Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Disease > CT Disorders and Xerostomia > Flashcards

CT Disorders and Xerostomia Flashcards

1
Q

List examples of CT disorders

A 
Rheumatoid arthritis
Systemic and discoid lupus erythematosus
Systemic sclerosis
Sjogrens syndrome
Mixed CT disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rheumatoid arthritis features?

A

Autoimmune
HLA-DR4 60%, genetic factors account for 50%
Inflam disease of synovium and adjacent tissues
Females>Males
Peak incidence 35-50yrs
Mortality risk
40% of individs become disabled 10 yrs post onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinal features of rheumatoid arthritis?

A 
Insidious onset
Pain and stiffness of small joints
Fatigue and malaise
Anaemia
Weight loss
Muscle weakness and wasting

Neurological effects - carpel tunnel syndrome
Lymphadenopathy
Lung problems - pleural nodules and effusions
15% cases have sjogrens syndrome
TMJ damage in juvenile RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of people have their hands, spine, wrist and TMJ affected with rheumatoid arthritis?

A

Hands 90%
Cervical spine 80%
Wrist 80%
TMJ 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Extra-articular manifestations of rheumatoid arthritis?

A 
Weight loss
Malaise
Fever
Lymphadenopathy 
Rheumatoid nodules
Sjogrens syndrome
Amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to diagnose rheumatoid arthritis?

A 
Clinical - morning stiffness, symmetrical joint pain, weight loss
Radiographic changes = fusion of joints
Anaemia
Raised ESR, CRP
Anti-CCP positive (80% plus)
Rheumatoid factor positive (80%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of rheumatoid arthritis?

A 
Education - self management programmes
Exercise - fitness and maintain bulk muscle
Physio 
Surgery for progressive deformity
Dietary advice - weight reduction

Pharmacotherapy

  • DMARDS (disease modifying anti-rheumatic drugs) = hydroxychloroquine, azathioprine, methotrexate
  • Corticosteroids - IA/IM/PO
  • Biological agents (anti-TNFalpha, non-TMF agents
  • Symp relief - NSAIDs

Surgical tx (synovectomy, reconstructive surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NSAID oral side effects?

A 
Stomatitis
Eryhthema multiforme
Gastrointestinal bleeding 
- Depapillated tongue
- Burning tongue
- Candidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Methotrexate (DMARD) and hydroxychloroquine side effects?

A

Methotrexate
- Oral ulceration

Hydroxychloroquine

  • Lichenoid reactions
  • Pigmentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Infliximab (biological drug) oral relevance?

A 
Histoplasmosis infection
Mandibular osteomyelitis
Parotid swelling
Ulceration
Erythema multiforme
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do biological drugs often cause?

A

Oral candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Orofacial aspects of rheumatoid arthritis?

A

Access
- Individ with RA less likely to visit dentist

Atlanto-axial joint dislocation
- Physical support - pillows, short appts

Impaired manual dexterity
- Electric toothbrush more effective than manual

TMJ

  • Commonly affected but one of last joints involved
  • May lead to open bite

Secondary sjogrens syndrome

Felty’s syndrome

  • RA and splenomegaly and lymphadenopathy
  • Increased risk of infection (chronic sinusitis)
  • Oral ulceration
  • Angular cheilits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Types of lupus erythematosus?

A

Immunologically mediated condition
2 forms:
DLE (Discoid)
SLE (systemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aetiology of lupus erythematosus?

A

Genetic predisposition
Environmental trigger (UV, microbes, drugs)
T cell dysregulation of B cell activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Features of discoid lupus erythematosus?

A

Affects skin and oral mucosa
F>M
Peak incidence 40yrs
Oral lesions similar to lichen planus in appearance
Diagnosis based on clinical/biopsy/immunology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Appearance of discoid lupus erythematosus lesions on the skin?

A

Scaly, erythematous patches
Atrophic, hypopigmented areas
Occur on exposed surfaces
May be premalignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DLE diagnosis?

A

Clinical appearance
Biopsy
Circulating autoantibodies - ANA, dsDNA, may be positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DLA management?

A

Treat as for lichen planus

Difflam MW and spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Systemic lupus erythematosus features?

A

Age of onset 30yrs
F:M = 9:1
Up 40% have oral lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Systemic features of SLE?

A 
Malar rash
Polyarthritis
Photosensitivity
Lymphadenopathy, anaemia
Renal/cardiac/haematological/neurological 
Oral lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Oral lesions with SLE?

A

Unilateral or bilateral white patches with central area of erythema or ulceration
May involve palate
May be extensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis of SLE?

