CMS Flashcards
what types of disease can arthersclerosis cause?
ischaemic heart disease
peripheral vascular disease
cerebrovascular disease
renovascular disease
what are the biggest risks of heart disease?
smoking high cholesterol high bp diabetes genes
what is primary hypertension?
caused by obesity, alcohol, high salt diet, genetics
what is secondary hypertension?
endocrine - excess hormones
renal - kidneys not working
what drugs are used in the tx of hypertension?
B blockers duiretics ACE inhibitors angiotensin 2 inhibitors Ca channel blockers
what are the types of ischaemic heart disease?
angina
acute coronary syndromes
heart failure
arrhytmias
what are the types of peripheral vascular disease?
chronic - intermittent claudication
acute - ischaemic limb
what medications manage angina?
antiplatelets
statins
symptom relief - nitrates, calcium antagonists, B blockers
why can heart failure happen?
IHD
hypertension
valvular heart disease
alcohol excess
why should NSAIDs be avoided in heart failure?
fluid retention
what is regurgitation?
stenosis?
- leaky valve
- narrow valve
what do patients with valvular disease at risk of?
what is it caused by?
infective endocarditis
strep viridans
staph aureus
what is AF associated with? what does it cause an increased chance of?
cerebrovascular disease
Stroke
what is SVT?
tachyarrhytmia - too fast and irregular
adenosine
what is bradyarrhytmia?>
too slow
what is Ventricular arrythmia?
tachycardia
med emergency
what oral side effects can statins cause?
Taste disturbance
lichenoid reaction
what oral side effects can beta blockers cause?
lichenoid reactions
what oral side effects can nifedipine cause?
hyperplasia
what oral side effects can ACE inhibitors cause?
taste disturbance
lichen planus
what oral side effects can nicorandil cause?
painful oral ulcers
what oral side effects can antihypertensives cause?
dry mouth
in what situations would you not treat a cardiac patient?
1 month post MI
unstable angina
why should you be cautious with adrenaline?
interacts with vasoconstrictors
what are the links of IE and dentistry?
no association with dental procedures
reg TB as much of a risk
prophylaxis not cost effective
what patients are at risk of IE?
valvular heart disease
valve replacement
structural congenital heart disease
prev IE
what oral side effects can anaemia cause?
recurrent apthous stomatitis - minor, major, herpetiform
what oral side effects can type 2 diabetes cause?
acute pseudomembranous candidosis
what is burning mouth syndrome and what can it be associated with?
idiopathic burning and oral discomfort
amitryptiline, gabapentin
if a lichen planus pt has an oral lesion what percent chance do they have a skin lesion?
if they have a skin lesion percent chance of an oral lesion?
25-30%
70-75%
opthalmic disease can be associated with what orally?
mucous membrane pemphigoid
what can GI disease be associated with orally?
recurrent oral ulceration
what can HIV/AIDS present with orally?
hairy leukoplakia
kaposi’s sarcoma
candidosis
what is the definition of MRONJ?
current or prev tx with bisphosphonates or anti angiogenic agents
exposed bone or bone that can be probed through an intra oral or extra oral fistula in the maxillofacial region that has persisted for 8 or more weeks
no history of radiation to the jaws or obvious metastatic jaw disease
what meds can cause MRONJ?
bisphosphonates
Rank ligand inhibitor - denosumab
antiangiogenics
what is the action of bisphosphonates?
used orally to tx? IV to tx?
deposit in bone and persist inhibit formation, recruitment and function of osteoclasts increase apoptosis orally - osteoporosis iv - cancer
what is the action of denosumab?
ab against RANK ligand
inhibits osteoclast function
inhibits bone resorption
what happens during MRONJ?
reduced bone turnover reduced vascularity inflammation and infection adverse effects on soft tissues immune dysfunction
what risks increase the chance of MRONj?
potency of drug
route of administration
antiangiogenic and bisphosphonate
systemic corticosteroids, immunosuppressants, chemo and radio
what is stage 0 MRONJ?
no clinical evidence
non specific symptoms or clinical radiographic findings
what is stage 1 MRONJ?
exposed necrotic bone or fistulas that probe to bone
asymptomatic
what is stage 2 MRONJ?
exposed bone that is nectrotic or fistulas that probe to bone
associated with infections
pain/erythema
what is stage 3 MRONJ?
same as stage 2 with necrosis extending past alveolar bone pathological fracture extra oral fistula oral antral or nasal communication
what is the tx of the stages of MRONJ?
