5. GI: Oral/Dental Considerations Flashcards by J L

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

appetite
belching
hiccups
pain

hematemsis
flatulence
constipation

EHR
negatives

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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”

erosion
dysgeusia
glossodynia
erythema

erosion
taste
burning

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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

medical
stability
undiagnosed
medical history
positioning

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Example of erosion
- ____ surfaces > higher rate of erosion due to exposure to gastric contents
- Occlusal surfaces > pitting feature

lingual/palatal

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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

mouthrinses
fluoride
alcohol
protect
durable

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Vinyl tray > not used for ____ habits

* Can be used with ____ or just as a protective device fro acidic contents

parafunctional

fluoride

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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 \_\_\_\_

erosion
vascular
candidiasis
xerostomia
glossitis
cheilitis

tongue
commissures

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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 \_\_\_\_

bled
pseudomembranous colitis
surface
antifungal

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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?

saliva
dry
shiny

caries
yeast

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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

menstrual
medications
hemorrhagic

pain
descript
target-like

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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

depapillated
color
erythematous
commisures
fungi
bacteria

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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

ASA / NSAIDs
alcohol
diagnosed
undiagnosed
medical history

weakness
cardiac output
palpitations

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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

H pylori
GI
acetaminophen
PPI

calcium

brown-black hairy tongue
bleach

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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 (____)

UC/CD
UC
UC
CD
CD
CD
UC/CD

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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

symmetric
yellow-white
painful
CS

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IBD

• Pyostomatitis vegatans
• \_\_\_\_ appearance to the gingiva
• Consider doing a biopsy bc it's not that easy to spot
	○ \_\_\_\_ in histology

pustular

granulomatous

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IBD

• Oral hairy leukoplakia
• On biopsy > OHL
	○ She was \_\_\_\_ patient > treated with an \_\_\_\_
	○ Not as common anymore; more common in immunodeficient patients

immunocompetent

antiviral

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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

blood
medication

cobblestoning
swelling
angioedema

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IBD

• Lichenoid reactions
• Patient had lesions on ____ > told he had oral cancer
○ Biopsy > lichenoid inflammation to ____ that he was using

floor of mouth

medication

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IBD

* Lichenoid reaction with a \_\_\_\_ tongue
* Asymptomatic
* Started \_\_\_\_ > made a temporal connection
* Can take weeks-months to resolve without topical therapy; sometimes lasts a year+

* Told oral cancer from a physician
* Patient using \_\_\_\_ on a regular basis for joint pain > looks like a lichenoid reaction > stop ibu and come back in a few weeks > resolved completely

fissured
medication
ibuprofen

IBD – Dental management

Thorough baseline ____
Diagnosis / management of condition to date
Review of systems
Stability of diagnosed disease
Recognition of undiagnosed disease
Need for medical consultation / referral

• Update ____ at each visit

medical history

IBD – Dental Management

Elective dental care during periods of ____
Avoid ____ / NSAIDs
Use of immunosuppressants
Increased risk of ____
Bone marrow suppression
____ suppression
Gingival overgrowth

• Laboratory evaluation

Caution with ____
Promote growth of C. difficile
- Patients may have low ____ and platelets
- Adrenal suppression > problems with ____ response especially during major surgery

remission
ASA
infection
adrenal
antibiotics
WBC
stress

IBD

• Fibrotic gingival overgrowht associated with \_\_\_\_

immunosuppressants

Pseudomembranous colitis
• Oral / dental manifestations
• ____

• Dental management
• Recognize signs / symptoms of PC
• Medical history
---• \_\_\_\_ use
---• Recent hospitalizations
---• Patient \_\_\_\_
---• Previous episode of PC and clinical outcomes
• Review of systems responses
• Need for \_\_\_\_ referral / consultation

Update ____ at each visit
- Higher frequency of developing yeast infections

candidiasis
antibiotic
age
medical
medical history

Celiac disease – oral / dental manifestations * Dental ____ defects * Delayed tooth eruption * Diagnosed with celiac disease before ____ years of age * Aphthous ____ * Atrophic ____ * ____ * Lichen ____ * ____

enamel 7 ``` ulcers glossitis cheilitis planus xerostomia ```

Celiac * Mild chielitis - doesn't look like angular ____ that we saw earlier * Mild inflam appearance

chielitis

Celiac * Classic ____ LP > picked up in patients incidentally * ____ * ____ texturely

reticular asymptomatic rough

Celiac disease – Dental Management * Thorough baseline ____ * Diagnosis / management of condition to date * Review of systems * Stability of diagnosed disease * Recognition of undiagnosed disease * Need for medical consultation / referral * Update ____ at each visit

medical history | medical history

Celiac disease – Dental Management * Gluten-free diet * Reduced ____ burden * Reduced ____ rate • Dental materials must be ____-free • Minimize risk of ____ of dental instruments with gluten- containing items • Medications must be ____-free • Dental materials must be gluten-free > may be difficult; if there's gluten it will be a problem

``` plaque caries gluten cross-contamination gluten ```

Eating Disorders – Oral / Dental Manifestations * Dental erosion * ____ teeth, lingual / palatal surfaces * Dry lips * ____ * Parotid gland swelling * ____ * Temporomandibular disorders • Dehydrated bc depleted of ____ ○ ____ glands begin to swell > more prone to infection or recurrent swelling

