LO 6 Flashcards
How does xerostomia impact nutritional intake?
- Chewing difficulties because a bolus cannot be formed without additional moisture
- Chewing is painful because the mouth is sore
- Swallowing is difficult because of loss of lubrication from saliva
- Food intake may decrease because of changes in taste perception.
How do Gustatory & Olfactory Functions impact nutritional intake?
Taste & Smell – affect appetite and food intake. With loss of taste patient may take greater amounts of sodium and sugar than they need
_________% of individuals over 65 years experience xerostomia.
30
Describe iron deficiency anemia
Etiology (cause of disease)
1. Increased needs during growth periods such as infancy or pregnancy
2. Excessive bleeding
results in lack of oxygen to cells – oral manifestations of the disease may include a burning sensation of the tongue and dry mouth. Clinical symptoms include gingival & mucosal pallor and atrophy of papillae – this will in turn affect appetite.
Describe the oral manifestations of iron deficiency anemia
- Atrophic glossitis
- Aphthous Ulcers
- Gingival and mucosal pallor
- Angular cheilosis
- Candidiasis
- May impair wound healing
What are the dental hygiene considerations of iron deficiency anemia?
- May need to postpone invasive nonsurgical periodontal therapy until IDA improves
- Encourage iron-rich food (e.g., meat)
- Encourage Vitamin C to enhance absorption
- If iron supplement is liquid, dilute with water or juice and drink with straw to minimize tooth staining
Describe pernicious anemia
Occurs when vitamin B12 is deficient in the diet, is not being absorbed or requirements are increased.
Oral Symptoms can include:
1. Angular Cheilosis
2. Recurrent apthous ulcers
3. Erythematous mucositis
4. Pale or yellow oral mucosa
5. Atrophic glossitis, beefy red color
Describe megaloblastic anemia
Can include poor diet or medications that interfere with absorption of folate (e.g., phenytoin {anti-convulsive} or methotrexate {used to treat rheumatoid arthritis})
Oral manifestations can include:
1. Oral manifestations can include:
2. Atrophic glossitis
3. Ulcerations
4. Glossodynia (Burning of the tongue)
5. Angular chelitis
6. Fungal infections
What are the dental hygiene considerations for pernicious and megaloblastic anemia?
- Encourage folate-rich food sources and supplement to meet the RDA for folate(400 mg)
- Large doses of folate can negate effects of anticonvulsants, so consultation with medical provider is necessary.
- Encourage intake of foods from animal sources high in Vitamin B12 for pernicious anemia
- Encourage vegans to eat fortified foods
- Patients with permanent gastric or ileal damage need month B12 intramuscular or oral B12
- Refer to a registered dietician
Describe aplastic anemia
result from exposure to toxic chemicals which inhibit bone marrow production of RBCs – example: chemotherapy treatment- pallor of conjunctiva & oral mucous membranes may be present.
Describe Neutropenia
The presence of abnormally small numbers of neutrophils (white blood cells) in the circulating blood.
Etiology
1. Drugs (e.g., chemotherapeutic)
2. Autoimmune disease (e.g., rheumatoid arthritis)
3. Hematologic disease (e.g., leukemia)
4. Nutritional deficiencies
5. Bacterial or viral infection
What are the dental hygiene considerations for Neutropenia?
- Invasive dental hygiene treatment contraindicated until white blood cell count rises
- Palliative care such as non-alcohol chlorhexidine rinse may reduce bacterial load until patient can perform more thorough oral self-care
- Stress importance of frequent oral prophylaxis and meticulous oral hygiene care once mucositis pain subsides
- Refer to a registered dietician
Describe Gastroesophageal Reflux Disease (GERD)
occurs when the lower esophageal sphincter (LES) is weakened or immature (in infants sometimes) thus allowing gastric content (acid, pepsin, etc.) to reflux back into the esophagus causing symptoms (heartburn, acid regurgitation, etc.) and mucosal inflammation and injuries
Other etiologies could be:
1. Hiatal hernia
2. Obesity
3. Pregnancy
What are the dental hygiene considerations for GERD?
