Dent cases Flashcards
thc
pschoactive
- produces high by dopamine
- causes intoxication, motor impairment, anxiety,
cbd
cannbidol not psychoactive
- anti inflammatory
- theraputic
- needs thc to bind
- low side effect
sativta
more stimulating, higher thc
indica
relaxing, higher cbd, more pain relief
cannabis plant anatomy
bud contains the cannabinoids, only on females, must be dried before use
methods of cannabis use
inhalation: fast and direct to blood thru smole
oral
sublingual: under tongue so blood vessels can absorb
topical: reduces pain and inflammation
endocannabinoid system
- 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
exogenous cannabinoids
produce biological effects through interactions with receptors (cbd and thc)
thc and exogenous cannabinoids
interacts with system by binding to both cb1 and cb2
- inhibits adenylyl cyclase, decrease in kinase
- increase dopamine
cbd and exogenous cannabinoids
- not known
- maybe extends life of cannbinoids or another receptor
what does cannabis treat
- hiv, cancer, galucoma, ptsd
medicinal use of cannabis
- pain: antiinflammatory
- anorexia: increase in appetite and symptosm of cancer
- reduces nausea and vomiting from chemo
- relaxes muscles in MS
- less seizures
legal stats of cannabis
- legal in 37 states, 4 territories and district of columbia
- requires doctor, id card and age
rec use of cannabis
- legal in 18 states, 2 territories
- 21 years +
symptoms of cannabis
- altered sense and time, mood change, body movement, more hunger, thinking, hallucinations, psychosis
signs of cannbis use
- dizzy, being silly, bloodshot eyes, hard time remembering, tiredness
long term cannabis effect
- brain dev, breathing, high heart rate (vasodilation and ischemia), hyperemesis syndrome (nausea, vomiting, dehydration), mental illness
cannabis and hr
cb1 activates brain, increase in pulse, increase in bp
is cannabis addictive
- can lead to substance disordeer, 9-30% develop a disorder, if use before 18 then 4-7x more likely to get disorder
oral health and cannabis
- 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))
oral cancer and cannabis
- acts as a carcinogen
- asspcoated wotj lesions
- leukoplatia (whie lesions)
- tumors on anterior floor of mouth or tongue
periodontitis and cannabis
- 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
cannabis and dental treatment
- cannabis lasts 2-3 hours
- increases likelihood of patients getting anxious and paranoid
- tachycardia then give epi
- need 220% higher dose of sedation
can’t use this for weed patients
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
xerostomia and weed
- dose dependent
- give sugar free gu, saliva substitute, low cariogenic diet
how do dentists talk to weed users
- theraphy
- give rewards to patients who are drug free
- tell them the effects
- gie topical fluorides
- importance of regular dental visit
renal cortex
- located between renal corpuscule and renal medulla. contains blood vessels that connect to nephrons, also makes erythropoeietin
renal medulla
- innermost region that contains builk of nephrons and is arranged in pyramid like structure
renal pelvis
- contains a hilum, where renal artery, vein, and nerves enter kidney and where ureter leaves kidney, connects kidney with circulatory and ns system
external kidney regions
- renal fascia, perinatal fat capsule, renal capsule
nephron
- 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
cortical nephrons
- originate from glomeruli and have short loop of henle and more superficial (80%)
juxtamedullary nephrons
- less prevalent type, located deeper in the cortex, have long loop of henle and form the papillae (20%)
kidney function fluid and electrolyte balance
- 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
filtration kidney function
- filters fluids and solutes from plasma into nephrons
reabsorption of kidney
- reabsorbs fluids and solutes out of the renal tubules (nephron) into circulation
secretion of kidney
- 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)
erythropoetin
-stimulates rbc blood cell production in marrow
renin
- converts angioteninogen into angiotensin I
kidney and vit d
convert it from 25 hydroxy to 1,25 hydroxy which is active
- used to regulate calcium levels and maintain homeostasis
ultrafiltrate flow ( not afferent efferent)
- 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
FILTRATION PROCESS
- 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
bowmans capsule
cup like sac that surrounds the glomerulus that passes filtrate to the proximal convulated tubule.