A 
Clinical
Immunological:
- Hypegammaglobulinaemia
- ANA, ds DNA 90%
- Rheumatoid factor 30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SLE pharmacological management?

A 
85% survival 10 yrs
NSAIDs
Hydroxychloroquine
Corticosteroids
Cytotoxic drugs
- Cyclophosphamide
- Methotrexate
- Azathioprine
Biological DMARDS (belimumab)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SLE prognosis?

A

Depends on extent of disorder
Death due to renal involvement
Males>females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What drugs can cause lupus like lesions?

A

Carbamazepine
Hydralazine
Penicillamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Scleroderma/systemic sclerosis features?

A

Autoimmune disorder
Affects mainly females 20-50yrs
Dense collagen is deposited in tissues of the body
Clinical features include raynaud’s phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is crest syndrome?

A

limited cutaneous form of systemic sclerosis (lcSSc)

Presentation:
C - Calcinosis (calcium nodules can become ulcerated)
R - Raynaud's phenom 
E - Oesophageal dysfunction
S - Scelorodactyly
T - Telangiectasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Features of limited cutaneous systemic sclerosis?

A

Limited to skin on face, hands and feet

10 yr survival 75%

29
Q

Features of diffuse cutaneous systemic sclerosis?

A

More extensive skin involvement
May progress to visceral organs
10 yr survival 55%
Death most often from pulmonary, heart and kidney involvement

30
Q

Types of systemic sclerosis?

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Crest syndrome

31
Q

Orofacial manifestations of systemic sclerosis?

A 
Facial skin rigidity
Sharp nose
Thinning of lips
Loss of facial wrinkles
Microstomia
- Poor access for OH
- Increase incidence of dental caries
- Increase incidence of periodontal disease (abnormal immunoregulation and obliterative microvasculopathy)

Hypomobile tongue (less mobile)
Dysphagia and xerostomia
PDL widening on XR
Pseudoankylosis of TMJ

Tight cheeks = affects speech, eating, cleaning, deteriorating QoL

32
Q

Systemic sclerosis diagnosis?

A

Difficult diagnosis
Clinical
Skin biopsy
Scl-70 autoantibodies

33
Q

Systemic sclerosis management?

A

Difficult tx
Aims to reduce symptoms, slow progression of disease, prevent complications, minimise disability

Nifedipine
D-penicilllamine
Corticosteroids
DMARDs

34
Q

How to manage microstomia?

A

Exercise programme
- Mouth stretching and oral augmentation
Sectional dentures
Implants

35
Q

Sjogren’s syndrome features?

A

Autoimmune exocrinopathy
Primary and secondary (with another systemic autoimmune condition such as RA/SLE)
Focal lymphocytic infiltration of salivary and lacrimal glands
Incidence 0.5-2%
Females only
15% RA pts have secondary SS
30% SLE pts have secondary SS

36
Q

Aetiology of sjogren’s syndrome?

A

Genetic predisposition - HLA-B8, HLA-DR3

Viral agents - herpes viruses (EBV, BMV, HHV6), retroviruses

37
Q

Pathogenesis of sjogren’s syndrome?

A

Lymphatic infiltration of exocrine glands
Hypertrophy of ductal epithelium: formation of epimyoepithelal islands
Acinar atrophy and fibrosis
Probable hyperactivity of B cells

38
Q

Symptoms of xerostomia in pts with sjogren’s syndrome?

A 
Difficulty swallowing/chewing dry food
Sensitivity to spicy food
Altered salty bitter metallic taste
Burning mucosa
Lack of diminished taste
Salivary gland swelling/pain
Cough
Voice disturbance
Nocturnal discomfort
39
Q

Sjogren’s syndrome oral signs?

A

Initially often little change
Oral mucosa - dry, atrophic, wrinkled, ulcerated, increased debris
Tongue - dry, red, lobulated, loss of papilla
Teeth - increased caries
Salivary glands - firm on palpation (if swollen)

40
Q

Diagnosis of sjogren’s syndrome?

A

European diagnostic criteria:

  • I Ocular symptoms
  • II Oral symptoms
  • III Ocular signs
  • IV Histopathology (Biopsy from salivary gland - lower lip minor salivary glands)
  • V Salivary gland involvement
  • VI Autoantibodies

Primary SS:

  • Presence of any 4 of the above items as long as either item IV or VI positive
  • Presence of any 3 of III, IV, V, VI

Secondary SS
- Well defined CT disease and presence of item I or II plus any 2 from III, IV and V

41
Q

Sjogren’s syndrome increases the risk of non-hodgkin’s lymphoma - when is the risk worse?

