LO 10 Flashcards
1
Q
Describe Oral Manifestations of
Systemic Diseases
A
- Many systemic diseases are reflected in the oral mucosa, maxilla, and mandible
- Ulceration or mucosal bleeding
- Immunodeficiency can lead to opportunistic diseases such as infection and neoplasia
- Bone disease can affect the maxilla and mandible
- Systemic disease can cause dental and periodontal changes
- Drugs prescribed for a systemic disease can affect oral tissue
2
Q
What local factors may be involved in the manifestation of systemic disease in oral mucosa?
A
- The mucosa may be more easily injured
- Mild irritation and chronic inflammation may cause lesions that otherwise would not occur
- Endocrine disorders
- Disorders of red and white blood cells
- Disorders of platelets and other bleeding and clotting disorders
- Immunodeficiency disorders
3
Q
List the common endocrine disorders
A
- Hyperpituitarism
- Hyperthyroidism
- Hypothyroidism
- Hyperparathyroidism
- Diabetes mellitus
- Addison disease
4
Q
Describe endocrine disorders
A
- The endocrine system consists of a group of integrated glands and cells that secrete hormones
- The amount of hormone circulating in blood triggers factors that control production
- Diseases may result from conditions in which too much or too little hormone is produced
- Diseases may result from gland dysfunction
- Diseases may result from a problem with hormone control and production
5
Q
Describe Hyperpituitarism
A
- Excess hormone production by the anterior pituitary gland
- Caused most often by a benign tumor, a pituitary adenoma, that produces growth hormone
- Gigantism results if it occurs before the closure of long bones- before puberty
- Acromegaly results when hypersecretion occurs during adult life- after puberty
6
Q
Describe the Clinical Features and Oral Manifestations of Hyperpituitarism
A
- Affects (mostly) men and women in their 40s
- Poor vision/Light sensitivity
- Enlargement of hands and feet
- Increase in rib size
- Facial changes - Enlargement of maxilla and mandible may cause separation of teeth and malocclusion; Frontal bossing (enlarged forehead) and an enlargement of nasal bones; Enlargement of maxillary sinus leads to voice deepening
- Mucosal changes - May have thickened lips and macroglossia
7
Q
Describe the Diagnosis and Treatment
of Hyperpituitarism
A
- Diagnosis involves measurement of growth hormone
- Normal: Decrease in growth hormone through puberty
- Acromegaly: Growth hormone will not decrease
- Treatment - Pituitary gland surgery; Medical management; Radiation therapy
8
Q
Describe Hyperthyroidism (aka Thyrotoxicosis or Graves Disease)
A
- Excess production of thyroid hormone
- More common in women than men, in 30s and 40s
- Most common cause is Graves disease
- Graves disease is an autoimmune disorder in which antibodies, thyroid-stimulating immunoglobulins (THIs), stimulate thyroid cells
- The thyroid gland enlarges
- Too much thyroid hormone is produced
- Increase in patient’s metabolism
9
Q
List the Clinical Features of Hyperthyroidism
A
- Thyroid enlargement (goiter)
- Rosy complexion
- Erythema of the palms
- Excessive sweating
- Fine hair
- Softened nails
- Exophthalmos - bulging eyes
- Anxiety, weakness, restlessness, and cardiac problems may also be associated
- Thyroid storm - A serious flood of hormones that occurs during stress-can alter vitals and be fatal-CAN HAPPEN IN DENTAL CHAIR
10
Q
What are the oral manifestations of Hyperthyroidism?
