dentist autoimunity Flashcards
diabetes - autoimmune oral causes
Candida/ dry mouth/ sialosis, glossitis.
Severe periodontitis may upset glycaemic control
Vigorous treatment of oral and facial infections
thyroid issues and there effects on dentistry
Analgesics and sedatives incl GAs can precipitate myxoedema coma- which can be serious
carbizomol and its effects orally and what it is used for
Carbimazole can cause agranulocytosis ( low neutrophil counts) which can cause oral or oropharyngeal ulceration.
celiac disease dentitry
Anaemia (iron or folate)
Aphthous ulcers
Dermatitis herpetiformis- on elbows small raised rash
celiac disease diagnosis
Investigation Anti-endomysial antibody positive Anti TTG antibody positive Biopsy – gold standard if you want to test if you are 6 weeks 3 pieces of bread
Autoimmune haemolytic anaemia
Acute severe or mild chronic anaemia
Associated with thrombocytopenia
Autoimmune neutropenia ( low neutrophils)
Oral ulceration
Increased risk of infection
Prophylaxis with antibacterials and anti-fungals
Immune thrombocytopenic purpura
Idiopathic or preceded by viral infection
Purpura, bruising and nose bleeds
May need high dose steroids, splenectomy ( not as coonon now) or rituximab( try’s to get rid of bad cells)
Bullous pemphigoid
Elderly
Subepidermal blisters
Mucous membranes
Oral prednisolone or azathioprine- immunosuprression
Pemphigus vulgaris
Rare blistering disorder
Non-healing erosions of mucous membranes
Flaccid blisters on skin
High dose steroids
kidney disease
Can be autoimmune
Non-organ specific – Wegeners granulomatosis, microscopic polyarteritis,SLE and Goodpastures
Goodpastures
anti-GBM antibodies bind to both glomerular and alvelolar basement membrane and these bind in the kidney and also alveolar basement membrane and cause lung disease too
Type II hypersensitivity
renal failure
from kidney disease Bleeding tendencies Impaired drug excretion Steroid treatment Hypertension Infections increase Anaemia Dysrhythmias in the heart because of elecrolytes distrubence
liver and cns problems
Liver Autoimmune hepatitis Primary biliary cirrhosis Nervous system Guillain-Barre CIDP Myasthenia gravis
rheumatoid arthritis and how to diagnose
Associated with extra-articular disease, Sjogren’s syndrome- dry mucous membranes
Diagnosis is clinical
ESR and CRP will be raised- inflammatory mediators
Rheumatoid factor, IgG anti-IgG, anti-CCP autoantibody found in 65
you can also get:
Gastrointestinal problems
Felty’s syndrome
Splenomegaly9 ENLARGED SPLEEN) & neutropenia
sclerderma presentation other than skin
Limited (CREST) Calcinosis Raynauds Oesophageal immotility- difficult to swoolow Sclerodactyl- sausage fingers Telangiectasia Pulmonary hypertension
sclerderma presentation other than skin and the antibodies
Limited (CREST) Calcinosis Raynauds Oesophageal immotility- difficult to swoolow Sclerodactyl- sausage fingers Telangiectasia Pulmonary hypertension
antibodies: Anti-centromere antibodies
sclerderma dental aspects
Periarticular involvement of temperomandibuliar joint with microstomia
Constriction of oral orifice- skin tightening around mouth
Thickened, stiffened tongue
Oral telangiectasia
Widening of periodontal membrane space without tooth mobility
Potential problems for GA
Dysphagia
Pulmonary, cardiac and renal disease
diffuse systemic sclerderma and the antibodies
V. evident changes of skin affecting face and mouth
Hands may develop flexion deformities
Intracutaneous and subcutaneous calcification
Renal involvement
Anti-Scl70 andtibodies
sjogrens syndrome
Triad of :
Dry eyes
Dry mouth
Associated inflammatory arthritis
Lymphocytic infiltrate of lacrimal and salivary glands
Also affects other exocrine glands in pancreas, lungs and vagina
clinal features:
Ocular and oral features
Non-specific fatigue
Dyspareunia
Recurrent chest infection
Dry mouth
Increased cariogenic diet because of impaired sense of taste
Candida infection & angular stomatitis
Ascending parotitis
GA risk
sjogrens disease antibodies
Anti-nuclear antibodies
Anti-Ro
Anti-La
Rheumatoid factor (esp in arthritis) can. Be detected in this condition
Polyclonal increase in immunoglobulins
But association with lymphoproliferative disease
Vasculitis
Granulomatosis with polyangiitis upper respiratory / sinus involvement Nasal ulceration Haemoptysis Cytoplasmic ANCA ( antibodies) Rash secondary to the vasculaitus
renal involvement
Cryoglobulinaemia
skin involvement
vasculitis diagnosis
Inflammation of blood vessels Elevated inflammatory markers ANCA- anti neutrophil cytoplasmic antibodies U&Es- as kidney function may be impared Urinalysis Anaemia of chronic disease Imaging e.g. CXR
behcets
Clinical triad of: Aphthous-type oral ulceration Genital ulcers Iritis Other symptoms Skin lesions Pathergy- blistering lesion a couple of days aftert aking blood
Skin lesions: Papulopustules Folliculitis Erythema nodosum Acne
Venulitis Large vessel thrombosis Other manifestations Neuro-Behcet’s Gastrointestinal Ocular involvement Iritis and retinal vascultits Arthritis
diagnosis
No diagnostic tests
Colchicine & thalidomide
Immunosupression
Anti-TNF
autoimmune disease treatments
Anti-inflammatories
Steroids- steroids not used as much as steroids so use other immunological supperseants
Immunosuppressants/DMARDs
Monoclonal antibodies
immunosuppressants risks
Consider need for increased dose of steroids with infection, illness, surgery
Poor wound healing, increased risk of infection
Avoid aspirin and NSAIDs as risk of peptic ulceration
Oral candidiasis
Increased risk of infection (e.g. susceptibility to infection, activation of latent viruses (e.g. shingles)
Altered red and white cell counts
Liver function abnormalities
anti immune drugs
Cytotoxics:
Cyclophosphamide
Antimetabolite drugs:
Methotexate
Antiproliferative drugs:
Azathioprine
Mycophenolate mofetil
Anti-T cell activation:
Ciclosporin- hypertrophy
Tacrolimus
