Auto Immune Disease Flashcards
What is immunologic tolerance?
Body’s ability to discriminate between it’s own antigens and foreign antigens
What is autoimmunity?
Immumnologic tolerance fails, activating T cells and immune system attacks its own tissues
What are the two primary triggering factors for autoimmune disease?
Genetics and environmental triggers (infection, fever, trauma)
Dental considerations for dental pts. w/ autoimmune disease
- Pt. may need several dental specialists
- Make pt. aware of oral complications related to their disease
- May need palliative treatment for discomfort
- 2-3 month recare appointments
- Assess overall health
What are we considering when assessing the patient?>
- Their medical/dental histories
- Is it safe to provide treatment?
- Do thei rmedical needs supersede their need for oral care?
- Are they showing signs of a disease they were not diagnosed with?
- Do they need a referral?
What will need to be considered when making a diagnosis?
- Human needs assessment may differ, depends on the disease
- Diagnosis will be based on the needs of the pt during diagnosis
- Use objective and subjective assessment to make a diagnosis and support proposed treatment
What should be considered when treatment planning?
Tx may be complicated due to medical issues
Coordinate care w/ medical care
Shorter appts (joint pain/stiffness)
Supportive devices may be needed
Advocate for the pt- are their needs met by their medical team?
Do they need to be scheduled at certain times?
What should be included in the evaluation at their recare appointments?
- Assess the host response
- Reinforce self care
- Do they need additional treatment?
- Were your goals met?
Characteristics of rheumatoid arthritis?
- Inflammatory destruction of the joints
- Unknown cause
- Connective tissue disease
- Body interprets synovial membrane as a threat– attack causes buildup of fluid in the joint
- Systemic
Signs and symptoms of rheumatoid arthritis
- Onset is between ages 20-40
- Joint pain, swelling, warmth
- Fingers, hands, knees and feet affected first
- Women affected more
- Hip joint least affected
- Stiffness in AM and after activity
- Some people develop nodules
- RA and perio are both chronic inflammatory diseases
- Can affect the TMJ
Which RA petients are nodules most often seen in?
People who take methotrexate (antimetabolic- decreases the activity of the immune system)
What are the differences between RA and osteoarthritis?
- RA involves multiple joints, OA just one
- RA has pain w/ inflammation, OA can have pain w/o inflammation
- In RA, morning stifness lasts longer
- RA has systemic manifestations like fatigue and fever, OA has no systemic involvement
- RA can develop at any age, OA only in elderly
How is diagnosis of RA made?
- Med hx, physical, lab studies, radiographs
- Diagnosis depends on signs/symptoms/diagnostics
- Must include 4 criteria for RA: AM stiffness, 3 or more areas, arthritis of hand joints, symmetric, nodules, serum rheumatoid factor, radiographic changes
- Differential diagnosis can be made to rule out other diseases like lymes, scleroderma, osteoarthritis, fibromyalgia, sjogrens and TMJ
Tx of RA
- Rest, exercise, stress reduction, care of joints
- NSAIDS
- Steroid injections
- Gold injections
- Disease-modifying antirheumatic drugs such as methotrexate
- Surgery
DH care for pts w/ RA
- Medical consult
- Examine relationship btw RA and perio: elevated erythrocyte sedimentation rate– the fewer the teeth, the greater the risk for joint inflammation
- Watch instrumentation- delayed healing
- Watch TMJ- limited opening
What instructions should be given to an RA patient with TMJ pain?
Moist heat or ice, soft diet, occlusal appliance
In what percentage of RA cases does TMJ occur?
75%
TMJ symptoms
- Preauricular pain
- Tenderness, swelling
- Stiffness, decreased mobility
- Locking, crepitus
- Radiographic changes: Erosion of condyles, reduced translation, sclerosis of the condyle eminence
- Anterior open bite