glomerular hydrostatic pressure
- exerted by blood inside glomerular capillaries
60 mmhg - subtract the other pressures from this
glomerular colloid (oncotic pressure)
exerted against direction of filtration by proteins in capillaries
- 32 mmhg
bowman’s capsulre pressure
- exerted against filtration by fluid within the capsule itself
- net pressure is 10-15
- 18 mm hg
glomerular filtration rate
- 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
clearance
- 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
proximal convoluted tubue
- proximal convoluted tubule
- responsible for gross adjustment reabsorption
reabsorption
- all gluc and AA are REabsorb in early PCT
- 65% water, sodium and cl are absorbed
secretion
- H+ ions are secretion to reabsorb bicarb
- toxins and urea also secreted
descending loop of henle
- thin, water is allowed
- absorbs 20% of water
ascending loop of henle
- 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
dct and cortical collecting duct
- 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)
jga
- monitors the gfr and regulates bp
- too much fluid then constricts arterioles to reduce flow
- also secrete renin
medullary collecting duct
- 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
adh
- 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
chronic kidney disease
- 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
ckd causes
- 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)
symptoms of cdk
- nausea, vomitinng, tired, pee problems, cramps, swellin of feet, chest pain
kidney friendlt diet
- whole grain carbs, low sodium, protein intake control
kidney and bones
- 97% calium and 80% phos is filtered in kidney is resabs
- ca stimulates osteoblast
- vit d stuff for calcium too
kidney regulates ca and p
- low cal, pth is released. decreases p absorption. makes calcitrol (vit d??) which allows pct to absorb ca
calcitrol
negative feed on pth
- stimulates release of ca and p
- pth also bone abs of ca
bone problems in ckd
- mineral imbalance, effecting bones
- ca imbalance
- p buildup
- pth surge so ca leaves bones
mineral and bone problem treatment
- bones break, bone pain, itchy skin, anemia
- low phos diet, vit d suppleents, ca supplements, surgery of pt gland
morbidities associated with cdk
- renal osteodystrophy: bone problems
- hypocalcemia: low levels of ca in blood
hypertension, dia - hyperlipidemia
- cardiovascular disease
- calcification
- uremia (too much pee and urine)
oral problems of ckd
- periodontitis, xerostomia, uremic fetor (halitosis), pale mucosa, delayed eruption of teeth, hypoplasia, wound healing problem, root canal calficifation
hemodialysis
- 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
endocarditis
- 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
prevention of endocarditis
- antibiotics (not for ortho, routine treatment, prostho)
- prosthetic cardiac valves
- 6 weeks for antibiotics
medications for ckd
- nsaids (ibuprofen) not for later stages
- anlgesics: acetaminophen
- opiates: morpheine, codeine for GFR less than 50
- antibiotics: avoid tetracycline
dental treatment and dialysis
- only 24 hours after, not same day
- give heparin to prevent clot so make sure no heparin b4 treatment
- do sutures
prior to kidney transplant dental
- no periodontal
- platelet count
- do all treatment b4 but can do after
- extractions
dental after transplant
- no dental for 3 mos
- can maybe do treamtnet from 3-6 mos
- check bp
- stop bleeding
enameil
- hardest
- ameloblast
- no living cells
- fluoride
dentin
- odontoblast
- dentinal tubules
- soft
dentin and enamel meet at
dej
cementum
- coveres root of tooth
- cementoblast
- cause sensitivity
- meets enamel at CEJ
pulp
- center of tooth
- contains blood vessels and nerve tissue
- lined by odontoblasts
- divided into pump chamber and pulp canal
odontogenesis initiation
- 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)
bud stage
- 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
cap stage
- 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
cap stage defects
- cyst, odontomoa (tumor), gemination, fusion, dents in dente
bell stage
- 11 weeks 0 histodifferentiate - IEE turn to ameloblast - papilla turn to odontoblast - defect is yellow teeth - weird structure
apposition
- 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)
IEE + OEE = REE
- junctionn epithelium which protects tooth as it erupts
cervical loop
- 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
maturation
- 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
enamel organ
- made of ameloblasts giving enamel
papilla
0 odontoblasts to make dentin
- central cells make up pulp
follicle
- decretes cementoblasts, osteoblasts (alveolar bone) and fibroblasts (periodontal ligament)
eruption
- 20 bb teeth at 6 mos
- by 21, should have all 32 teeth
tooth discoloration
- food
- health of teeth
0 dental materials - aging (worn enamel)
dental health and tooth discoloration
- genetics
- environment (f ions)
- trauma (hit in mouhth)
classification of tooth yellow
- extrinsic: surface
2. instrinsic dentin discoloration
extrinsic stain
- external deposits on teeth
- smoking, plaque, bad food
- bad toothbrushing
- abrasive stuff
intrinsic discoloration
- structure change
- not common
- injury, flurosis, teeth dev, genetics, tetracycline
tetracycline
- 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
tetracycline stained teeth depends on
- dosage, length, stage of calcification
- mild: is yellow
- moderate: deeper stain in various places
- severe: banding and stain
- intractable: intense pigment
pregnancy and enamel defects
- 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
treatment of ETD
- teeth whitening, dental bonding, porcelain veneers
intrinsic stainning treatment
- hcl microabrasion
- macroabrasion
- veneering, tooth bleaching
tetracycline stain treatment
- veneers or growns, bleaching
enamel defects in kids
- reduce sensitivty and strengthen
- fluro or tooth mousse
- restorations
- extractions and ortho
