HD 8 – Dental Management of patients with musculoskeletal disorders Flashcards
What is osteogenesis imperfecta?
Brittle bone disease
What is the genetics behind having osteogenesis imperfecta?
Autosomal dominant/ sporadic (mutation)
What does blue sclera show?
Colloidal layer of eyeball shows through sclera due to the impact on collagen formation
How can osteoporosis lead to impaired respiratory function?
- Thoracic spine vertebral bodies become less dense – mechanical collapse
- Vertebral collapse may lead to chest deformity
Why do people with osteoporosis take bisphosphonates?
Alter bone metabolism, impacting osteoclast function
How is a patient on bisphosphonates treated when extractions are needed?
If taking IV bisphosphonates – refer for specialist to extract teeth
If taking oral bisphosphonates – can treat in primary care
= Unless bone very unstable, don’t remove as will impact healthy bone deep to the surgery site
What is osteopetrosis?
Spongy bit of bone doesn’t exist – all bone is compact (MARROW SPACE DISSAPEARS)
As marrow is absent, less haematopoiesis = ANAEMIA
What could happen post extraction in osteopetrosis case?
Possibility of post-extraction osteomyelitis
= Brittle bone, tooth will snap in socket – no room for tooth to move = difficult surgical extraction (refer to hospital)
What are the genetics behind fibrous dysplasia?
Monostotic/polyostotic - not inherited
What increases risk of fibrous dysplasia?
- Increased risk of hyperthyroidism
* Diabetic tendency
What is seen in a bone biopsy of fibrous dysplasia?
Islands of bone shaped like Chinese letters
What genetics are behind cherubism?
Rare = autosomal dominant
What occurs in cherubism?
- Males predominate
- Large cheek bones
- Cellular and vascular fibrous tissue with giant cells
Why are blood tests carried out in cherubism?
To exclude hyperparathyroidism
What is the treatment of cherubism?
Surgery
Males (18)/ females (17) = when stop growing
What does the bone look like in Paget’s disease of the bone?
- Periods of bone deposition/ resorption – end up with reversal lines
- Mosaic appearance
What are the symptoms of Paget’s disease of the bone?
- Patients may be in cardiac failure – high output cardiac failure
- Chest deformities
- Dentures get tighter = bone deposition (or hats don’t fit anymore)
- Saber tibia – due to mechanical weight on bone modelling in an asymmetric fashion
- Glass in concrete syndrome – like trying to take teeth out of bone = TEETH (GLASS)/ BONE (CONCRETE); Teeth likely to break (brittle) and bone very tough
Why is OH poor in rheumatoid arthritis?
Ulnar deviation (fingers drifting in direction of baby fingers)
Why does dental treatment need to be completed before cytokine inibitor medication is started?
Alpha-TNF inhibitors = Affect immune response
If extractions are done before radiotherapy treatment, what should occur to aid healing?
Cover bone with soft tissue
How long after radiotherapy should extractions be avoided for?
6 months to 1 year
How is osteoradionecrosis treated?
Do not treat surgically (i.e., drilling bone) = provide antibiotics instead
What steps should be carried out to aid healing if post-radiotherapy extractions take place?
- Minimal trauma (minimise periosteal lifting) – small flaps, for higher perfusion of blood for healing
- No vasoconstrictor
- Trim sharp bone edges
- Close soft tissues accurately
- Prophylactic antibiotics for 1 month or until sockets heal
Why does radiation caries occur? And how is this treated?
- Caused by very bad xerostomia
- Optimise oral hygiene
- Use topical fluoride
What genetics are behind marfan’s syndrome?
Autosomal dominant
What lung problems occur in marfan’s syndrome?
- Collapsed lungs = pointy lung tip – more likely for lung to peel away causing pneumothorax
- Pulmonary cysts leading to spontaneous pneumothorax
What heart problems occur in marfan’s syndrome?
Aortic and mitral incompetence
What spinal problems occur in marfan’s syndrome?
- Kyphosis (A-P spine curvature)
* Scoliosis (lateral curvature)
When looking in the mouth of a marfan’s syndrome patient what are you likely to see?
High arched palate
What heart and blood defects are seen in Ehler’s Danlos syndrome?
- Mitral valve prolapses = FLOPPY MITRAL VALVE
- Cardiac conduction defects
- Platelet anomalies – haemostatic function usually ok
What are the dental problems encountered in ankylosing spondylitits?
- Decreased mouth opening – intubation/treatment difficulties
- Question mark posture
- Spinal deformities may lead to secondary thoracic deformity
What heart problmems are seen in ankylosing spondylitits?
Aortic valve problems
What conditions does Gout increase the risk for?
- Hypertension
- Ischaemic heart disease
- Diabetes Mellitus
What bone problems are seen in cleidocranial dysostosis?
Affects skull, jaws and clavicle
What dental problems are seen in cleidocranial dysostosis?
Delayed/ non-eruption/ supernumerary teeth
How do NSAIDs protect against periodontal disease?
Interfere with prostaglandin synthesis
What dental problems are associated with COX2 inhibitors?
Taste disturbances
Stomatitis
What dental problems are associated with penicillamine?
Lichenoid reactions
Oral ucleration
What type of drug in penicillamine?
Anti-rheumatic drug
What dental problems are associated with ciclosporin?
Gingival overgrowth
What drugs should be avoided if taking methotrexate?
NSAIDs
Corticosteroids
Penicillin
What dental problems are associated with methotrexate?
Oral ulceration, probably due to low folic acid
What is allopurinol used to treat?
Gout
What dental problems are associated with allopurinol?
Taste disturbance and paraesthesia
What is baclofen used to treat/manage?
Used as antispasmodic agent – may be used in multiple sclerosis as well as musculoskeletal disorders
What dental problems are associated with baclofen?
Xerostomia