0 - nil
1- antimicrobial rinses
2- antimicrobial rinses with systemic antibiotics and analgesics and debridement
in pregnancy avoid high doses of what antibiotic?
metronidazole
caution with what local anaesthetic in early pregnancy?
mepivicaine
oral manifestations during pregnancy are secondary to?
increased vascular permeability
reduced immunocompetence
increased infection susceptibility
why is gingivitis likely to happen during pregnancy?
progesterone
when is a pregnancy epulis likely to happen?
1st trimester
what is pytalism?
linked to nausea
settles in 12-14 weeks
why is there an increased erosion risk during pregnancy?
secondary to vomitting
what is the link with gestational diabetes and perio?
9x more likely to suffer from perio disease
perio is associated with what in terms of pregnancy?
pre term birth weight
pre eclampsia
low birth weight
what is asthma?
reversible small airway obstruction
what drugs are used to tx asthma?
inhaled beta agonists - sabutamol
inhaled corticosteroids
combo inhalers
anti leukotrienes
avoid prescribing what drug with asthma?
NSAIDs
what side effects can asthmatic drugs cause?
oral candidiosis
altered taste
dry mouth
what is COPD?
airway obstruction that is not fully reversible
what is pneumonia?
lung infection
what is a pneumothorax?
leak of air into the pleural space
what is sleep apnoea?
failure of upper airways during sleep
what is intersitial lung disease?
inflammation of lung tissue
restrictive lung defect
avoid sedation
what is CF?
gene defect = abnormal cl channels
highly viscous mucous - lungs, pancreas, gonads
avoid what in dentistry with CF patients?
immunosuppressants
sedation
what are too big cells? too small? increased white blood cells? reduced white blood cells? increased platelets? reduced platelets?
macrocytic microcytic leukocytosis leukopenia thrombocythaemia thrombocytopenia
what are the causes of anaemia?
lack of raw materials - vit b12, iron, folate
production problems - erythropoietin lack, bone marrow failure
longevity problem - haemolysis
what is neutropenia?
white cell deficiency
BM failure, autoimmune
candida, herpes simplex
what is leukeamia?
proliferation of immature cells in blood and bone marrow
what is lymphoma?
proliferation of cells in nodes/spleen, liver, bone marrow
what can haematological conditions cause orally?
atypical infections
bleeding
lymphadenopathy
gum infiltraion
what is the coagulation cascade?
vessel injury - vasoconstriction, platelet aggregation, coagulation cascade = clot formation
what can interfere with coagulation cascade?
protein deficiency - liver disease/malnutrition
congenital - haemophilia, von wilebrands
what is haemophilia?
absent or low factor VIII, IX
what is von willebrands?
function problem of factor VIII
what are types of coagulopathy?
acquired - alcoholics, thrombocytopenia, drugs
congenital - haemophilia A/B, von willebrands, antiphsopholipid
what drugs should be avoided with idiopathic thrombocytopenic purpura?
NSAIDS
aspirin
what can anaemia cause orally?
angular chelitis
candidiasis
minor apthous ulcers
how does warfarin work?
antagonises Vit K
48-72 hours to develop
reversed by vit K
what happens if INR is over 1?
longer clotting time
what should be established about the INR prior to tx?
assessed within 72 hours
stable
<4
what is INR controlled by warfarin influenced by?
irregular tablet taking
high vit K
alcohol indigestion
cranberry juice
what are types of antiplatelets?
aspirin
clopidogrel
what are NOAC’s and what are they used for?
rivaroxaban
prophylaxis of venous thromboembolism`
dentally, what should we be aware of with upper GI problems?
