lupus erythematosus - what - 2 types - what do the oral lesions mimic - what feature of the lesions separate it from the other disease - what antibodies are associated

- autoimmune CT disease, - systemic/cutaneous - Lichen Planus - discrete, unilaeteral lesion. Most are patches of atrophy/keratosis on H/S palate - ANA/DSDNA

stroke - risk - sources - complications/dental WHAT PART OF MOTOR NEURONE AFFECTED

- hypertentsion/smoking/alcohol/AF/IHD/diabetes mellitus - infarction/haemorrhage/subarachnoid haemorrhage/venous thrombosis - motor function loss/swallowing difficulty/sensory loss/cognitive impairment UPPER motor neurone - muscle spasm/LOWER - muscle atrophy -dental - impaired dexterity/mobility/communication difficulty/cardiac emergency (MI/FURTHER STROKE)/lack of protective reflexes

osteoarthristis - symps - treatment - dental considerations

degenerative joint disease - cartilage repair dysfunction - pain - worse in morning/improved with rest, loss of joint space on Rg - NSAIDs/replace joint - TMJ involvement/chronic NSAID use - bleeding risk/oral ulceration

Rh arthritis - early signs - late signs - dental

early-symmetrical synovitis of: MCP/PIP/wrist joints late-hyperextension of PIP/ulnar deviation at PIP/z deformity of thumb/subluxation of wrist/feet and ankle deformity - reduced dexterity/sjogren associated/joint replacement - drugs-NSAIDs (bleeding/OU)/Steroids (inf risk)/oral pigmentation and ulceration-methotrexate/oral lichneoid reaction - gold - atlanto axial instability

ALL Qs Flashcards by Amy C

lupus erythematosus - what

2 types
what do the oral lesions mimic
what feature of the lesions separate it from the other disease
what antibodies are associated

autoimmune CT disease,
systemic/cutaneous
Lichen Planus
discrete, unilaeteral lesion. Most are patches of atrophy/keratosis on H/S palate
ANA/DSDNA

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Lupus erythematosus

management
dental considerations

-immune suppression/analgesics
-chronic anaemia/bleeding risk/renal disease (drug met)
immunosupression (inf risk)/lichenoid reactions/oral pigmentation

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what is lupus anticoagulant
symps
important info

anti-phospholipid antibody syndrome
-recurrent thrombosis

NEVER STOP ANTICOAGULANT

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sjogren - antibodies associated

Snti Ro/La/ANA

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systemic sclerosis - what
antibodies
dental considerations

excessive collagen deposits - loss of elastic tissue
anticentromere(local)/anti scl70 (generealised)
-reduced mouth opening/dysphagia/renal disease - reduced drug metabolism/raynaud’s syndrome

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Giant cell (temporal) arteritis
what
major complication
tests
managed

pain - facial/headache
chewing claudication
occlusion of central retinal artery - blind
-ESR > and c reactive protein
high dose steroids - prednisolone 60mg

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MS
what
sign/symp
dental

demyelination of axons, progressive functional loss
-muscleweakness/dysarthria/tremor/spasticity/visual disturbance/altered reflexes/balance and hearing loss/proprioreception loss
-limited mobility/chronic orofacial pain/sensory disturbance
>trigeminal neuralgia risk

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Parkinson’s - what
features
dental

degeneration of dopaminergic neurones in substantia nigra (basal ganglion)
-bradykinesia/resting tremor/difficulty initiating movement/rigidity/impaired gait/mask like face/swallowing issues/communication issues

-difficulty accepting /tremor/dry mouth from antiparksonian drugs

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epilepsy -what

classification

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tonic clonic seizure features

precipators

prodromal dura, LOC, postictal drowsiness, hypoxic

alcohol/lights(strobe)/poor medical compliance/stress or fatigue

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tretament of epilpsy

preventative - gaba receptor action/sodium channel
surgery

carbamazepine/valproate/phenobarbitone
GABA - BZD/valproate
sodium channel - carbamazepine/phenytoin

surgery - removal of focal neurological lesion

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dental complications of epilepsy

fit complications - ST injury/emergency

drugs
phenytoin=gingival hyperplasia
anticonvulsants=xerostomia
valproate=bleeding risk

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stroke

risk
sources
complications/dental

*WHAT PART OF MOTOR NEURONE AFFECTED

hypertentsion/smoking/alcohol/AF/IHD/diabetes mellitus
infarction/haemorrhage/subarachnoid haemorrhage/venous thrombosis
motor function loss/swallowing difficulty/sensory loss/cognitive impairment

UPPER motor neurone - muscle spasm/LOWER - muscle atrophy
-dental - impaired dexterity/mobility/communication difficulty/cardiac emergency (MI/FURTHER STROKE)/lack of protective reflexes