A
- May lead to premature exfoliation of deciduous teeth in children and premature eruption of permanent teeth
- Osteoporosis may affect alveolar bone
- Caries and periodontal disease may appear and develop more rapidly in these patients
- Burning tongue
11
Q
Describe the treatment of Hyperthyroidism
A
- Surgery
- Medications to suppress thyroid activity
- Administration of radioactive iodine - kills off function of thyroid
- Clinical mismanagement of hyperthyroidism may lead to hypothyroidism
12
Q
Describe hypothyroidism
A
- A decreased output of thyroid hormone
- Most common endocrine condition worldwide
13
Q
List the causes of hypothyroidism
A
- Developmental disturbances
- Autoimmune destruction of thyroid: Hashimoto thyroiditis
- Iodine deficiency
- Drugs
- Treatment for hyperthyroidism
14
Q
Describe Hypothyroidism Oral Manifestations in infants and adults
A
Infants
1. Thickened lips
2. Enlarged tongue (macroglossia)
3. Delayed eruption of teeth
Adults
1. Enlarged tongue (macroglossia)
15
Q
Describe Hyperparathyroidism
A
- Results from excessive secretion of parathyroid hormone (PTH) from the parathyroid glands
- PTH plays a role in calcium and phosphorus metabolism
- Hypercalcemia: Elevated blood levels of calcium-can lead to muscle and heart problems - can be deadly
- Hypophosphatemia: Low levels of blood phosphorus
- May be the result of hyperplasia of parathyroid glands, a benign tumor of one or more parathyroid glands, or a malignant parathyroid tumor
- Much more common in women than men
- PTH increases the uptake of dietary calcium from the gastrointestinal tract and is able to move calcium from bone to circulating blood when necessary
16
Q
Describe the Clinical Features of Hyperparathyroidism
A
- Mild cases may be asymptomatic, or may cause joint pain or stiffness
- Lethargy and coma may occur with severe disease
- Kidney stones
- Affects skeletal system and gastrointestinal system
17
Q
Describe the Oral Manifestations of Hyperparathyroidism
A
- Bone changes: Loosening of teeth
- Well-defined unilocular or multilocular radiolucencies
- “Ground glass” appearance, loss of lamina dura
- Microscopically, lesions appear to be central giant cell granulomas (CGCGs)
18
Q
Describe the diagnosis and treatment of Hyperparathyroidism
A
- Measurement of PTH blood levels, to include serum calcium and phosphorus measurements
- Treatment is directed at correcting the cause of increased hormone production (tumors, renal disease, kidney failure, vitamin D deficiency)
19
Q
Describe Diabetes Mellitus
A
- A chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels
- Results from a lack of insulin or defective insulin that does not work to lower blood glucose levels, or increased insulin resistance caused by often by genetic factors/obesity
- Type l (no insulin), Type ll (insulin resistance), Gestational (pregnancy), Pre-diabetic
- Hyperglycemia: High blood glucose levels
20
Q
Describe insulin works in a non-diabetic and body’s reaction to high blood sugar in diabetes
A
- Glucose signals beta cells of the pancreas to make insulin
- Insulin is then secreted into the bloodstream to facilitate the uptake of glucose into fat, skeletal muscle and the liver
- Extremely high blood sugar levels can result in a life threatening condition called ketoacidosis
- Ketoacidosis: Production of ketone acid that lowers the blood pH
21
Q
Describe ketoacidosis
A
- Breakdown of fatty tissue leads to production of ketone acid
- Often related to type l diabetes
- Ketone acid lowers the blood pH
- Acute condition can lead to coma and death
- Macrophages: Phagocytic activity is reduced
- Neutrophils: Chemotaxis is delayed
- Lymphocyte function: Adversely affected
- Collagen production is abnormal
- Uncontrolled diabetes leads to immunosuppression - always insure sugar levels are controlled before DH treatment
22
Q
Describe common Complications of Insulin-
Dependent Diabetes Mellitus
A
- Damage to blood vessels
- Complications with organ systems - Eyes (blindness), Kidney (end-stage kidney failure), nerves (numbness/Paresthesia or peripheral neuropathy)
