Auto Immune Disease Flashcards
1
Q
What is immunologic tolerance?
A
Body’s ability to discriminate between it’s own antigens and foreign antigens
2
Q
What is autoimmunity?
A
Immumnologic tolerance fails, activating T cells and immune system attacks its own tissues
3
Q
What are the two primary triggering factors for autoimmune disease?
A
Genetics and environmental triggers (infection, fever, trauma)
4
Q
Dental considerations for dental pts. w/ autoimmune disease
A
- 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
5
Q
What are we considering when assessing the patient?>
A
- 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?
6
Q
What will need to be considered when making a diagnosis?
A
- 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
7
Q
What should be considered when treatment planning?
A
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?
8
Q
What should be included in the evaluation at their recare appointments?
A
- Assess the host response
- Reinforce self care
- Do they need additional treatment?
- Were your goals met?
9
Q
Characteristics of rheumatoid arthritis?
A
- 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
10
Q
Signs and symptoms of rheumatoid arthritis
A
- 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
11
Q
Which RA petients are nodules most often seen in?
A
People who take methotrexate (antimetabolic- decreases the activity of the immune system)
12
Q
What are the differences between RA and osteoarthritis?
A
- 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
13
Q
How is diagnosis of RA made?
A
- 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
14
Q
Tx of RA
A
- Rest, exercise, stress reduction, care of joints
- NSAIDS
- Steroid injections
- Gold injections
- Disease-modifying antirheumatic drugs such as methotrexate
- Surgery
15
Q
DH care for pts w/ RA
A
- 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
16
Q
What instructions should be given to an RA patient with TMJ pain?
A
Moist heat or ice, soft diet, occlusal appliance
17
Q
In what percentage of RA cases does TMJ occur?
A
75%
18
Q
TMJ symptoms
A
- Preauricular pain
- Tenderness, swelling
- Stiffness, decreased mobility
- Locking, crepitus
- Radiographic changes: Erosion of condyles, reduced translation, sclerosis of the condyle eminence
- Anterior open bite
19
Q
Characteristics of myasthenia gravis
A
- Autoimmune neuromuscular disease characterized by weakness and fatigue of the voluntary muscles
- Breakdown in connection from your nerves to your muscles
- More often in women
- Thymus gland involvement
- Progressive
- Affects DH care
20
Q
Signs and symptoms of myasthenia gravis
A
- Weakness in the legs
- Fatigue
- Shortness of breath
- Weak voice
- Weakness worsens w/ exercise and improves w/ rest
- Fatigue worsens throughout the day
- Drooping eyelids- double vision
- Difficulty swallowing- soft palate weakness
- Respiratory muscles affected= serious complications
21
Q
How is myasthenia gravis diagnosed?
A
- Administration of drugs that will temporarily improve muscle strength
- Nerve stimulation tests
- Ice pack tests
- CT of thymus
22
Q
Treatment for myasthenia gravis
A
- Aimed at remission
- Drugs
- Surgery to remove the thymus- may take years to improve
- Treatment similar to dialysis to remove antibodies but only lasts a few weeks
23
Q
Considerations for DH care for pts with myasthenia gravis
A
- Med hx
- Short appts early in the day
- Frequent recare
- Stress reduction, cool room
- Reduce infection
- N2O can reduce anxiety
- Watch other meds
- Potential respiratory risk
- Power scalers and air polishing contraindicated
- Mouthprop
- Dark glasses
- Diet eval
- OHI
24
Q
What may cause a myasthenic crisis?
A
- Undermedication
- Respiratory muscles become too weak to do their job
- Unable to speak, swallow, double vision, drooping eyelids, rapid shallow breathing, anxiety
25
What may cause a myasthenia gravis cholinergic crisis?
* Overmedication (too much acetylcholine)
* Symptoms will occur 30-60 min after meds
* Signs will occur within 1 hour (SLUD- but not always)
26
What is scleroderma?
* Chronic autoimmune rheumatic condition
* CT disorder- over production- hardening and tightening
* Not genetic- just susceptibility gene
* Cause is unknown
* Localized or systemic but more often localized
* Onset at 30-50 years
* More common in women
27
Characteristics of scleroderma
* Depression, fatigue, pain
* In organs- BV and digestive tract
* Joints and muscles
* Sjogren's syndrome
* Raynaud's Phenomenon- response to cold and stress- vasoconstriction- pain and color changes to fingers and toes
28
How is a diagnosis made of scleroderma?