A 
Worse in pts with:
Vasculitis
peripheral neuropathy
anemia
lymphopenia 
chronic glandular swelling
42
Q

Sjogren’s syndrome management?

A

Palliative;

  • Increase lubrication
  • Maintain oral/dental health
  • Review candida status

Therapeutic

  • Pilocarpine
  • Immunomodulating agents
43
Q

What is xerostomia?

A

Symptom of oral dryness
May exist with or without hyposalivation
Hyposalivation = actual decrease in saliva flow rate

44
Q

Types of salivary glands?

A

3 Major

  • Parotid
  • Submandibular
  • Sublingual

> 600 minor salivary glands
Within lips/cheeks and palate

45
Q

Salivary gland tissue - what produces saliva and what are the types of saliva?

A

Acini = saliva producing cells
Serous - watery secretion
Mucous - viscous saliva

Parotid glands mainly serous cells
Other glands mainly mucous

46
Q

Components of saliva?

A

99.4% water

Organic solids:

  • Protein
  • Gamma globulin
  • Amylase
  • Lactoferrin
  • Glucose
  • Lipids

Inorganic

  • Sodium
  • K
  • Ca
  • F
  • Cl
47
Q

How is saliva formed?

A

Salivary gland secretion mainly under autonomic nervous control
Various hormones may modify salivary composition
Salivary flow mainly a result of parasympathetic activity
Vasodilation in BVs within glands

2 components of saliva:

  • Fluid component includes ions produced by parasympathetic stimulation
  • Protein component arising from secretory vesicles in acini - released in response to sympathetic stimulation

Effects of parasympathetic stimulation stronger and longer lasting
Parasymp stimulation - copious saliva of low protein concentration

Symp stimulation - little saliva but with high protein concentration

48
Q

What is the flow rate of saliva?

A 
500mls saliva in 24hrs 
Resting flow rate 0.3ml/min
Flow rate during sleep 0.1/minute 
During eating/chewing 4-5ml/minute
Unstimulated conditions - 60% saliva from submandibular glands, 20% from parotids and 2-5% from sublingual glands
During eating parotid contributes to 50% saliva
Smell/taste affect salivary flow
Anxiety can decrease salivary flow
49
Q

Functions of saliva?

A

Lubricant effect
Physical cleaner
Caries control - buffers acid
Saliva saturation with ca and phosphate = prevents demineralisation
Pellicle formation - salivary proteins form barrier
Antimicrobial
Taste
Digestion of carbohydrates begins (amylase)

50
Q

Effects of long standing xerostomia?

A 
Difficulties in oral function and wear of dentures
Freq of caries (particularly cervical caries)
Acute gingivitis 
Dysarthria
Dysphagia 
Taste disturbances
Susceptibility to oral candida
Burning tongue/depapillation of tongue 
Dry, cracked lips
Salivary gland enlargement
51
Q

Causes of dry mouth?

A

Physiological:

  • Dehydration
  • Mouth breathing
  • Anxiety

Congenital
- Salivary gland hypoplasia

Iatrogenic

  • Drugs - antidepressants (tricyclics and SSRIs), antihistamines, diuretics, sedatives etc
  • Radiation

Disease

  • Sjogren’s syndrome
  • HIV
  • Sarcoidosis
  • HCV

Congential
- Ectodermal dysplasia (hypodontia and missing salivary glands)

52
Q

Radiation induced salivary dysfunction?

A

Therapeutic doses of radiation for head and neck cancer - permanent reduction in salivary gland function
Damage dependent on no and volume of salivary glands exposed
26Gy = threshold below which recovery of 25% stimulated saliva flow rate can occur
Saliva can become sticky

53
Q

How to take a history for xerostomia?

A 
Does your mouth usually feel dry?
Does your mouth feel dry when eating?
Difficulty swallowing food?
Require liquids to swallow foods?
Water to bed at night?
Soreness of mouth?
Difficulty wearing dentures?
Dryness of eye/skin/genital area?
PMH
Anxiety/depression
Drug history
SH - smoking/alcohol
FH - autoimmune diseases
54
Q

Xerostomia clinical examination?

A 
General appearance
Extraoral - CT disease features, salivary gland swellings
Intraoral:
- Lack of pooling of saliva in floor of mouth
- Dental mirror sticks to mucosa
- Food retention
- Gingival health 
- Caries
- Candidosis 
- Depapillation/lobulation of tongue
55
Q

Xerostomia investigations?