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osteoarthristis

symps
treatment
dental considerations

degenerative joint disease - cartilage repair dysfunction

pain - worse in morning/improved with rest, loss of joint space on Rg
NSAIDs/replace joint
TMJ involvement/chronic NSAID use - bleeding risk/oral ulceration

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Rh arthritis

early signs
late signs
dental

early-symmetrical synovitis of: MCP/PIP/wrist joints
late-hyperextension of PIP/ulnar deviation at PIP/z deformity of thumb/subluxation of wrist/feet and ankle deformity

reduced dexterity/sjogren associated/joint replacement
drugs-NSAIDs (bleeding/OU)/Steroids (inf risk)/oral pigmentation and ulceration-methotrexate/oral lichneoid reaction - gold
atlanto axial instability

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osteoporosis

risk
effect
prevent

Loss if mineral/matrix - reduced bone density
female/age/genetic/race (caucasian)/inactivity/smoking/poor dietary calcium/early menopause/antiepilectics/steroid use
greater # risk/scoliosis/height loss

-daily excersise and calium/HRT

HRT for osteoporosis issues

Bisphosphonates

Oestrogen - breast cancer risk and endometrial cancer risk
>DVT risk
Bisphosphonates - MRONJ risk

chemotherapy side effects

rapidly dividing cells killed - hair loss/oral ulceration
later cancer risk/nephrotoxicity/taste loss
-oral - xerostomia/halitosis/mucositis risk/ulcers/greater bleeding and bruising/>inf risk

Radiotherapy side eff

Xerostomia
Osteoradionecrosis
Increased risk of infection
Increased risk of poor wound healing
Caries
Oral ulceration
Dry mouth/taste loss
Burns

microcytic anaemia blood results

MCV<80,

GI conditions causing microcytic anaemia

Crohn’s, UC, Carcinoma

Oral consequences of microcytic anaemia

Recurrent aphthae
o Poor wound healing
o Generalised Mucosal atrophy
o Increased Candida infection
o Atrophic glossitis
o Tenderness or burning sensation of oral mucosa

white plaque that scrapes off leaving erythematous base - diagnosis

pseudomembranous candidosis

local and medical condition that cause ps candidosis

local - inh steroid use/nutritional def/broad spe AB

med - HIV/immunocomprimised/diabetes mellitus

oral swab vs oral rinse

Oral swab § Simple and site specific but can be easily contaminated and uncomfortable o Oral rinse § Records whole mouth and can separate healthy organisms but is not site specific and some patients find the rinse process difficult to do. § It is a quantifiable amount but difficult to standardise

features of erythematous candidosis | newton's classification

burning sensation/halitosis/erythema and oedema of denture bearing area/bad taste -newton I - localised inflammation/hyperaemic foci II - diffuse inflam confined to denture bearing mucosa III - granular inflam, erythema and papillary hyperplasia

what can cause smokers/traumatic keratosis - what histological features may indicate malignancy - what clinical features may indicate malignancy

``` Tobacco smoke o Pipe smoking o Long term drinking of very hot beverages o Chronic inflammation o Drugs – hydroxychloroquine ``` ``` -Hyperkeratosis o Hyperchromatism o Atypia o Dysplasia o Infiltrate of macrophages ``` ``` -Raised rolled border o Indurated (hard) lesion o Non-homogenous (speckled, flat and raised area) ```

desquamative gingivitis - what | -what conditions have this

It is the clinical descriptive term of non-specific clinical expression in the gingivae (redness, burning, erosion, pain and plaque) of several dermato-mucous disorders -LP/Pemphigoid/pemphigus

what exaccerbates DG

``` Smoking o Plaque build up o Poor overhanging restorations o Partial dentures o SLS toothpaste ```

how to treat DG

Confirm diagnosis and any underlying conditions and manage these appropriately § Blood tests § Immunofluorescence assay o Treat underlying cause: § Allergy to SlS – use SLS free toothpaste o Improve oral hygiene as plaque aggravates lesions/smoking cessation o Topical steroid use – betamethasone § rinse or meter dose inhaler or use of steroid cream in gum shield o Topical tacrolimus immunomodulator mouthwash rinse or cream o Systemic immunosuppressant

cause of pigmented patch on mucosa

Local: § Amalgam tattoo due to macrophages (melanin) and granulation tissue surrounding amalgam § Pigmented Incontinence linked with chronic inflammation § Macule (flat) due to increased melanin production § Naevus (raised) due to increased melanocytes § Mucosal melanoma secondary to metastatic cancers § Vascular malformations (haemangioma) o General: § Racial/familial § Smoking = leakage of melanocytes and sub-mucosal fibrosis § Medications – contraceptive pill, iron tablets, antimalarials § Addison’s disease – reduced cortisol and aldosterone from adrenaline glands causes brown patch due to increased ACTH