``` maxillary glossodynia xerostomia electrolytes salivary ```

Eating disorders * Amalgam restorations are sitting over ____ * Could be ____ hypertrophy instead of parotid gland problem

plane of occlusion | masseter

Eating Disorders – Dental Management * Thorough baseline ____ * Diagnosis / management of condition to date * Review of systems * Stability of diagnosed disease * Recognition of undiagnosed disease * Need for medical consultation / referral * Update ____ at each visit

medical history | medical history

Eating disorders - consider ____ needs

dental restorative

Gardner’s Syndrome – Oral / dental manifestations ``` Oral and maxillofacial findings • Multiple ____ • Multiple odontomas • ____ teeth • Impacted teeth • Congenitally missing ____ • Facial asymmetry ``` Dental management • No specific ____ • Involve more radiographic findings

osteomas supernumerary teeth recommendations

Gardner's syndrome * Multiple ____ are present * Attached to ____ surfaces

osteomas | mandibular

Plummer – Vinson Syndrome – Clinical Considerations ``` Oral / dental manifestations • ____-deficiency anemia • Atrophic glossitis • ____ • Dysphagia • ____ lesions ``` Dental management • No specific ____

iron dysphagia hyperkeratotic recommendations

PJ syndrome * ____ pigmentation is a classic manifestation * Located both periorally and ____

perioral | intraorally

Cowden’s Syndrome – Clinical considerations ``` Oral / dental manifestations • ____ lesions • Facial papules • ____ / oral papillomatous lesions • Oral ____ lesions • Oral fibromas ``` Dental Management • No specific ____

mucocutaneous perioral verrucal recommendations

Cowden's syndrome * Subtle on dorsum tongue * Verrucal * Papular

YAY

GI Neoplasia – Clinical Considerations * Oral / dental manifestations * No specific ____ * Related to complications of disease ``` • Dental management ____ • Cancer type • ____ • Disease course • ____ • Prognosis ```

findings medical history stage management

Dental Management of Patients Undergoing Chemotherapy * ____evaluation * Considerations during ____ * After ____

pre-treatment chemotherapy chemotherapy

Dental Management of Patients Undergoing Chemotherapy • Pre-treatment Evaluation * Past ____ and dental history * Laboratory ____ * Head and neck examination * ____ exam * ____ exam

medical evaluation extraoral intraoral

Dental Considerations * Active ____ and or peri-apical infections * Sites of potential infections * ____ defects * Salivary gland function * Dental ____ * Oral mucosal disease * ____ treated teeth and adequacy of fill * 3rd molars * ____-bearing surfaces for lack of irritation * Eliminate any source of ____ * Every one thing has to be taken into consideration for pre-chemo treatment

``` periodontal bony caries endodontically denture infection ```

Dental Management of Patients Undergoing Chemotherapy * Pre-treatment Evaluation * Panoramic and ____ radiographs should be evaluated * Potentially complicating oral disease should be eliminated prior to initiation of ____ * Dental procedures should be performed at least ____ days prior to the initiation of chemotherapy consistent with stable blood counts • Must be ____ stable to undergo dental extractions

periapical chemotherapy 14 hemaologically

* PA pathology below the root > may need to be ____ prior to starting chemo * Need a thorough ____ and radiographic evaluation

extracted | clinical

Dental Management of Patients Undergoing Chemotherapy During chemotherapy • Necessary (____) emergent dental treatment should be performed during chemotherapy to avoid potential complications • In most cases, dental procedures will need to be provided with ____ care * ____ not recommended if the patient is * ____ * ____ • More favorable to do the treatment before chemotherapy > patients are unstable, and will have low ____ counts and they'll be thrombocytopenic > more likely to develop ____ problems

``` minimal supportive flossing neutropenic thrombocytopenic blood bleeding ```

Dental Management of Patients Undergoing Chemotherapy During chemotherapy • ____ (Peridex®) rinses are recommended • Denture wearing should be kept to a ____ • Infections should be ____ and treated appropriately * Mucositis can be treated palliatively with oral ____ * May require systemic ____ • Peridex = ____

``` chlorhexidine minimum cultured anesthetics analgesia antimicrobial ```

Dental Management of Patients Undergoing Chemotherapy After chemotherapy • Between cancer chemotherapy episodes, ____ dental treatment should be performed • ____ evaluation is necessary • Antibiotic ____ should be considered in consultation with medical team • Not standard of ____ to give antibiotic prophylaxis in these patients after chemo, but primary team may want them bc they feel they're at an increased risk of developing infection

definitive hematologic prophylaxis care