True lip \_\_\_\_ * Acute \_\_\_\_ of her lip
A
blood
medication
cobblestoning
swelling
angioedema
19
Q
IBD
• Lichenoid reactions
• Patient had lesions on ____ > told he had oral cancer
○ Biopsy > lichenoid inflammation to ____ that he was using
A
floor of mouth
medication
