Cerebrovascular disease

Question 1

Know what a stroke is and what causes it

Answer 1

• A stroke is the death of brain cells due to lack of blood flow

Types of strokes:
• Ischemic (blockage) stroke, most common
• Haemorrhagic (bleeding) stroke, least common

Question 2

List the risk factors that predispose individuals to an ischaemic stroke

Answer 2

• Hypertension
• High blood cholesterol
• Heart disease (inc. angina, atrial fibrillation, heart failure)
• Obstructive sleep apnoea
• Smoking
• Obesity
• Diabetes
• Age
• Family history
• Menopause
• Hypoperfusion stroke (shock)

Question 3

List the risk factors that predispose individuals to a haemorrhagic stroke

Answer 3

• Aneurism
• Hypertension
• Trauma
• Vessel malformation

Question 4

Understand the mechanism behind a stroke

Answer 4

• Depletion of local tissue oxygen
• Lack of oxygen will impact production of energy. This will cause neuronal activity to cease
• Voltage gradients cannot be maintained if the neuron has no energy
• Influx of Na+ ions into cell & calcium leaks from intracellular compartments
• Water moves in as it tried to dilute the high levels of calcium and Na+. However, this causes the neuron to swell and build up
• Neuronal death

Question 5

List stroke symptoms

Answer 5

• Sudden weakness or numbness of the face, arm or leg, usually on one side of the body
• Difficulty speaking or understanding language
• Decreased or blurred vision in one or both eyes
• Sudden, severe headaches
• Unexplained loss of balance or dizziness
• Transient ischaemic attacks: momentary loss of function to brain (lasting minutes up to 24 hours). Nearly half TIA events will lead to a stroke within 72 hrs.

Question 6

Understand the concept of symptom localisation

Answer 6

• Match the symptoms of the stroke with the part of the brain involved in controlling that part of the body under normal circumstances
• This may indicate where the lesion is in the brain

Question 7

List the oral manifestations of a stroke

Answer 7

• Loss of sensation of oral tissues
• Unilateral paralysis of orofacial muscles
• Inability to spit (expectorate) and swallow (dysphagia)
• Inability to manage oral secretions
• Inability to maintain a protective gag reflex
• Unable to talk
• Unable to reproduce a jaw posture necessary for a functional occlusion

Question 8

Know the oral health implications of stroke patients

Answer 8

• Pocketing of food
• OH impairment: caries, periodontal disease, halitosis
• Difficulty to control tongue during dental procedures
• Post-stroke depression
• Memory defects

Question 9

Know the dental management of these patients

Answer 9

• Delay non-essential treatment for 6 months after a stroke
• Positioning of patient
• Difficulty to control tongue during dental procedures
• Post-stroke depression
• Control of fluid and oral structure protection
• Emergency protocols eg. First-aid training, oxygen availability, resuscitation equipment
• Tailored oral hygiene regime; fluoride supplementation; frequent recalls