Dental Correlation Flashcards
Odontogenic infection of Ludwing’s Angina
most commonly from?
Etiology?
Most commonly from fisrt, second, third molars
local trauma, salivary gland infections, infected brachial cleft or thyroglossal duct cyst, oral surgery procedures
clinical presentation of Ludwing’s angina swelling
B/L swelling of the subandibular, submental, sublingual spaces
painful swallowing, difficulty swallowing, shortness of breathe, trismus, inability to handle oralsecretions, fever, malaise
clinical presentation of hyperthyroidism
nervous, diaphoretic (sweating), thin, with tremor and exopthalmus, heat intolerance
what are the levels of TSH and T3 and T4 with primary hyperthyroidism?
The TSH is LOW
and the T3 and T4 are higher
what tests do you order with a patient with hyperthroidism?
Thyroid functoin tests for T3 T4 and TSH
thyroid antibodies
thyroid radioactive iodine 123
what is the most common cause of hyperthyroidism? describe it
Grave’s Disease
Autoimmune disease that produces IgG type of antibodies known as thyroid stimulating immunoglobulins (TSI’s) – they bind to the TSH receptor in the thyroid gland and cause the release of T3 and T4
how is hyperthyroidism treated?
Antithyroid medication - to try and inhibit the synthesis of thyroid hormones
Radioactive iodine therapy – can destroy thyroid follicular cells – but could lead to hypothyroidism (avoid in pregnancy and children)
Thyroidectomy – side effects
Propanolol- treat tachycardia and hypertension
what oral findings may be associated with hyperthyroidism?
Increased susceptibility to caries
perio disease
enlargement of extraglandular thyroid tissue
maxillary or mandibular osteoporosis
accelerated dental eruption
burning mouth syndrome
describe dental management with hyperthyroidism patient
Establish the current diagnosis of the hyperthyroidism (primary / secondary?)
What tx are they one? – medication?
Know their medical status and latest findings on test
STRESS REDUCTION PROTOCOL – morning appointments, nitrous oxide, sedation, go WITHOUT A VASOCONSTRICTOR?? – so can use epi ONLY IF IT IS WELL CONTROLLED
describe thyroid storm
Life threatening – represents a sudden and severe exacerbation of the signs and symptoms of hyperthyroidism manifested by fever, restlessness, tachycardia, a fib, pulmonary edema, tremor, sweating….nnot treated = coma or death
Synthroid medication
treats hypo thyroidism – often patients with hyper will eventually take this b/c those medications can cause hypo
how does hypothyroidism present clinically?
cold intolerance weight gain weakness fatiue decreased BMR decreased CO dry, rough skin, edema, aemia?
oral maifestations associated with hypothyroidism?
MACRO-glossial - large tongue
Dysgeusia – alteration of taste
delayed eruption of teeth
poor perio health
delayed wound healing
Dental Tx considerations in Hypothyroiod patient
IF WELL CONTROLLED – no special precaustions for routine or emergency
if patient seems lethargic or decrease in respiratory rate – need to think maybe it is uncontrolled
Dental Tx considerations in Hypothyroidism pt that is undiagnosed, uncontrolled, or untreated
elected procedures should be delayed
surgical procedures should be avoided
acute orofacial infections treat aggresivly
BE OBSERVANT TO INCREASED LETHARGY– decreases in respiratory rates
oral implications of DIABETES
Xerostomia – 2nd to salivary gland dysfunction
increased risk of oral infections
increase incidence and severity of gingival inflammation, perio abscess, and chronic perio disease
increase incidence and severtiy of caries
glossodynia = burning mouth and some dysgeusia
Type 1 DM
disordered carb metabolism and inappropriate hyperglycemia
due to deficiency of endogenous insulin secretion
results of DM
accelerated atherosclerosis, neuropathy, nephropathy, and retinopathy
type 2 DM
either a deficiency of endogenous insulin secretion and or a combination of insulin resistance and inadequate insulin secretion to compensate
clinical manifestations of DM
Polyuria- large quantities of dilute urine Polydispsia -- increases in thirst Polyphagia- excessive hunger weight loss fatigue nausea candidal infections frequent infections
lab test for Blood sugar control
fasting blood glucose level
Hb1Ac levels – monitored every 3 months = glocosylated hemoglobin
Fasting blood sugar is more than should you defer tx? HbA1c levels?
greater than 250 mg/dl
if HbA1c levels is over 9%
time for diabetic pt apointment?
mornings
what level of fasting sugar should you give patient glucose
if only 70-90 md/dl give glucose
if over 200 defer elective tx
Describe COPD
insidious onset
usually presents in 5th or 6th decade of life and complaints of excessive cough, sputum productoin, and shortness of breathe
blue bloater
predominatley with chronic bronchitis
secondary to chronic hypoxemia and hypercabia (increased Co2 levels)
peripheral edema
tachycardia, tachypnea, and chronic cough with production of large amounts of sputum
pink puffers
predominately emphysema
a cachectic appearance, but pink skin color
dyspnea manifested by PURSED LIP breathing and use of accessory muscles of respiration
LA for pt with COPD?
pateint in supine position
LA is NOT contraindicated – but if demonstrating CV side effects – may require the limited use of vasoconstrictors
use of oximeter to determine oxygen saturation
most epi you can give cardiac patient of epi
0.04
T/F with severe COPD use of rubber dam is problematic, nitrous oxide is contraindicated, and sedative medications rewuire low dose oral benzodiazepines
TRUE
+ narcotic analgesics are used with caution b/c they are respiratory depressants
T/F asparin should be avoided in aspirin sensitive asthmatics
TRUE
angina =
chest pain
stable angina
attacks of chest pain are limited duration and are predictably induced by exertion
pain is usually relieved by decreasing the cardiac metabolic demand or by nitroglycerin (which helps widen the blood vessels – dilation)
unstable angina
attacks occur more frequently and produce more symptoms than those with stable – can occur more progressively (w/ less activity and may occur at rest)
variant angina (Prinzmetal’s)
ST deviation on ECG – coronary artery spasms associated
- attacks in morning
- if prolonged could result in MI and dysrhythmias or death
patients tend to be younger than patietns with chronic stable angina or unstable angina
vasocontrisctors contraindicated in angina patients?
Not an absolute contraindication but they are a relative
- procedure short– dont
if pt. develops chest pain during dental tx?
put patient in comfortable position – supplement oxygen to sat > 94% – check vital signs of BP and pulse
give .4 mg of Nitroglycerin – recheck VS
if not better assume MI (myocardial infarction) and call 911 M -- morphine O-- oxygen N -- nitroglycerin A-- ASA
pt. with past medical history of myocardial infarction?
need to be aware of the duration and extent of any procedure
obtain a current status and stability of patient
look for continued risk factors
- hypertension
- hyperlipidemia
- diabetes mellitus
- smoking
*use of pre-treatment nitrates
CONSIDER LIMITING TOTAL DOSE OF LA CONTAINING VASOCONSTRICTORS
signs of right sided heart failure
Jugular venous distension
enlarged and tender liver and spleen
ascites - abnormal swelling in peritoneal
peripheral edema
cyanosis
fatigue and weakness
tx of odontogenic infection
perform surgical drainage and to remove the cause of the infection
