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Clinical Dental Hygiene II > Chapter 63- pt w/ seizure disorders > Flashcards

Chapter 63- pt w/ seizure disorders Flashcards

1
Q

A paroxysmal (sudden) event that results from abnormal brain activity. May involve a loss of consciousness with or without convulsive movements or spasms

A

Seizure

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2
Q

Effects of gingival overgrowth

A 
Poses dental biofilm control problem
May affect mastication
May alter tooth eruption
May interfere with speech 
May cause serious esthetic concerns
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3
Q

Early clinical features of gingival overgrowth

A

Appears as a painless enlargement of interdental papilla with signs of inflammation. Tissue eventually becomes fibrotic, pink, and stippled, with a mulberry or cauliflower look

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4
Q

Advanced lesion of gingival overgrowth

A

Tissue increases in size and extends into the marginal gingiva and covers a large portion of the crown. Often cleft-like grooves between the lobules

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5
Q

Severe lesion gingival overgrowth

A

Large, bulbous gingiva May cover the enamel, tend to wedge the teeth apart and interfere with mastication

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6
Q

Microscopic appearance of gingival overgrowth

A

During therapy, phenytoin is found in the saliva, blood, sulcular fluid, and biofilm. Fibroblasts and collagen increase in number in the connective tissue. The stratified squamous epithelium is thick with longe rete ridges. Inflammatory cells are in greatest abundance near the base of the pockets

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7
Q

What appears to be the most important determinant of the severity of phenytoin induced gingival enlargement?

A

Biofilm

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8
Q

Contributing factors to gingival enlargement

A

Mouthbreathing
Overhanging restorations
Large carious lesions
Calculus and other biofilm retaining factors encourage gingival overgrowth

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9
Q

Treatments of gingival overgrowth

A

Change prescription
Nonsurgical treatment (scaling and biofilm control)
Surgical removal
Different diagnosis of medications causing gingival enlargement

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10
Q

The majority of patients with epilepsy or a history of seizure should receive the same level of dental care as the general population

A

True

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11
Q

Patient approach for someone with seizures

A

Provide a calm and reassuring atmosphere and treat the patient with patience and empathy
Encourage self expression
Recognize possible impairment of memory
Help pt develop an interest in caring for their mouth

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12
Q

Care plan prior to the start of phenytoin therapy

A

A rigorous biofilm control program and complete scaling are introduced

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13
Q

Initial appointment series for pt treated with phenytoin with slight or mild gingival overgrowth

A

Nonsurgical treatment including frequent scaling, can help tissue reduction. Frequent maintenance appointment can be important

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14
Q

Initial appointment series for pt treated with phenytoin with moderate gingival overgrowth

A

After the weekly biofilm instruction and scaling, re-evaluation of the tissue can determine if further procedures are needed.

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15
Q

Initial appointment series for pt treated with phenytoin with severe fibrotic overgrowth

A

Initial scaling and biofilm control are carried out to prepare the mouth for surgical pocket removal. Plans for changing the drug should be discussed with pts physician

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16
Q

Continuing care for someone with gingival overgrowth

A

Frequent appointments on a 1, 2, or 3 month recall depending on the severity of the gingival enlargement and the pts motivation to maintain their oral health

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17
Q

What has a vital part in the care of a pt with a seizure disorder?

A

Daily biofilm removal
Fluoride therapy
Sealants
Dietary control

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18
Q

Emergency care objectives for a pt with seizures

A 
Prevent body injury and accidents related to the oral cavity like..
Tongue bite
Broken or dislocated teeth
Dislocated or fractured jaw
Broken dentures
19
Q

Differential diagnosis of a seizure

A 
Syncope 
Migraine headache
Transient ischemic attack
Stroke
Sleep disorder
Movement disorders
Overdose of local anesthetic 
Hypoglycemia or insulin overdose
Hyperventilation
20
Q

Preparing for an appointment for a pt with seizures

A

Place emergency materials in a convenient location
Have pt remove dentures
Provide calm and reassuring atmosphere
Have other dental personnel ready in case of emergency

21
Q

Emergency procedures for a pt with seizures

A

No attempt should be made to restrain pt or stop convulsions
Terminate procedure and call for assistance
Protect pt from injury
(Don’t let them near anything sharp, don’t let them fall, monitor vitals, don’t put shit in their mouth, a bunch of obvious bullshit)

22
Q

When a seizure is still occurring or has recurred in 5 minutes activate emergency medical system

A

YES

23
Q

Emergency care in the postictal stage

A 
Complete the record or emergency 
Allow pt to rest
Talk to pt in low voice
Check oral cavity for trauma 
Contact pts family/friend
24
Q

Status epilepticus

A

One or more seizures that lasts more than 30 minutes. Brain injury can occur and result in long term morbidity or death.

25
Q

A term used to describe a group of functional disorders of the brain that are characterized by recurrent seizures

A

Epilepsy

26
Q

How is the diagnosis of seizures made

A 
Clinical signs and symptoms
History
EEG
Neuroimaging
Age-related onset
Symptoms
Location in the brain
27
Q

3 basic types of seizures

A

Generalized: Affects the entire brain at the same time
Focal: Involves only one part of the brain (partial)
Unknown: These include epileptic spasms

28
Q

Causes of seizures can be

A

Genetic, structural/metabolic, or unknown

29
Q

Prognosis for seizures

A

Good. 75% become seizure free

30
Q

Precipitating factors

A

Stress, apprehension, fatigue; sensory stimuli, like flashing lights, noises, peculiar odors, and use or withdrawal of alcohol or drugs

31
Q

Aura

A

Warning sign of seizure

32
Q

Primary prevention of seizures

A

involves avoiding brain injury with protective devices

33
Q

Secondary prevention of seizures

A

involves early detections and compliance with recommended treatment

34
Q

Tertiary prevention of seizures

A

involves interventions that decrease triggering factors that may cause seizures

35
Q

These drugs are used to control seizures

A

antiepileptic

36
Q

What medication is most common associated with gingival enlargement

A

Phenytoin

37
Q

How can herbal supplements affect dental treatment

A

increased bleeding

38
Q

Surgeries for epilepsy

A

Gamme-knife radiosurgery

Vagus nerver stimulation

39
Q

Epilepsy in itself produces no oral changes. Specific changes relate to the side effects of medications

A

TRUE

40
Q

Effects of accidents during seizures

A

Scars of lips and tongue

Fractured teeth

41
Q

How often does gingival overgrowth occur in pts on phenytoin

A

25% to 50%

42
Q

Mechanism of phenytoin and gingival overgrowth

A

Phenytoin may cause fibroblasts and osteoblasts to deposit excessive extracellular matrix, causing gingival overgrowth
Biofilm makes response worse

43
Q

Gingival overgrowth is greater in

A

Younger patients

Clinical Dental Hygiene II (14 decks)

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