NCTSL - acid reflux
osoephagus/stomach - caution with NSAIDs
oral ulceration/chronic blood loss anaemia
what is coeliac?
multi system autoimmune problem not an allergy
Small intenstinal venous atrophy
what are oral feautres of malabsorption?
iron, folate deficiency
oral ulceration
caution with what drug an coeliac pts?
bisphosphonates
what is IBD?
crohns - entire GI tract, non continuous lesions
UC - large intestine - continuous
oral features of crohns disease?
ulcers facial labial swelling mucosal tags cobblestone mucosa angular chelitis
what are the stages of swallowing?
pre swallow oral prep oral stage pharyngeal stage oseophageal stage
with aging how is swallowing affected?
delayed pharyngeal elicitation
loss of muscle reserve
increased laryngeal penetration
what are causes of dysphagia?
dementia CVA poor oh thrush parkinsons head injruy degenerative neurological disorders burns facial trauma
what is trismus?
persistent contracture of masticatory muscles
hypervascularity, neural damage
what can cause dry mouth?
thrush
sjogrens
meds
radiotherapy
what is osteoarthritis and what is the tx?
affects weight bearing joints and hands
steroid injections
what is rheumatoid arthritis?
autoimmune
synovial inflammation
what other body systems can rheumatoid arthritis?
nervous system lungs heart disease kidney failure eyes - inflammed sjogrens systemic inflammation
what medications treat rheumatoid arthritis?
DMARDS
corticosteroids
how is rheumatoid arthritis dentally relevant?
TMJ disease
sjogrens
hands - dexterity
what kind of disease is systemic sclerosis? what are some signs?
autoimmune
sclerodactyly, telangiectasia, calcinosis, beaked nose, fixed expression, radial furrowing of lip, limited mouth movements
what is systemic lupus erythematous?
autoimmuni multi system disease
what does SLE effect?
photosensitive butterfly rash small joint arthritis raynouds fits and paralysis valvular disease and endocarditis lungs effusions kidney failure
what is gout?
accumulation of urate crystals in joints
what is psoriatic arthritis?
destructive arthritis and psoriasis
what is hyperparathyroidism?
excess parathyroid hormone
adenoma in parathyroid gland
what can hypercalcaemia and hyperparathyroidism cause dentally?
bone resporption
loss of LD
giant cell lesions
what is pagets disease?
abnormal bone remodelling
what is osteomalacia?
vit d deficiency
bony pains and muscle weakness
affects tooth development in children
what is osteoporosis?
loss of bone mass
increased fracture risk
what is the relations between osteoporosis and dentistry?
risk with bisphosphonate tx
what are some causes of dry mouth?
psychogenic drugs radiotherapy dehydration sarcoidosis HIV sjogrens syndrome
what is sjogrens syndrome?
autoimmune disease
chronic inflammation of tear and saliva glands
primary and secondary forms
what are the causes of secondary sjogrens syndrome?
rheumatoid arthritis
systemic lupus erythematous
primary billiary chirrocis
mixed connective tissue disease
what is the drug tx of sjogrens syndrome?
5mg prilocaine 3 x daily
what are some salivary drug tx’s for sjogrens?
orthana spray bioextra glandosene salivix pastilles sugar free gum
what is orthana spray?
gastric mucin
xylitol
sodium fluoride
what is bioextra?
lactoperoxidase
lactoferrin
xylitol
how can you spot sjogrens orally?
erythema
lubrication of tongue
what problems can arise from lack of saliva?
opportunistic oral infections
perio disease
caries - esp cervical margins
how are fungal infections managed?
nystatin
amphotericin C
what is diabetes mellitus?
group of metallic diseases characterized by hyperglycaemia resulting from defects in insulin secretion and action
what is type 1 diabetes?
pancreatic beta cell destruction
insulin dependant
what is type 2 diabetes?
insulin resistant bc beta cell dysfunction
what is insulin resistance?
insulin receptor not as responsive to the insulin molecule and therefore less glucose enters the cell = build up of glucose in the blood
what are complicatins of diabetes?
