Gerodontology

Question 1

Define stroke.

Answer 1

Sudden interruption of blood supply to the brain leading to rapid neurological deficit/disturbance lasting for >24 hours.

Question 2

What are the two main types of stroke ?

Answer 2

Ischaemic - cerebral infarction.
Haemorrhagic - cerebral haemorrhage.
Carotid artery dissection (neck trauma).
Cerebral venous thrombosis - thrombus lodging in venous plexus.

Question 3

What are the symptomatic/medical consequences of a stroke ?

Answer 3

Dysphagia, dysarthria, facial weakness, slurred speech, gait disturbance, unilateral voluntary movement weakness, impaired sensation/pain (affecting face), loss of conciousness, epilepsy, dementia.

Question 4

What are the risk factors for having a stroke ?

Answer 4

Atrial fibrillation.
Hypertension.
Type 2 diabetes.
Infective Endocarditis.
Coronary heart failure.
Structural heart defects,
Non-modifiable - men, >55 years old.
Lifestyle factors - smoking, exercise, diet.
Family history.

Question 5

Name some dental considerations which should be given when treating a patient who has suffered a stroke ?

Answer 5

Mobility and access.
Communication and consent/capacity.
Depression leading to reduced self care.
Manual dexterity impairment.
Dysphagia - risk of choking with poor aspiration etc.
Sedation contraindicated - benzodiazepines.
Muscle control for maintaining dentures.
Weight loss for maintaining dentures.
Drugs - xerostomia.
Anticoagulants - risk of bleeding.

Question 6

For how long post-stroke, should you avoid non-emergency treatment ?

Answer 6

3-6 months.

Question 7

In what ways can you improve access to your dental practice ?

Answer 7

Ramp.
Doors wide enough to fit wheelchairs.
Referral to practice that are better able to accommodate them.

Question 8

In what ways can you help a patient suffering dysphagia to prevent choking during a dental procedure ?

Answer 8

High volume aspiration.
Saliva ejector.
Dry guard.
Cotton wool.
Dental dam.

Question 9

Will a patient having a stroke be able to wrinkle their forehead - yes or no ? And why ?

Answer 9

Yes.
Upper neuron event.
Forehead receives motor innervation from both hemispheres of the brain so forehead will continue to receive compensatory innervation from the other side of the brain.

Question 10

What are other symptoms that would indicate your patient is having a stroke in your dental chair ?

Answer 10

Speech difficulty, limb weakness/paralysis, pupil constriction, loss of consciousness.

Question 11

Your patient is having a stroke in your dental chair, what do you do ?

Answer 11

1. Call ambulance.
2. Talk to patient.
3. Make sure they are in a safe environment.
4. Roll onto their side.

Question 12

What treatment will be given to a patient having a stroke immediately by the ambulance service ?

Answer 12

Thrombolytic drug - tissue plasminogen activation (tPA).

Question 13

What are the two causes of Bells Palsy ?

Answer 13

Trauma to facial nerve or viral infection.

Question 14

Will a patient suffering Bells palsy be able to wrinkle their forehead - yes or no ? And why ?

Answer 14

No.
Lower neutron pathway affected.
Patient will be unable to close eye.

Question 15

Define dementia.

Answer 15

Acquired progressive loss of cognitive function.

Question 16

What are the signs of dementia ?

Answer 16

Memory loss, inability to concentration, personality change, disorientation, intellectual impairment.

Question 17

What are the five types of dementia ?

Answer 17

Alzheimers, vascular, dementia with lewy bodies, frontotemporal and Korsakofts.

Question 18

What are the factors you must consider when treating a patient with dementia in dental practice ?

Answer 18

Mobility, manual dexterity, capacity to consent, communication abilities.

Question 19

What is the cause of Alzheimers ?

Answer 19

Beta amyloid plaque build up between neurons in the brain and neurofibrillary tangles of tau proteins forming inside neurons - resulting in reduction in size of cortex.

Question 20

What are the signs of Alzheimers ?

Answer 20

STML, aphasia, mood swings, confusion, withdrawal, low self confidence.

Question 21

What are the risk factors associated with Alzheimers ?

Answer 21

Age, women, head injury, smoking, hypertension, low folate, high blood cholesterol, genetic mutation of chromosome 1, 14, 21.

Question 22

What is the cause of vascular dementia ?

Answer 22

Reduced blood flow to the brain caused by small blood vessel narrowing, single large stroke, multiple TIAs.

Question 23

What are the risk factors associated with vascular dementia ?

Answer 23

Hypertension, diabetes, overweight, smoking.

Question 24

Describe dementia with Lewy bodies.

Answer 24

Lewy body deposit build up in the brain in areas relating to memory.

Question 25

What is the cause of Korsakofts dementia ?

Answer 25

Vitamin B12 deficiency with links to alcoholism.

Question 26

Describe rheumatoid arthritis.

Answer 26

Autoimmune attack of synovial causing gradual inflammatory destruction of joints.

Question 27

What type of drugs might a patient with RA be taking to manage their condition ?

Answer 27

Analgesics.
NSAIDs.
Methotrexate/hydroxychloroquine.
Azathioprine.
Intra-articular steroids.

Question 28

What are the concerns related to dentistry regarding patients affected by RA ?

Answer 28

Mobility and access.
Sjogrens syndrome - xerostomia, cervical caries.
Increased bleeding due to NSAIDs.
Increased infection risk due to immunosuppressant medication.
Lichenoid reactions to medication - hydroxychloroquine.
Ulceration due to medication - methotrexate.
Oral pigmentation due to medication - hydroxychloroquine.
Manual dexterity.

Question 29

Describe osteoporosis.

Answer 29

Reduce quantity of normally mineralised bone due to imbalance of osteoclastic and osteoblastic activity.

Question 30

What are the risk factors to development of osteoporosis ?

Answer 30

Age, women, post-menopause, smoking, exercise, low Vitamin D, anti-epileptics, Cushings disease.

Question 31

What type of drugs can patients with osteoporosis be put on to manage their condition ?

Answer 31

Anti-resorptive - bisphosphonates, RANKL inhibitors (monoclonal antibodies), selective oestrogen receptor modulators.
HRT.

Question 32

Give an example of a bisphosphonate.

Answer 32

Alendronic acid (oral).
Zoledronic acid (IV).

Question 33

Give an example of a RANKL inhibitor.

Answer 33

Monoclonal antibodies i.e. denosumab.

Question 34

What medications are responsible for causing MRONJ ?

Answer 34

Anti-resorptive drugs - bisphosphonates, RANKL inhibitors, selective oestrogen receptor modulators.
Anti-angiogenic drugs - axitinib.

Question 35

Why might a patient be taking an anti-angiogenic drug ?

Answer 35

Cancer management - prevents blood vessel growth.

Question 36

Why might a patient be taking a selective oestrogen receptor modulator ?

Answer 36

Cancer management - breast, cervical cancer.
Management of osteoporosis.

Question 37

Why might a patient be taking a bisphosphonate orally ?

Answer 37

Osteoporosis, recent fracture and elderly.

Question 38

Describe MRONJ.

Answer 38

Medication-related osteonecrosis of the jaw.
Medications interrupt the bone remodelling signals to the jaw resulting in necrosis - unknown specific mechanism (same for ORN).

Question 39

What factors will put patient at higher risk of developing MRONJ ?

Answer 39

Taking anti-resorptive or anti-angiogenic drugs.
For >5 years.
If given IV.
If taking with systemic glucocorticoid medication in cancer treatment.