Case Pres Flashcards
For case pres
why did you chose the radiographs you did?
Wanted to see the quality of the crown margins, the RCF and the periapical condition. Can also assess the bone levels. Although there were a lot, they were all useful and a larger view wouldn’t have been as beneficial for the information required and would have still necessitated further views
OPT – 70mGycm3, the PAs taken were between 0.57 and 1.13mGy
Dose of radiation reduced vs OPT and selective Pas for diagnosis.
What is psoriasis?
autoimmune disease
rapid growth of epidermal layer of skin. premature maturation of keratinocytes, DNA released from dying cells causes inflammatory reaction
What other conditions are associated with psoriasis?
arthtopathy lymphomas cardio vascular disease crohns disease depression oral psoriasis fissured tongue (possible erythema migrans)
what is the presentation of psoriasis?
red, dry, itchy scaly patches on skin koebner phenomenon (trauma triggering) elbows, scalp, knees symmetrically distributed 2nd/3rd decade 5 types - plaque, guttate, inverse, pustular and erythrodermic
What is the histopathology of psoriasis?
a. Surface epithelium has marked parakeratin production
b. Elongated rete pegs
c. CT papilla with dilated capillaries reach close to surface ep.
d. Perivascular inflammatory infiltrate Is present.
e. Collections of neutrophils are present in the parakeratin layer (munro abscess)
What are treatment options for psoriasis?
a. Psoralen and ultraviolet light a photo therapy
b. Treatment with steroid creams, D3 cream, UV light, immunosuppressants (methotrexate).
d. Non-biologic systemic treatments frequently used for psoriasis include methotrexate, ciclosporin, hydroxycarbamide, fumarates such as dimethyl fumarate, and retinoids
What is MOA of methotrexate?
Disease modifying anti-rheumatic drug. DMARD. Immune suppressant. Inhibits dihydrofolate reductase, reduces the turnover of DNA and RNA
Excreted by the kidneys. Anything that alters kidney function or interfered with excretion will increase blood concentrations
What are side effects of methotrexate?
Stomatitis
Interferes with folate. Anti inflammatory.
Increased concentrations are toxic to liver, kidneys, lungs and suppression of bone marrow.
Dose is 1 pw. Tablet.
Interacts with some AB and NSAIDs can reduce excretion
Give folic acid at a different day of the week to mtx – reduces the side effects
Liver and lung fibrosis
What do you need to be aware of with regards to dentistry and psoriasis?
drug interactions:
Must avoid anything containing trimethoprim. Only take NSAIDs if GP has prescribed them.
Lower risk if taking if for psoriasis and with normal renal function
Increased risk of infection - impaired neutrophil production
Oral psoriasis
What are you careful with regards to patients XLA when on methotrexate?
Liver function – can cause problems with bleeding. Suppression of bone marrow – leading to reduction in neutrofils. Reduction of immune system function, increased chance of infection following extraction. but the risk is not such that pre-emptive ABs are needed
What blood tests are required when patient is on methotrexate and why?
Blood dyscrasias and livere cirrhosis occurs with low dose methotrexate. Pts have full blood count, liver and renal function tests every 1-2 weeks until stable, and then monitored every 2-3 months
What is case pres patients oral cancer risk?
stopped smoking >12 years ago, smoking related oral cancer risk is back to normal
psoriasis increases chance of lung cancer and lymphoma
methotrexate increase incidence of hodgkins and non hodgkins lymphoma
How would you treat a patient with BPE
323
223
repeat BPE at next appt. detailed perio charts of sextants scoring 3 after treatment (BSPD guidelines)
What guidelines are you following for case pres?
smoking cessation guidelines alcohol guidelines BSPD - for perio FGDP for radiographs BNF - drug interations
What are different options for temporary replacement of an extracted tooth
over denture
do nothing
temporaty bridge and crown