A

Sialometry
Schirmer’s test
Rose bengal staining

Radiological

  • Ultrasound
  • Sialography
  • Salivary scintigraphy
  • PET scan
  • MRI
  • CT

Lab based

  • Immunology - ENA/ANA/Rh factor
  • Haematology - FBC/CRP/ESR, HbA1c (glucose diabetes) Liver func, thyroid function, immunoglobulins

Labial gland biopsy
- Examine at least 5 lobules of minor glands

Histopathological features supportive of sjogrens:

  • Acinar loss
  • Duct dilation
  • Focal aggregate of at least 50 lymphocytes
56
Q

Treatment of xerostomia?

A 
Directed at underlying cause
Prevention key 
Assess pts before radio and chemo tx 
Manage xerostomia early 
Prevent dental complications
Multidisciplinary approach often required

Improve symptoms

  • Salivary substitutes
  • Stimulate saliva - sialogogues
  • OH

Manage candidosis

  • Antifungals
  • Denture hygiene

Prevent/treat caries, gingivitis:

  • F-
  • Antibac MW
  • OH advice
  • Scale and polish
  • Diet advice

Investigations

  • Antibiotics?
  • USS?
57
Q

Dental caries prevention strategy?

A 
Pt education
Diet and nutrition counselling
Hygiene control
Fluoride
Microbial control
Rehydration therapy 
Dental tx considerations
58
Q

Diet and nutrition counselling for xerostomia?

A

Avoid soft sticky and liquid diets which promote plaque formation
Eliminate salty spicy foods - irritant
Non cariogenic foods - suggest sugar substitutes
Limit caffeine - dehydration

59
Q

Hygiene control for xerostomia?

A 
Soft electric toothbrush 
ID brush, floss
Disclosing tablets
Children's toothpaste - mint irritant 
Oranurse toothpaste - bland
60
Q

Microbial control for xerostomia?

A 
High levels of lactobacilli reported
Chlorhexidine rinse
Chlorhexidine varnish
F rinse has some antimicrobial activity
Alcohol containing mouthwashes avoided
61
Q

Dental tx for xerostomia pts?

A

3-4 monthly visits
Consider F applications
Remember fragility of oral tissues
Consider FS
Glass ionomer for provisional restorations
Dentine of exposed roots - dentine bonding resin adhesive systems
Amalgam more successful than bonded materials

Tongue can adhere to and dislodge denture
Mucosal irritation and ulceration common

Implants - increased comfort and function of prostheses

62
Q

Management of dry mouth?

A 
Oral moisturisers
Gustatory and mechanical stimulation of salivation
Milder toothpastes and alcohol free MW
Saliva substitutes
Lip creams and ointments 
Systemic therapy

Frequent sips of water
Saline solutions
Water plus sodium bicarbonate
Overuse of water removes mucous saliva from oral tissues = increases dry mouth sensation

63
Q

Gustatory and mechanical stimulants for saliva?

A

Acidic stimulation - uncomfortable and increase enamel demineralisation
Sugarless chewing gum
Lozenges

Acupuncture
- Stimulated salivary function affected

Electrostimulation

64
Q

Saliva substitutes?

A 
Carboxymethyl cellulose, mucin, oils, glycerin
Majority of pts prefer water
Relief insignificant and short lived
Impractical to handle 
Expensive
Mucin may have better pt acceptance 
ph>6 dentate pts = use saliva orthana 
ph<6 edentulous subjects = glandosane 
Glycerin
Olive oil
Anhydrous crystalline maltose
65
Q

Systemic therapy for sjogren’s syndrome?

A

Used when residual secretory capacity in salivary glands exists may use cholinergic agents:

Pilocarpine
- Approved for tx of radiation induced sjogrens

Interferon alpha
- Improvement of salivary gland histopathology

Infliximab

  • Increases salivary flow rate
  • Improved symptoms of oral dryness
  • Increased risk lymphoma

Hydroxychloroquine

  • Improved oral discomfort
  • Flow rate increased in 82% pts
  • Improved oral discomfort
  • 40% decrease in number of oral infections
  • Few adverse effects

Corticosteroid irrigation of parotid gland

  • Increased flow rate
  • Symptom relief
  • Risk of infec and pain
66
Q

Pilocarpine adverse effects?

A

Flushing, sweating, urinary infrequency

67
Q

Pilocarpine contraindications?

A

Uncontrolled asthmatics
Narrow angle glaucoma
Acute iritis

68
Q

Oral candidosis prevention?

A

Denture hygiene
Do not wear at night
Chlorhexidine MW 3x weekly
Acrylic dentures soaked in milton solution diluted to 50% with water
Metal dentures soaked in 0.2% chlorhexidine

Oral Disease (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions