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Dent cases Flashcards

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1
Q

thc

A

pschoactive

  • produces high by dopamine
  • causes intoxication, motor impairment, anxiety,
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2
Q

cbd

A

cannbidol not psychoactive

  • anti inflammatory
  • theraputic
  • needs thc to bind
  • low side effect
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3
Q

sativta

A

more stimulating, higher thc

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4
Q

indica

A

relaxing, higher cbd, more pain relief

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5
Q

cannabis plant anatomy

A

bud contains the cannabinoids, only on females, must be dried before use

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6
Q

methods of cannabis use

A

inhalation: fast and direct to blood thru smole
oral
sublingual: under tongue so blood vessels can absorb
topical: reduces pain and inflammation

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7
Q

endocannabinoid system

A
  • associated with memory, appetite, sleep, mood and fertility

2 key made: anandamide and arachidonoylglycerol
receptors are CB1 in central ns (most) and cb2 in periphera ns and immune

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8
Q

exogenous cannabinoids

A

produce biological effects through interactions with receptors (cbd and thc)

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9
Q

thc and exogenous cannabinoids

A

interacts with system by binding to both cb1 and cb2

  • inhibits adenylyl cyclase, decrease in kinase
  • increase dopamine
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10
Q

cbd and exogenous cannabinoids

A
  • not known

- maybe extends life of cannbinoids or another receptor

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11
Q

what does cannabis treat

A
  • hiv, cancer, galucoma, ptsd
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12
Q

medicinal use of cannabis

A
  • pain: antiinflammatory
  • anorexia: increase in appetite and symptosm of cancer
  • reduces nausea and vomiting from chemo
  • relaxes muscles in MS
  • less seizures
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13
Q

legal stats of cannabis

A
  • legal in 37 states, 4 territories and district of columbia

- requires doctor, id card and age

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14
Q

rec use of cannabis

A
  • legal in 18 states, 2 territories

- 21 years +

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15
Q

symptoms of cannabis

A
  • altered sense and time, mood change, body movement, more hunger, thinking, hallucinations, psychosis
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16
Q

signs of cannbis use

A
  • dizzy, being silly, bloodshot eyes, hard time remembering, tiredness
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17
Q

long term cannabis effect

A
  • brain dev, breathing, high heart rate (vasodilation and ischemia), hyperemesis syndrome (nausea, vomiting, dehydration), mental illness
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18
Q

cannabis and hr

A

cb1 activates brain, increase in pulse, increase in bp

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19
Q

is cannabis addictive

A
  • can lead to substance disordeer, 9-30% develop a disorder, if use before 18 then 4-7x more likely to get disorder
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20
Q

oral health and cannabis

A
  • poor oral health, incresed risk of infxn, xerostomia, periodontitis
  • changes in the epithelium: candidiasis, cannabis stomatitis (leukoedema of buccal mucosa, causes irritation, blocked salivary gland, leads to neoplasia (abnormal cell growth))
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21
Q

oral cancer and cannabis

A
  • acts as a carcinogen
  • asspcoated wotj lesions
  • leukoplatia (whie lesions)
  • tumors on anterior floor of mouth or tongue
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22
Q

periodontitis and cannabis

A
  • bacterial inflammation that goes deep into tissues, causing loss of bone and tissue
  • loose teeth
  • get gingivitis that is red and fiery
  • treat with scaling (removing tartar and bac from under gumline), root planing (smooth root surface so gums can attach, remove bac), antiobiotics (inhibit bac)
  • if advanced then do dental surgery
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23
Q

cannabis and dental treatment

A
  • cannabis lasts 2-3 hours
  • increases likelihood of patients getting anxious and paranoid
  • tachycardia then give epi
  • need 220% higher dose of sedation
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24
Q

can’t use this for weed patients

A

sedatives: ambien, lunesta, benadryl
- anxiety: xanax, valium, librium
anti dep: zoloft, prozac, lexapro
- pain meds: codeine, percocet, vicodin
- seizure: tegretol, topamax, depakene
blood thinners: coumadin, plavix and heparin

