Autominue conditions Exam 6 Flashcards
What is scleroderma?
- It is connect tissue disorder characterized by collagen overproduction
- progressive systemic sclerosis
- Cause is unknown: microvascular abnormalities, irregular collagen
- Physical symptom: immobility, rigifity of skin, inflammation
- Occurs at 30-50 years any age
- 2-5 times more common in FEMALEs
What are some notable changes with scleroderma?
- skin, gastrointestinal tract, kidney, heart muscles, lungs
- eventual death from renal failure , cardiac failure, pulmononary insufficiency, intestinal malabsorption
What are the clinical presentation for scleroderma?
Joints: pain, swelling, stiffness of fingers and knees
* Polyarthritis: symmetrical
* Skin: hard and fixed, ivory- white, yellow or gray
* Face: Mask-like, expressionless
What are the Oral presentation for scleroderma?
Lips: thin, rigid, difficulty opening and closing
* Mucosa: thin, pale, tender, rigid, poor healing
* Gingiva: pale, usually firm
* Teeth: increased mobility
* Radiographic findings: widened PDL
* Mastication: difficult; limited TMJ movement
* Tongue: immobile, speech difficult
What are the medical management for scleroderma?
- Physical therapy
- Maintain normal actvities
What are the dental management for scleroderma?
- Preserve teeth and gingival health
- Prevent extensive treatment
- Dentrue fabrication and wear difficult
- Sensitivity to cold and dampness
What is systemic lupus erythematosus ?
- Immune system attacks its own tissues, causing widespread inflammation and tissue damage to affected organs
- Can also affect joints, skin, brain, lungs, kidneys, and blood vessels.
- Unknown cause
- Possible triggers: infections, stress, diet, toxins, drugs, sunlight
- Affects women 8-10x more than men
Signs and Symptoms: Butterfly or malar rash (across nose and cheeks)
What is the medical management for lupus?
- Same medications as other rheumatologic disorder
- Observation for renal cardiac and clotting issues
- Avoid sun exposure
What is the dental management of
- Consider physician consult to determine patient needs based on disease status at time of appointment
- Review oral side effects of medications
- Possible antibiotic premedication → if taking corticosteroids or cytotoxins and have leukopenia
- Thrombocytopenia → Obtain platelet count for abnormal
bleeding (should be 50,000/mL)
What are the oral manifestations and complications for lupus?
- Lesions on lips and mucosa- red with white spots;
- Possible painful mucosal ulcerations; resemble lichen planus
- Xerostomia
- Hyposalivation
- Dysgeusia
- Glossodynia
What is Sjogrens Syndrome
An immune system disorder characterized by dry eyes and dry mouth. The bodys immune system attacks its own healthy cells that produce saliva and tears
unknown cause
What can sjorgens syndrome lead to?
- Keratoconjunctivitis sicca (dry eyes)
- Xerostomia
- Connective tissue disease
What is the clinical presentation of sjogrens syndrome?
- Dry eyes
- Hyposalivation/xerostomia
- enlarged parotid gland
What is the medical management ?
Medications: Hydroxychloroquine (plaquenil)
Eyes: Cyclosporine
Saliva: Pilocarpine
Immunosuppressives: Methotrexate
NSAIDS
What are the dental management for Sjorgens?
- Focus on palliative and preventive care → relief of symptoms and normal homeostatic environment
- Moisture and lubrication
- Treat conditions → mucositis or candidiasis
- Prevention → OHI, nutritional counseling, importance of frequent recare
What is rheumatoid arthritis?
- Chronic, immunologic systemic disease exhibiting inflammation of joints particulary hands feet and knees
- Cause: unknown
- Occurs in 20-40 years and any age
- More females
What are the signs and symptoms of Rheumatoid Arthritis?
- Joint pain and swelling
- Morning stiffness; stiffness after inactivity
- Weakness, fatigue, loss of appetite and
weight, anemia, low-grade fever - Progressive deformity, limited motion and
muscle atrophy
What is the medical management for rheumatoid arthritis?
- Pain relief and prevent joint damage
- Medications: Corticosteroids, NSAIDs
- Disease modifying antirheumatics: (Methotrexate, Plaquenil, Azulfidine, Arava, Imuran), Biologic agents to slow disease (Azathioprine, Cyclosporine)
- Physical and occupational therapy
- Joint replacement surger
What is the dental management for rheumatoid arthritis?
- Assistance with ambulation
- Adjust chair based on patient comfort
- Short appointments and frequent breaks
- Physical supports like pillows, etc. especially for long appointments.
- Medications for condition?
- Bleeding related to medications
- Corticosteroid therapy puts patient at risk for adrenal suppression, Immunosuppressive agents → anemia, agranulocytosis, thrombocytopenia, Possible physician consult for lab test results
- Joint replacement? Premedication?
- Radiographic narrowing of joint space,
articular surface irregularities, bone spurs,
sclerosis, remodeling - TMJ disc replacement
- Difficulty grasping a toothbrush or lifting arm
- Instrumentation
- Fatigue of TMJ
- Minimize pressure on mandible
What is Psoriasis ?
- Chronic disease where the immune system becomes overactive, causing skin cells to multiply too quickly
What is Psoriatic arthritis?
A form of arthritis that affects some people who have the skin condition psoriasis
What is the clinical presentation for psoriasis and prsoriatic arthritis?
- Flaky skin patches
- Swollen fingers and toes with pain
- Foot pain
- Lower back pain
- Small dents or pits in nails; nails may crumble or separate from the nail bed
- Eye inflammation including eye pain, redness, blurry vision; may lead to vision loss if untreated
What is the medical and dental management for psoriatic arthritis ?
Medical Management
* Medications
* Abatacept: Decreases blood level of cytokines and inflammatory proteins
* Enbrel: Reduce symptoms such as swelling, stiffness, and joint pain (used for severe RA)
Dental Management
* Same as a patient with Rheumatoid Arthritis
* May reschedule if skin lesions causing discomfort
What is osteoarthritis?
- Most common degenerative joint disease
- Affects weight-bearing joints in particular
- Inflammation not joint problem
- Unknown cause
What is predisposing factors for osteoarthritis?
Repeated trauma, obesity, age-related changes, mechanical stress, genetic predisposition
Occurrence
* 50-70 years old
* Onset 20 years later than rheumatoid arthritis
What are the symptoms of osteoarthritis?
- More pain, deformity, limited movement in a single joint
- Hips, knees, fingers, vertebrae
- Dull ache and stiffness in morning or after inactivity; diminishes with exercise
- Pain aggravated by temperature changes; bearing body weight
What is the medical management for osetoarthritis?
- Moderate exercise
- Pain-relieving drug therapy
- Weight reduction for obese patients
- Physical therapy
- Orthopedic surgical procedures
- Total hip or knee joint replacement
- Analgesic medications: Acetaminophen, aspirin, NSAIDs, steroid injections
What is Fibromyalgia ?
- Chronic disorder that causes pain and tenderness, fatigue, and trouble sleeping.
- Heightened sensitivity to pain
What is the medical management for fibromyalgia?
- Heterocyclic and selective
serotonin reuptake inhibitor - Antidepressants
- Anticonvulsants
What is the dental management for fibromyalgia?
- Consider comfort level of patient and adjust chair
accordingly - May cause TMJ pain which worsens throughout the day so
morning appointments may be considered