- Clients should be guided to avoid irritating foods (fatty foods, fried foods, caffeine, alcohol, carbonated beverages, acidic fruits and their juices, tomato products which can all be problematic).
- Focus clients instead on a diet of whole, live, natural foods & work on slowing down and chewing when eating (provides more surface area for digestive enzymes) when eating to improve digestion
Describe malabsorption issues
- Notably the Inflammatory Bowel Disorders: Crohn’s disease, ulcerative colitis, celiac disease (gluten intolerance) will interfere with absorption of nutrients (secondary nutritional deficiency) –
- Oral ulcerations may be present as well as swelling of the lip – glossitis & cheilitis are often present with vitamin B deficiencies – metallic taste alterations may also occur making food intake even more difficult
- Other oral conditions that can present is Diffuse pustular eruptions on buccal gingiva
Describe the dental hygiene considerations for malabsorption
- Consult with healthcare provider about patient’s need for supplemental steroids and prophylactical antibiotics before the dental appointment
- Encourage patient to eat a nutrient-rich and balanced diet to enhance healing
- Healthcare provider or registered dietician may recommend vitamin or mineral supplementation
Describe the relevant cardiovascular conditions
- Atherosclerosis (accumulation of fatty materials such as cholesterol on smooth inner walls of arteries) as plaque thickens arteries become narrow and rough and blood flow may be disrupted –
- Hypertension: High Blood pressure – clients are counselled to limit dietary intake of sodium and to avail themselves of a host of potassium rich foods: banana, avocado, apricots, cantaloupe, kiwi, orange/carrot juice
- Hyperlipidemia – Elevated Cholesterol – dietary strategies include: (as discussed under atherosclerosis)
Describe the dental hygiene considerations for cardiovascular conditions
- Monitor high blood pressure for each appointment
- Manage medication-induced xerostomia
- Recommend healthy diet with lots of fruits and vegetable, low sodium, reduced total fat, saturated fat and dietary cholesterol
- Medication used to lower serum lipids may cause malabsorption of fat-soluble vitamins and folic acid
Describe systemic bone diseases
(osteoporosis most common) impact the periodontium & cause systemic bone disturbances – changes in shape (morphology) of mandible (jawbone); mobility of individual teeth; pain or discomfort in the jaw; increased sensitivity of the teeth; changes in occlusion of the teeth (bite).
Describe the etiology of systemic bone diseases
- Osteoporosis which is treated with bisphosphonates and multiple myeloma increases risk for osteonecrosis (bone death in the jaw)
- Hyperparathyroidism
- Paget’s disease is a generalized skeletal disease. Bone resorption & formation are increased, leading to thick & soft bones.
- Fibrous dysplasia of the jaw is giant cell lesions of the jaw.
Describe oral manifestations of systemic bone diseases
- Increase in size and alteration in contour of maxilla and mandible
- Alteration in radiographic pattern
- Mobility of individual teeth without significant periodontal disease
- Increased sensitivity of teeth without obvious dental or periodontal disease
- Changes in occlusion of teeth
- Abnormal sequence of deciduous tooth loss or eruption of permanent molar is young
Describe type 1 and type 2 diabetes
- Type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes), accounts for 5% to 10% of all people with diabetes. In type 1 diabetes, the body’s immune system destroys the cells that release insulin, eventually eliminating insulin production from the body. Without insulin, cells cannot absorb sugar (glucose), which they need to produce energy. This is an autoimmune disease. This is an irreversible condition.
- Type 2 diabetes (formerly called adult-onset diabetes) can develop at any age.
Describe the etiology and oral manifestations of Hypopituitarism
Etiology - Congenital, tumor, head trauma, stroke, radiation or brain infection
Oral manifestations
1. Decreased skeletal growth results in
2. disproportionate retardation of mandibular growth
3. Delayed eruption
4. Malocclusion
Describe the etiology of Hypothyroidism
- Inadequate consumption of iodine
- Inborn error of metabolism
- High intake of goitrogen foods (e.g., cabbage and rapeseed)
- Treatment of hyperthyroidism
- Thyroid gland disorder
- Deficient secretion of Thyroid Stimulating 7. Hormone (TSH)