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25
Q

xerostomia and weed

A
  • dose dependent

- give sugar free gu, saliva substitute, low cariogenic diet

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26
Q

how do dentists talk to weed users

A
  • theraphy
  • give rewards to patients who are drug free
  • tell them the effects
  • gie topical fluorides
  • importance of regular dental visit
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27
Q

renal cortex

A
  • located between renal corpuscule and renal medulla. contains blood vessels that connect to nephrons, also makes erythropoeietin
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28
Q

renal medulla

A
  • innermost region that contains builk of nephrons and is arranged in pyramid like structure
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29
Q

renal pelvis

A
  • contains a hilum, where renal artery, vein, and nerves enter kidney and where ureter leaves kidney, connects kidney with circulatory and ns system
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30
Q

external kidney regions

A
  • renal fascia, perinatal fat capsule, renal capsule
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31
Q

nephron

A
  • part of kidney that makes urine while removing wastes and substances from blood
  • surrounded by vasa recta: capillaries that supply the nephron with nutrients and oxygen and incorporate reabsorbed materials back into blood
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32
Q

cortical nephrons

A
  • originate from glomeruli and have short loop of henle and more superficial (80%)
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33
Q

juxtamedullary nephrons

A
  • less prevalent type, located deeper in the cortex, have long loop of henle and form the papillae (20%)
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34
Q

kidney function fluid and electrolyte balance

A
  • kidney regullates extracell fluid via control of rebabsorption and excretion of Nacl and water. responsible for the regulation of ions such as na, cl, hco3
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35
Q

filtration kidney function

A
  • filters fluids and solutes from plasma into nephrons
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36
Q

reabsorption of kidney

A
  • reabsorbs fluids and solutes out of the renal tubules (nephron) into circulation
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37
Q

secretion of kidney

A
  • after entering the peritubular capillaries, certain substances will be secreted into tubular fluid. this excretes substances such as potassium and acetylcholine (endogenous) and penicillin and salicylic acid (exogenous)
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38
Q

erythropoetin

A

-stimulates rbc blood cell production in marrow

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39
Q

renin

A
  • converts angioteninogen into angiotensin I
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40
Q

kidney and vit d

A

convert it from 25 hydroxy to 1,25 hydroxy which is active

- used to regulate calcium levels and maintain homeostasis

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41
Q 
ultrafiltrate flow (
not afferent efferent)
A
  • filtered fluid from glomerula capillaries flow into bowman’s capsule and eventually into the proximal tubule
  • fluid then flows into the loop of henle; fluid travels through the loop of henle and reaches the thick portion closer to the cortex, travels past the macula densa and into the distal tubule
  • from the distal tubule, the fluid enters the connecting tubule and the cortical collecting tubule, which ultimately leads to the cortical collecting duct
  • ducts merge and become large, empty into renal pelvis
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42
Q

FILTRATION PROCESS

A
  • glomerulus, capillaries collecting oxygenated, nutrient blood to be filtered. blood enters through the afferent arteriole is filtered through fenestrations in the endothelium, then exits via the efferent arteriole.
  • about 20% plasma volume is filtered, 180 L of filtrate per day
  • podocytes sit on the surface of glomerular capillaries in fenestrated fashion. they selectively filter the filtrate (water glucose, sodium) to pass through them into the bowman’s capsule space
  • protein can’t pass through the fenestrations
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43
Q

bowmans capsule

A

cup like sac that surrounds the glomerulus that passes filtrate to the proximal convulated tubule.

44
Q

glomerular hydrostatic pressure

A
  • exerted by blood inside glomerular capillaries
    60 mmhg
  • subtract the other pressures from this
45
Q

glomerular colloid (oncotic pressure)

A

exerted against direction of filtration by proteins in capillaries
- 32 mmhg

46
Q

bowman’s capsulre pressure

A
  • exerted against filtration by fluid within the capsule itself
  • net pressure is 10-15
  • 18 mm hg
47
Q

glomerular filtration rate

A
  • amount of plasma that is filtered across glomerulus
  • benchmark of renal function
  • normal: 100-125 mL/mon
  • men is higher
  • factors: net filtration pressure, hydraulic permeability, surface area
48
Q

clearance

A
  • volume of plasma needed to travel through kidneys over some time to clear a given amount of substance through urine
  • for a substance that is freely filtered (no reabs or secretion), GFR = clearance. a physician could measure both GFR and clearance from motitoring levels of
  • insulin: free filtered. method is to infuse insulin then collect urine. measure amt of insulin cleared/unit of time
49
Q

proximal convoluted tubue

A
  • proximal convoluted tubule

- responsible for gross adjustment reabsorption

50
Q

reabsorption

A
  • all gluc and AA are REabsorb in early PCT

- 65% water, sodium and cl are absorbed

51
Q

secretion

A
  • H+ ions are secretion to reabsorb bicarb

- toxins and urea also secreted

52
Q

descending loop of henle

A
  • thin, water is allowed

- absorbs 20% of water

53
Q

ascending loop of henle

A
  • lower thin region, upper thick region. both can’t take water
  • reabsorbs na, cl and k as well as ca, bicarb, potassium
  • ascending loop is site that diuretics act on
  • empties into DCT
54
Q