IHD stroke neuropathy nephropathy retinopathy erectile dysfunction psychaitric
what is diabetes the leading cause of?
blindness
dialysis
amputation
what are signs of low blood glucose?
sweats shakes flushing palpitations
confusion, reduced conscious, collapse, seizures, coma
what are types of hyperglycaemia>?
1 - diabetic ketoacidosis
2 - hyperosmolar non ketotic coma
what should blood glucose pre meal?
after meal?
4-8mmol
<10
what are causes of hyperthyroidism?
autoimmune - graves disease
goitre/toxic ademona
pituitary driven
what are signs of hyperthyroidism?
sweating heat intolerance irritable poor sleep anxiety palpitations excess apatite weight loss pretibial myxoedema
what drugs tx hyperthyroidism?
beta blockers
antithyroid drusg
what are causes of hypothyroidism?
autoimmune
iatrogenic
iodine deficiency
rarely pituaitary disease
what are signs of hypothyroidism?
reduced metabolism, cold intolerance, weight gain, mental slowness, hair loss, slow pulse, goitre
what is hypopthyroidism treated with?
thyroxine
levothyroxine
what are the types of goitre?
- not associated with disease - simple cysts/adenomas, iodine deficiency
- associated with intrinsic disease - autoimmune, toxic adedoma
- malignant
what difficulties can goitres cause?
dysphagia
breathing difficulties
what can anti thyroid drugs cause orally?
neutropenia
taste disturbances
what disease has excess corticosteroids?
cushings syndrome
excess ACTH, bc pituitary ademona, ecptopic production by cancers
what risks do cushings pts suffer from?
high bp
diabetes
prone to infection
what is a deficiency of corticosteroid production called?
addisons
iatrogenic
hypopituitarism
adrenal destruction
what can be seen orally with addissons disease?
hyperpigmentation
buccal mucosa, scars, pressure points, skin creases
what can be seen orally with cushings disease?
oral infections
what is acromegaly?
excess growth hormone
prognathism, ID seperation, large tongue, diabetes
how common is type 1 diabetes?
insulin dependent or independent?
affects who
what type of disease is it?
10% of diabetics
dependent
autoimmune disease in younger people
how common is type 2 diabetes?
dependent or independent?
what type of disease?
affects who?
90%
non insulin dependent
insulin resistant and deficiency
more likely if obese
what is a risk for diabetic patients?
increased infection risk
what drugs can cause xerostomia?
antidepressants
antihypertensives
anxiolytics
what can fungal infections be caused by?
fungal infections
why can angular chelitis be caused?
staph infection
iron deficiency anaemia
how can angular chelitis be treated?
miconazole
where are oral carcinomas commonly found and what type are they commonly?
lips and tongue
squamous cell
tumours found where in the mouth metabolise the fastest?
tongue and floor of mouth
what is the at risk dose of paracetamol?
normal toxic dose?
- 7g in 24 hours
- 10g in 24 hours
what are some signs of an apsirin overdose?
increased resp rate ringing in ears parasthesia vomitting, nausea drowsiness
what are some signs of an NSAID overdose?
antiplatelet effects - bleeding and bruising
metabolic effects - dizzy, tired, parasthesia
GI irritation - epigastric pain, nausea, vomitting
what are the eventual effects of an NSAID OD?
renal impairment
cerebral oedema
cardiac arrest
what are some signs of an opiate OD?
pupils constrict
drowsiness - confusion and agitiation
reduced GCS
what is a seizure?
excess electrical activity
what is a focal/partial seizure?
what is a generalised seizure?
part of brain affected
whole brain affected
what are types of generalised seizures?
grand mal
tonic clonic
what are some causes of seizures?
hereditary structural problems electrolyte disturbance alcohol withdrawl hypoglycaemia
what drugs are used to tx epilepsy?
