Lecture 9 Flashcards
OSTEOPETROSIS
DEFECT IN THE FORMATION OF OSTEOCLASTS - BONES HARDEN AND BECOME MORE DENSE
OSTEOMALACIA
SOFTENING OF THE BONE CAUSED BY DEFECTIVE BONE MINERALIZATION SECONDARY TO INADEQUATE AMOUNTS OF AVAILABLE PHOSPHORUS AND CALCIUM
OSTEOPOROSIS
BONES BECOME FRAGILE AND MORE LIKELY TO FRACTURE
BONE LOSES DENSITY WHICH MEASURES THE AMOUNT OF CALCIUM AND MINERALS IN THE BONE
50% OF ALL WOMEN AND 25% OF ALL MEN AGES 50+ WILL FRACTURE A BONE B/C OF OSTEOPOROSIS (MAINLY SEEN IN CAUCASIAN AND ASIAN WOMEN)
RISK FACTORS OF OSTEOPOROSIS
- ) AGEING
- ) BEING SMALL AND THIN
- ) FAMILY HISTORY (GENETIC INVOLVEMENT)
- ) CERTAIN MEDICATIONS
- ) MOST COMMONLY IN OLDER WOMEN
**GWAMS
OSTEOPOROSIS TREATMENT
BISPHOSPHONATES
PROMOTE PRESERVATION OF BONE DENSITY BY INHIBITING RESORPTION BY OSTEOCLASTS
PRENYLATION - ADDITION OF A HYDROPHOBIC MOLECULE TO A PROTEIN NEEDED TO ACTIVATE OSTEOCLASTS - ACCOMPLISHED BY THE ENZYME FPP
OR… BISPHOSPHONATE FORMS A COMPLEX W/ HAP AND THIS IS A TOXIC SUBSTANCE IN ENDOCYTIZED BY THE OSTEOCLASTS
NITROGEN-CONTAINING BISPHOSPHONATES
INHIBIT FPP AND BLOCK INTRACELLULAR SIGNAL CONDUCTION
GTP BINDING PROTEINS - NECESSARY FOR OSTEOCLAST ACTIVATION AFTER BEING PRENYLATED
1.) RHO
2.) RAC
3.) CDC42
BISPHOSPHONATES USED FOR
ORAL ADMIN. - STABILIZING BONE LOSS BY OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN
IV ADMIN. - STABILIZING METASTATIC CANCER (BREAST/PROSTATE), TREATMENT OF BONE RESORPTION DEFECTS OF MULTIPLE MYELOMA AND SEVERE HYPERCALCEMIA
SIDE EFFECTS OF BISPHOSPHONATES
PAINFUL EXPOSURE OF MAX/MAN BONE (CORRELATION ESTABLISHED BETWEEN BISPHOSPHONATE USE AND OSTEONECROSIS OF THE JAW ->BRONJ OR MRONJ)
BRONJ/MRONJ RISK FACTORS
- ) DENTAL XO
- ) SX BONE MANIPULATION
- ) TRAUMA FROM DENTURES
- ) ORAL INFECTION
- ) POOR ORAL HEALTH
DSTOP
THEORIES FOR BRONJ/MRONJ
- ) CESSATION OF BONE REMODELING/TURNOVER - OSTEOCLAST/BLAST ACTIVITY IMBALANCE
- ) INHIBITION OF CAPILLARY NEOANGIOGENESIS => ENDOTHELIAL CELL PROLIFERATION INHIBITED IN THE JAW CAUSES A LOSS IN BLOOD VESSELS AND AVASCULAR CONDITION => NECROSIS
DENOSUMAB - MONOCLONAL ANTIBODY
ALTERNATIVE TREATMENT FOR OSTEOPOROSIS
BLOCKS RANKL AND PREVENTS OSTEOCLAST ACTIVATION => OSTEONECROSIS OF THE JAW
EARLY PREVENTATIVE MEASURES OF OSTEONECROSIS OF THE JAW
DENTAL EVALUATION XO OF TEETH DENTAL TREATMENT PLAN RESTORATIVE DENTISTRY GOAL SETTING PROPHYLAXIS PERIODONTAL HEALTH STATUS
MANAGEMENT OF DENTAL CARE DURING OSTEONECROSIS OF THE JAW
ROUTINE RESTORATIVE CARE
AVOID DENTAL XO
EXTENSIVELY CARIOUS TEETH SHOULD BE CONSIDERED FOR ENDODONTIC THERAPY
ELIMINATE SHARP EDGES OF BONE THAT TRAUMATIZE SOFT TISSUE
SOFT VINYL APPLIANCES TO COVER EXPOSED NECROTIC BONE
REEVALUATE PROSTHETIC APPLIANCES
ATRAUMATIC SRP/PROPHYLAXIS
TREATMENT OF ODONTOGENIC INFECTIONS AGGRESIVELY
POST NATAL GROWTH
1.) APPOSITIONAL GROWTH/REMODELING - WIDENING
2.) INTERSTITIAL BONE GROWTH - LENGTHENING
3.) SUTURAL GROWTH - APPOSITIONAL GROWTH OCCURS HERE AND PERIOSTEAL ACTIVITY DUE TO THE PRESSURE OF THE GROWING BRAIN
4.) SURFACE APPOSITION/REMODELING RESORPTION
CRANIAL VAULT = IM GROWTH (COMPLETED @ 8 Y.O.)
CRANIAL BASE = EC GROWTH (COMPLETED = ANT @ 10 Y.O., POST. @ 20 Y.O.)
WOLFF’S LAW
BONE IN HEALTHY INDIVIDUALS ADAPTS TO LOADS UNDER WHICH THEY ARE PLACED
MECHANICAL STRESS APPLIED TO BONE INCREASES OSTEOBLAST ACTIVITY AND REMOVAL OF MECHANICAL STRESS DECREASES OSTEOBLAST ACTIVITY