- Atherosclerosis of large and medium-size blood vessels - Aneurysm, Thrombi (clots), Myocardial infarction (heart attack), Stroke
23
Q
What are the Diagnostic Criteria of Diabetes
A
- Fasting blood glucose greater than or equal to 126 mg/dL
- A random blood glucose greater than or equal to 200 mg/dL in a symptomatic patient
- A 2-hour blood glucose greater than or equal to 200 mg/dL after drinking a glucose solution of 75 grams
- A glycosylated hemoglobin level greater than or equal to 6.5%
24
Q
Describe the criteria for Prediabetes
A
- Fasting blood glucose between 100 and 125 mg/dL
- Two-hour blood glucose between 140 and 199 mg/dL after the OGTT
- Glycosylated hemoglobin level between 5.7% and 6.4%
25
Describe Type 1: Insulin-Dependent
Diabetes Mellitus (IDDM)
1. Thought to be an autoimmune disease
2. Associated with Addison disease, Graves disease, pernicious anemia
3. Insulin-producing cells of the pancreas (beta cells) are destroyed - Least common type of diabetes, but most severe; Can occur at any age; the peak is at 20 years
4. **Polydipsia**: Excessive thirst and intake of fluid
5. **Polyuria**: Excessive urination
6. **Polyphagia**: Excessive appetite
7. Patients require insulin their entire lives
8. The current approach to management of these patients involves multiple insulin injections and proper diet, exercise, and frequent determination of blood glucose levels
9. Hypoglycemia: Low blood sugar
26
List Type 1: Insulin-Dependent
Diabetes Mellitus (IDDM) Alternative
Methods of Treatment
1. Oral hypoglycemic medications (E.g. Dextrose tablets)
2. Transplantation of pancreatic beta cells into the liver
3. Stem cell infusion
4. Insulin pump
27
Describe Type 2: Non–Insulin-Dependent
Diabetes Mellitus (NIDDM)
1. Characterized by insulin resistance
2. 97% of all diabetic patients have this type of diabetes (most common type)
3. Gradual onset
4. Usually occurs in patients 35 to 40 years of age or older
5. Role of dentists and dental hygienists: Patient education on periodontal/infection risks
28
Describe Gestational Diabetes (GD)
1. Occurs during pregnancy
2. Results in high blood sugar levels affecting fetus development
3. Disappears after pregnancy in most cases
4. Increased birth weight of child likely
5. Mother and child have higher risk of developing type 2 diabetes later in life
29
Describe the Clinical Features of Type ll Diabetes
1. Atherosclerosis, a thickening of the blood vessel wall from fibrofatty plaques, can lead to impaired circulation, causing impaired oxygenation and nutrition in tissue
2. This increases the risk of ulceration and gangrene of the feet, high blood pressure, kidney failure, stroke
3. Diabetic retinopathy in the eye can lead to blindness
4. The nervous system may be affected
5. The person may have decreased resistance to infection
30
List the Oral Complications of Type ll Diabetes
1. Oral candidiasis
2. Mucormycosis: A rare oral fungal infection that affects the palate and maxillary sinuses
3. Bilateral asymptomatic parotid gland enlargement
4. Xerostomia
5. Periodontal disease
6. Accentuated response to plaque
7. Slow wound healing
8. Increased susceptibility to infection
31
List the Considerations for Dentists
and Dental Hygienists regarding Type ll Diabetes
Periodontal disease
1. Significant complication of diabetes
2. Aggravates the control of diabetes
3. Significant prognostic or predictive clinical marker for diabetes
4. Uncontrolled diabetes = uncontrolled periodontal conditions
32
Describe Addison Disease (Primary Hypoadrenocorticism)
1. Insufficient production of adrenal steroids
2. Causes of adrenal gland destruction include - Malignant tumor, Tuberculosis, Deep fungal infections, HIV infection, Autoimmune disease, Unknown
3. To compensate, the pituitary gland increases production of adrenocorticotropic hormone (ACTH)
33
Describe the Clinical Features of Addison Disease
1. Stimulation of melanocytes - Bronzing of the skin; Melanotic macules on oral mucosa
2. Treatment - Steroid replacement therapy
34
