HUMANS- Neuralgia

Question 1

What is Multiple sclerosis?

Answer 1

Inflammation causing changes to the myelin sheath that surrounds the nerve axons causing progressive functional loss.

Question 2

Compare the two types of multiple sclerosis.

Answer 2

Relapsing and remitting- episodes of active disease and loss of function then periods of respite. The damage builds up to be the same as progressive disease.

Primary progressive- Slow, steady progressive deterioration causing culmulative neurological damage.

Question 3

How is Multiple sclerosis treated?

Answer 3

Disease modifying drugs to slow down the progressive forms e..g Cladribine/ Siponomod/ Ocrelizumab.

Question 4

How does multiple sclerosis affect dentistry?

Answer 4

Limited mobility- making oral hygiene more difficult.

Treat under LA

May have orofacial or sensory disturbance.

Chronic orofacial pain is possible.

There is enhanced trigeminal neuralgia risk.

Question 5

What is motor neuron disease?

Answer 5

This is degeneration of the spinal chord causing progressive loss of motor function.

Question 6

Discuss the prognosis of motor neuron disease?

Answer 6

Most will die within 3 years due to:

• Aspiration penumonia (protective reflexes to stop food in the airway no longer work)
• ventillation failure

Question 7

What are some signs of Multiple sclerosis?

Answer 7

Tremor

Muscles remaining contracted.

Question 8

What are some signs of motor neuron disease?

Answer 8

Tripping (due to weakness in ankles or legs)

weak grip (dropping things)

Slurring of speech.

Question 9

Discuss the use of Rizuole?

Answer 9

This can be used to slow progression of MND by 6-9 months.

Question 10

How does motor neuron disease affect dentistry?

Answer 10

• Muscle weakness of the head and neck causes dental care difficulties.
• Swallowing difficulties
• Drooling (patient may want medications that dry up salvia, or botox injections into salivary glands)
• Need realistic treatment planning- patient should not spend end of life getting treatments.

Question 11

What is parkinson’s disease?

Answer 11

This is a problem in the message passage from thinking to doing caused by a lack of dopamine in the brain.

Question 12

What are the signs of parkinson’s disease?

Answer 12

• Bradykinesia- slow movement and initation of movement.
• Rest tremour
• Increased muscle tone- causing the patient to be stiffer and move in jerks.

Question 13

How are patients with parkinson’s treated?

Answer 13

• Physiotherapy and Occupational therapy- helping them live with the condition
• Dopamine and dopamine analogues. .

Question 14

How does parkinson’s affect dentistry?

Answer 14

Rest tremor- but often when the patient’s jaw opens the tremor stops.

Impaired use of upper limbs

Problems swallowing

Dry mouth (due to the anticholinergic effects of the drug.

Question 15

What is epilepsy?

Answer 15

Reduced GABA levels in the brain leading to abnormal cell message propagation.

Question 16

What are febrile seizures?

Answer 16

These are seizures caused by fever. These are different from epilepsy.

To prevent these in children we montior the temperature and cool the patient down if they are hot.

Question 17

Discuss the classifications of epilepsy?

Answer 17

generalised- central focus that can spread signals all over the cortex.

Partial- focus is much closer to one part of the cortex, so will mostly affect that part of the cortex

Question 18

What is tonic clonic epilepsy?

Answer 18

When a patient has:

• Loss of conciousness
• (tonic) Initial stiffness (breathing muscles cannot work during this)
• Clonic (intermittent contractions and relaxation causing spasms)

Question 19

What are the issues with tonic clonic epilepsy?

Answer 19

You can cause injury due to uncontrolled falling to the ground.

asphyaxia- there is no normal breathing during the seizure (use supplemental oxygen)

Question 20

What is status epilepticus?

Answer 20

This is recurrent seizures.

Prolonged seizures can cause hypoxia.

Question 21

What is petit mal epilepsy?

Answer 21

Short lived episodes of 10-15 seconds

These are normally in childhood and there can be multiple attacks in a single day.

It results in loss of awareness.

Question 22

Compare the different types of partial seizure?

Answer 22

Simple partial- motor localised to one region of the brain.

Sensory- would cause hallucinations

Complex partial- repetitive purposeless movements that stop at the end of the seizure e.g. lip smacking.

Question 23

How do we treat epilepsy?

Answer 23

Medication to prevent the seizures.

e.g. Anticonvulsant drugs (e.g. gabapentin)

Tonic/clonic- e.g. Valproate

Absence e.g. Levitiracetam

Question 24

How does epilepsy affect dentistry?

Answer 24

• You need to know the liklihood of a patient having seizures
• Complications of fits (injuries to the soft and hard tissues)
• Complications of treatments:
  
  • Phenytoin- causes gingival hyperplasia
  • Valproate- causes a bleeding tendancy
  • Recurrent aphthous like ulceration.

Question 25

What is a stroke?

Answer 25

Blockage of a blood vessel in the brain, causing hypoxia and cell death which results in a loss of functional brain tissue.

Question 26

What are the two types of stroke?

Answer 26

Haemhorragic strokes- strokes due to bleeding in the brain.

infarction due to a narrowing of the blood vessels and plaque formation.

Question 27

What are the signs of strokes?

Answer 27

F- facial drooping

A- arm weakness

S-speech difficulty

T- how long has it been lasting for.

Question 28

How do strokes affect dental treatment?

Answer 28

Patient will have :
impaired mobility and dexterity (affecting attendance and oral hygiene)

Communication difficulties (Cognitive/ dysphonia/ Dysathria)

Memory impairment

Risk of cardiac emergencies

Loss of protective reflexes (aspiration risk/ we will need to manage saliva)

Patient will have stroke pain (generated due to the damaged CNS)