dct and cortical collecting duct

A
  • responsible for fine tuning and diluting filtrate. no water and urea in
  • absorbs ca, na, secrete k
  • macula densa: group of cells btw dct and afferent arteriole (part of jga)
55
Q

jga

A
  • monitors the gfr and regulates bp
  • too much fluid then constricts arterioles to reduce flow
  • also secrete renin
56
Q

medullary collecting duct

A
  • final site
  • reabsorbs the least stuff but can be induced by adh
  • urea is reabsorbed since it increases osmolirity of meullary interstitium
  • secretion: h+ ions against concentration gradient to reulate acid base balance
  • then ureter then bladder
57
Q

adh

A
  • high adh means more permeable to water
  • low adh means more pee water
  • if too mich water, then dilute urine (50 osm)
  • less water than can go up to 1200 osm
58
Q

chronic kidney disease

A
  • 1) kidneys work, mild damage, protein in urine,
    2) same as 1
    3a) bad kidney, waste builds up and causes complications like hypertention and bone disease
    3b) worse gfr values (lower)
    4) hypertension, bone disease, anemia, heart disease, pain in lower back, acidosis,
    5) end stage. failure or failed. need dialysis and kidney transplant
59
Q

ckd causes

A
  • diabetes (bad insulin), high bp (blood vessel damage), genetics (cysts on kidney)
  • glomerulonephritis (bad glomerulus)
  • interstital nephritis (swelling of tubules)
  • ut obstrcution (kidneystone prostate)
  • vesicouretal (urine backs into kidney)
  • pyelonephritis (kidney disease)
60
Q

symptoms of cdk

A
  • nausea, vomitinng, tired, pee problems, cramps, swellin of feet, chest pain
61
Q

kidney friendlt diet

A
  • whole grain carbs, low sodium, protein intake control
62
Q

kidney and bones

A
  • 97% calium and 80% phos is filtered in kidney is resabs
  • ca stimulates osteoblast
  • vit d stuff for calcium too
63
Q

kidney regulates ca and p

A
  • low cal, pth is released. decreases p absorption. makes calcitrol (vit d??) which allows pct to absorb ca
64
Q

calcitrol

A

negative feed on pth

  • stimulates release of ca and p
  • pth also bone abs of ca
65
Q

bone problems in ckd

A
  • mineral imbalance, effecting bones
  • ca imbalance
  • p buildup
  • pth surge so ca leaves bones
66
Q

mineral and bone problem treatment

A
  • bones break, bone pain, itchy skin, anemia

- low phos diet, vit d suppleents, ca supplements, surgery of pt gland

67
Q

morbidities associated with cdk

A
  • renal osteodystrophy: bone problems
  • hypocalcemia: low levels of ca in blood
    hypertension, dia
  • hyperlipidemia
  • cardiovascular disease
  • calcification
  • uremia (too much pee and urine)
68
Q

oral problems of ckd

A
  • periodontitis, xerostomia, uremic fetor (halitosis), pale mucosa, delayed eruption of teeth, hypoplasia, wound healing problem, root canal calficifation
69
Q

hemodialysis

A
  • make point into blood (arteriovenous shunt)
  • dialysis cleans blood
  • 3/4 times a week for.4 hours
  • increase protein intake and limit minerals

2 parts

1) for blood
2) washing fluid: dialysate where small stuff goes
- separated by thin mem

70
Q

endocarditis

A
  • bac infection of heart lining
    1) acute IE; develops suddenly and dead in days
    chronic IE: develops in weeks
  • mitral valve most effected
  • stap aures
71
Q

prevention of endocarditis

A
  • antibiotics (not for ortho, routine treatment, prostho)
  • prosthetic cardiac valves
  • 6 weeks for antibiotics
72
Q

medications for ckd

A
  • nsaids (ibuprofen) not for later stages
  • anlgesics: acetaminophen
  • opiates: morpheine, codeine for GFR less than 50
  • antibiotics: avoid tetracycline
73
Q

dental treatment and dialysis

A
  • only 24 hours after, not same day
  • give heparin to prevent clot so make sure no heparin b4 treatment
  • do sutures
74
Q

prior to kidney transplant dental

A
  • no periodontal
  • platelet count
  • do all treatment b4 but can do after
  • extractions
75
Q

dental after transplant

A
  • no dental for 3 mos
  • can maybe do treamtnet from 3-6 mos
  • check bp
  • stop bleeding
76
Q