phenytoin
carbamazepine
sodium valporate
what is used to treat tension headaches?
tricyclic antidepressants
conventional analgesics
what are migraines treated with?
conventional analgesia
metoclopramide, serotonin antagonists
what is trigeminal neuralgia and what is it treated with?
intense stabbing 10/10 pain
touch shaving and waxing make it worse
paroxsymal
carbamazepine
what is raised intracranial pressure caused by?
tumours
bleeding
drainage problems
abscess
what are signs of bacterial meningitis?
impaired conscious meningism \+/- rash drowsy photophobia
what is encephalitis?
inflammation of brain parenchyma viral impaired conscious personality changes meningism/seizures
what is giant cell arteritis?
scalp tenderness and jaw claudication with vision loss
risk of blindness, stroke and death
high doses of prednisolone to tx
what is glaucoma?
constant aching around the eye
reduced vision
nausea and vomitting
red congested and dilated non reactive pupil
what is a stroke and what is it caused by?
disorder of vascular supply to the brain
infarction - atherosclerosis
cardiac emboli
haemorrhage - hypertension
what can brain infarctions cause?
transient ischaemic attacks
completed strokes
what is the tx of strokes caused by infarctions?
anti platelets
warfarin if AF
NOACs
what is parkinons disease and how can it be spotted?
degeneration of dopaminergic neurones in the basal ganglia
bradykinesia, rigidity, tremor
tx with dopaminergics
what is essential tremor? what is it treated with?
hereditary
unilateral
improves with alcohol
tx with beta blocker and primidone
what is MS?
autoimmune destruction of the central nervous system
loss of myelin - demylination
- relapsing and remitting
- chronic progressive
what do you tx MS with?
acute episodes tx with prednisolone
reduce relapse rate with beta interferron
where does peripheral neuropathy?
generalised and specific nerves
what is bells palsy?
viral
palsy of lower motor neurone of facial nerve
oral steroids in 72 hours improve outcome
what is motor neurone disease?
obstruction of motor neurones
limb weakness
swallowing problems
what problems can liver disease cause?
impaired wound healing
impaired clotting - deficient clotting factors, reduced platelets
risk of blood borne virus
what are primary infections of HSV1?
gingivostomatitis
pharyngitis
what is a recurrent infection involving HSV1?
herpes labialis
how long do orolabial herpes last for?
self limiting in 7-10 days
how many strains does HPV have?
what can they cause?
what strains are oncogenic?
what does HPV hold links with orally?
> 70
can cause orolabial warts
oncogenic
links to oral cancers
what causes syphillus?
treponema pallidium
invades skin and mucous membranes
what is the function or the kidney?
excretory function
acid base balance
endocrine function - erythropoietin and activates vit D
what are some consequences of renal failure?
excretion failure - oedema, high K
acid base balance - acidosis
endocrine - no erythropoietin, no vit D, high bp
what are some causes of renal failure?
atherosclerosis diabetes high bp hypovolaemia NSAIDs angiotensin 2 diuretics tetracyclines infections obstructions
what are the two types of dialysis?
peritoneal
haemolysis
what are issues with organ transplanting?
rejection
immunosuppression
high cardiovascular mortality
what are some oral considerations with renal failure?
care with prescribing NSAIDs
secondary anaemia effects - slow tooth eruption
oral opportunistic infections and stomatitis
dry mouth/taste disturbances
post op infections and bleeding
renal osteodystrophy - loss of lamina dura, radiolucencies, problems with bone healing and XLA
complications with immunosuppressants
when should you treat a patient on dialysis?
day after dialysis, heparin
what patients have bleeding tendancies?
abnormal platelet production
diminished factor 3
von willebrands
what are oral side effects of chronic renal failure?
dry mouth halitosis metallic taste insidiuous oral bleeding and purpura salivary gland swelling anaemia - oral ulceration and changes
what is acne treated by?
topical abrasives and antibiotics, vitamin A, analgesics, isotretinoin
what is rosacea treated by?
isotretinoin
antibiotics
what is impetigo? what might it cause?
staph and strep
may cause glomerulonephritis
what is folliculitis caused by?