* Blood tests- look for antibodies
* Specialized tests- breathing tests, CT of lungs
29
Treatment for scleroderma
* No cure
* Depends on affected organs- skin will often diminish in 3-5 years
* Drugs- immune suppress therapy, relieve pain
* Physical therapy
* Esophageal dilation
* Mouth exercise
30
Scleroderma oral characteristics
* Affects the head and neck region in more than 70% of pts
* Tooth mobility
* Xerostomia- excess colagen in glands- fibrosis- administer pilocarpine or saliva substitutes when severe
* Issues w/ speaking, chewing and swallowing
* Widening of periodontal space
* Asymptomatic alveolar bone resorption--> increased risk for mandibular fractures
* Pt more prone to oral disease due to xerostomia, carb rich, soft diet, poor OH
31
DH considerations in care for pts w/ scleroderma
* Microstomia complicates care
* Purpose is to preserve teeth
* Frequent recare appts
* Meds and oral effects
* Physician conault
* Pre-med
* Short appts
32
How should the patient be cared for in the operatory?
* Warm room
* Anti-anxiet pre-med
* Humidifier
* Semi-supine
* Mouthprop
* X-rays
* Anesthesia
* Ultrasonic and air polishing
33
OH instruction for pts w/ scleroderma
* Flossing aids
* Enlarged TB handle
* Finger cots for flossing
* Smaller head TB
* Diet counseling
* Oral exercises
34
What is Sjogren's syndrome?
* Chronic systemic rheumatic autoimmune disease
* Causes dry eyes and dry mouth
* Can occur at any age but more common in women over 40
* Causes are typically unknown but can also be causen by genetics or Epstein-Barr virus
35
Characteristics of Sjogren's syndrome
* Usually accompanied by other autoimmune diseases like RA or lupus
* Skin rashes- dryness
* Joint pain and stiffness
* Affects internal organs- lungs, kidney infection and cirrhosis of liver
* Lymphadenopathy
36
Oral characteristics of Sjogren's syndrome
* Reduced saliva
* Difficulty swallowing, altered taste, difficulty wearing dentures, candida, burning mouth, mucositis, angular cheilitis
* Increased dental disease- very high risk for caries
* Fissure tongue and atrophy of papilla
* Firm enlargement of salivary glands
37
How is Sjogren's diagnosed?
* Physical exam
* Blood studies- check for antibodies, rule out liver or kidney problems
* Salivary function studies- sialogram and salivary scintigraphy
* Eye tests- Schrimer test- tear production
* Biopsy of lower lip glands
38
Treatment for Sjogren's
* No cure
* Palliative tx
* Moisturizers, lubricants, sialagogues
* Artificial tears
* Salivary substitutes
* Xylitol gum
* Meds- pilocarpine, immunosuppressants and plaquinil
* Sinus lavage and topical corticosteroid
* Analgesics- if w/ RA
* Prognosis is good
39
Sjogrens DH care
* IO/EO Exam- glandulr swelling, lymphadenopathy
* Tx of xerostomia- saliva substitutes
* Caries control- Fluoride
* Hydration for burning tongue
* Antifungal meds for secondary infections
40
What is multiple sclerosis?
* Chronic progressive degeneration of the myelin in the brain and spinal cord
* Affects the CNS by damaging the myelin sheath that surrounds the nerves
* Damaged areas are called plaques
* Motor, sensory, cognitive and emotional changes
* 4 categories of M.S.: relapsing-remitting, secondary progressive, primary progressive, progressive relapsing
41
What are the causes of M.S. and who does it affect?
* Unknown
* Most likely genetics
* Viral from Epstein-Barr
* Abnormal immunological event
* Lack of essential fatty acids, environmental factors
* Occurs in ealry adulthood- 20-40 years
* Affects mostly women
* More common in cold and temperate climates
42
Characteristics of M.S.
* Weakness and fatigue
* Loss of bowel or urinary function
* Tremor of upper extremities
* Loss of balance and equilibrium
* Lack of coordination
* Involuntary motion of the eyes
* Blurred double vision
* Numbness and tingling of extremities
* Paralysis
* Susceptibility to upper respiratory infection
43
Oral characteristics of M.S.
* 2-3% of the pop w/ MS
* Trigeminal neuralgia
* Paresthesia- facial numbness/pain
* Xerostomia from meds
* Facial palsy
* Speech disorders
44
How is MS diagnosed?
* Blood test to look for markers- rule out other diseases
* MRI- for brain lesions
* Spinal tap for antibodies
* EMG
45
Treatment for MS
* Purpose is to prevent relapse
* Meds to treat attacks- corticosteroids
* Plasma exchange for severe cases
* Meds to prevent progression
* Nutrition
* Rest
* Avoid strain
* PT
* Light exercise
46
DH care for MS
* Optimal time for DH is during remission
* Relapse can be brought on by infection
* All tx planning dictated by health of pt
* Frequent recare
* May need modified HC aids
* Shorter AM appts
* Comfortable, stress-free environment
* Xerostomia- Fluoride and saliva substitutes