enameil

A
  • hardest
  • ameloblast
  • no living cells
  • fluoride
77
Q

dentin

A
  • odontoblast
  • dentinal tubules
  • soft
78
Q

dentin and enamel meet at

A

dej

79
Q

cementum

A
  • coveres root of tooth
  • cementoblast
  • cause sensitivity
  • meets enamel at CEJ
80
Q

pulp

A
  • center of tooth
  • contains blood vessels and nerve tissue
  • lined by odontoblasts
  • divided into pump chamber and pulp canal
81
Q

odontogenesis initiation

A
  • 6-7 week
  • oral epithelium comes from ectoderm
  • lamina: budding tooth is ectoderm
  • ectomecenchyme thick layer at bottom to proliferate into lamina (neural crest)
  • sumernumary (extra tooth when this goes wrong)
82
Q

bud stage

A
  • placode: new bud at 8 weeks
  • lamina is growing fast and invades the mesenchyme
  • lamina pinches off to form buds
  • mesenchyme condenses
  • failure will result in no or extra tooth
83
Q

cap stage

A
  • 9 week
  • placode grows and indents to form enamel organ
  • OEE: outer cell layer
  • IEE inner cell layer
  • stellate reticulum
  • mesenchyme forms the papilla (dentin and pulp)
  • follice is the sac
84
Q

cap stage defects

A
  • cyst, odontomoa (tumor), gemination, fusion, dents in dente
85
Q

bell stage

A 
- 11 weeks
0 histodifferentiate
- IEE turn to ameloblast
- papilla turn to odontoblast
- defect is yellow teeth
- weird structure
86
Q

apposition

A
  • late bell stage, 14 wks
  • odontoblasts deposit collagen (dentin matrix)
  • ameloblast do enamel (amelogenin)
  • cervical loop is where root starts (IEE and OEE join here)
87
Q

IEE + OEE = REE

A
  • junctionn epithelium which protects tooth as it erupts
88
Q

cervical loop

A
  • forms hertwig’s epithelial root sheath (HERS)
  • stimulates odontoblasts to secrete reticular dentin
  • hers is vestigial and leaves cells called epithelial rests of malassez
  • papilla becomes pulp
89
Q

maturation

A
  • 14 + weeks
  • deposition of enamel and dentin
  • calcification begins at cusp tip where enamel knots are
  • takes 2 years to complete crown and 4-5 years for permanent tooth
  • defetions: white spots, fluorosis, tetracycline staining
90
Q

enamel organ

A
  • made of ameloblasts giving enamel
91
Q

papilla

A

0 odontoblasts to make dentin

- central cells make up pulp

92
Q

follicle

A
  • decretes cementoblasts, osteoblasts (alveolar bone) and fibroblasts (periodontal ligament)
93
Q

eruption

A
  • 20 bb teeth at 6 mos

- by 21, should have all 32 teeth

94
Q

tooth discoloration

A
  • food
  • health of teeth
    0 dental materials
  • aging (worn enamel)
95
Q

dental health and tooth discoloration

A
  • genetics
  • environment (f ions)
  • trauma (hit in mouhth)
96
Q

classification of tooth yellow

A
  1. extrinsic: surface

2. instrinsic dentin discoloration

97
Q

extrinsic stain

A
  • external deposits on teeth
  • smoking, plaque, bad food
  • bad toothbrushing
  • abrasive stuff
98
Q

intrinsic discoloration

A
  • structure change
  • not common
  • injury, flurosis, teeth dev, genetics, tetracycline
99
Q

tetracycline

A
  • antibiotic
  • protein synthesis inhibitor

the way it stains

  • teeth are exposed during calcification
  • tetracycline binds to ca
  • happens prior to tooth eruption through gingiva, causes fluorescent yellow
  • upon eruption, ca bound tetra will oxidize, causing a colour change to brown
100
Q

tetracycline stained teeth depends on

A
  • dosage, length, stage of calcification
  • mild: is yellow
  • moderate: deeper stain in various places
  • severe: banding and stain
  • intractable: intense pigment
101
Q

pregnancy and enamel defects

A
  • ingestion of minerals can cause discolouration
  • chalky spots on kid
  • 6 year old molars are most prone: causes are mothers health, medications to her, illnesses as a kid
  • results in decay, fragile teeth, sensitive
102
Q

treatment of ETD

A
  • teeth whitening, dental bonding, porcelain veneers
103
Q

intrinsic stainning treatment

A
  • hcl microabrasion
  • macroabrasion
  • veneering, tooth bleaching
104
Q

tetracycline stain treatment

A
  • veneers or growns, bleaching
105
Q

enamel defects in kids

A
  • reduce sensitivty and strengthen
  • fluro or tooth mousse
  • restorations
  • extractions and ortho

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