Staph aureus
infection of hair follicle
what is erysipelas?
form of cellulitis
strep infection
systemic antibiotics to tx
what is erythema multiforme caused by?
herpes viral infection
mucosal involvement
what is steven johnsons syndrome?
caused by infection or reaction to medications
acute onset and severe mucosal involvement, systemic disturbance
what is actinic keratoses?
hyperkeratotic areas on sun exposed skin
can progress to SCC but uncommon
what is bowens disease?
intra epidermal SCC
commonly on lower legs in elderly females
how can you spot a basal cell cancer?
sun exposed sites slow growing raised pearly edge telangiectasia, central ulceration locally invasive dont metastasise
where are melanomas common?
moles
history of sun exposure
sunbed use
skin type
what is ABCD of mole severity?
a - asymmetry
b - border - irregular
c - colour - multiple
d – diameter - >6mm
what drugs induce anaesthesia?
propofol
thiopental
etomidate
what inhalation drugs can induce and maintain anaesthesia?
nitrous oxide
o2 and air
what are benzodiazepines used for in anaesthesia?
pre med for anaesthetic - reduces amount of anaesthetic required
what are the 4 stages of anaesthetic?
1 - loss of conscious
2- excitement and delirium, coughing and vomitting
3- stage of surgical anaesthesia
4- cessation of respiration to death
what is a short and long acting muscle relaxant?
short - sumexathonium
long - attracurium
what is malignant hyperthermia?
abnormal accumulation of calcium in muscle cells = hypermetabolism, muscle rigidity, muscle breakdown
- increased expired CO2
- unexplained tachycardia
- increased O2 need
- increased temp
- tx with dantrolene and cooling
what is nociceptive pain?
neuropathic pain?
- appropriate physiological response to painful stimuli
- inappropriate response to pain bc dysfunction in the NS
what is chronic pain managed by?
non opiod analgesics opiods antidepressants anticonvulsants topical analgesics
how can chemotherapy affect the mouth?
chemo affects rapidly dividing cells - oral mucosa included
what are short time effects of radiotherapy orally? long term?
short - oral mucositis
long - osteoradionecrosis, xerostomia
what can oral mucotaneous ulcers be associations of?
SJ syndrome pemphigoid herpes simplex varicella zoster SLE crohns
what are some organic psychiatric disorders?
dementia and delirium
protected by adults with incapacity act 2000
what is a consideration with schizophrenic patients and oral health?
hypersalivation drugs caused by anticholinergic drugs
what is dentally relevant about bullimia?
acid erosion caries cheilosis parotid gland enlarges palate reddening lymphadenopathy
what acts protect those with mental health issues?
mental health care and tx act 2005
adults with incapacity act 2000
what can cancer tx cause orally?
ulceration and mucositis salivargy gland dysfunction and xerostomia radiation caries and perio disease infections - candidiasis loss of taste dysphagia osteoradionecrosis
what is mucositis and how is it treated?
inflammed mucosa - slough, ulceration, bleeding, heals 2-3 weeks post tx
soft TB, H peroxide MW, chx MW, topical analgesics, soft bland non carious diet and at low temp, avoid alcohol and tobacco
what risks present to a patient with decreased salivary production?
increased infection risk
increased demineralisation risk
mastication or swallowing impaired
how is decreased saliva treated?
prilocarpine
salivary substitutes - water atomiser, ice chips
F
sugar free gum
how should radiation caries be treated?
daily F application - 2800ppmF
Salivary substitute
caution with diet
what is osteoradionecrosis?
damage to blood vessels and bone cells
change in endothelial cells = sclerosis of vessels
= pain, trismus, exposed bone, suppuration, halitosis
what is dysgensia?
altered or loss of taste
regained after 2-4 months of tx
= dietary supplements plus zinc
if using chx and nystatin do what?
stagger use by one hour
