Medical conditions Flashcards
Aetiology of cardiac conditions in children
Maternal rubella
Maternal diabetes
Maternal drugs – alcohol, phenytoin
Foetal chromosomal abnormality- Down syndrome
Foetal inborn errors of metabolism and connective tissue disorder-Williams syndrome
name examples of cardiac conditions (congenital heart defects)
tetralogy of fallot
ASD/VSD
transposition of great arteries
CoA
important aspects of dental treatment in cardio disease
OH
nice guidelines
consult cardiologist if issues
anticoagulants/antiplts
down’s syndrome -
clinical features
impact
congenital heart lesions
atlantoaxial instability
umbilical hernia/rib abscence
immunological defects - periodontal disease
increased chance of alzheimers/hypothyroidism
Acute lymphoblastic leukaemia (20x)
-social development, motor skills, memory skills, speech and language, learning disability.
down’s syndrome - oral manifestation
high palate, CLP common small mouth - open lip posture macroglossia - fissured tongue hypodontia - microdontia, delayed eruption, hypoplasia bifid uvula increased risk of periodontal disease - white cell chemotaxis deficiency thick, dry fissured lips AOB, class III, posterior crossbite
dental management of down syndrome
prevention - OHI (CHD importance), fluoride use, treat under LA if poss, CHX for perio disease
asthma - drugs
beta2 agonists
bronchodilators -
salbutamol (Blue) - short acting b2 agonist, quick onset (2-3min) last4-6hr
for acute bronchial constriction - oral/inh/iv
Salmeterol (green?) - long acting b2 agonist, slow onset (1-2hr), last 12-15hr
prevent acute bronchial constriction
ALWAYS with inh steroid
asthma drugs - anticholinergics
Ipratropium (grey)
inhibit muscarinic nerve transmissionin autonomic n
reduce mucous secretion and encourage bronchodiliation
asthma drugs - corticosteroids
-compound prep
reduce inflammation of bronchilal walls beclomethasone (brown) budesonide (brown) flutisocone (orange) mometasone (pink) -compound prep = inh steroid and long acting B2 agon - seritide (fluticosone/salmeterol)
asthma treatment order
1. occasional b2 agonist 2 low dose inh steroid 3 high dose inh steroid 4 long acting b2 agonist/antimuscarinic 5 oral steroid
cystic fibrosis
who
1 in 2500 births. Autosomal recessive
affects EXOCRINE system - thick mucous produced and lack of pancreatic lipase - malabsorption
diabetes and liver cirrhosis
recurrent chest infections
oral manifestations of cystic fibrosis
dental implications
thickened saliva reduced caries (high ammonia in saliva) greater calculus levels lower plaque and gingival disease enamel defects and delayed eruption -GA risk, resp failure, high sugar intake (large energy diet), diabetes and liver disease
chemotherapy side effects
-acute oral complications
bone marrow suppression - immunocompromised
anorexia
nausea and vomiting
alopecia
-gingival bleeding / halitosis / taste disturbance / dysphagia / trismus / tooth mobility / paraesthesia
-infection risk
what is mucocitis and how is it treated
oral ulceration of mucosa - painful (stomatitis to burning and ulceration)
mucocitis localised to oropharynx
treatment - sodium bicarbonate every 2hr gelclair (2hr) biotene mw - (2hr) DIFFLAM (mw/spray) 2hr lignocaine application benzocaine flavoured gel orabase with/out corticosteroid
biotene mw - how do they work
Moisturises oral mucosal cells
Antibacterial effect of proteins
Reinforces antibacterial activity of saliva
Contains Xylitol which inhibits bacteria
Triple enzyme formula: lysozyme;
lactoperoxidase; lactoferrin.
Contains fluoride, glucose oxidase, aloe vera
renal failure - oral findings
~~~
Excessive plaque accumulation
Gingivitis: bleeding
Gingival overgrowth
Enamel hypoplasia
Some develop periodontitis
Osseous changes
Pulp obliteration
Pallour, petechiae, ecchymosis
Uraemic stomatitis
Reduced caries
dental considerations for renal failure
Bleeding tendencies and haemostasis
Treatment: day after dialysis
Infections can be poorly controlled
Signs of inflammation can be masked
Increased risk blood borne viral infections
Osseous lesions may be seen jaws; lamina dura thinning, osteolytic lesions, giant cell lesions
- antimicrobials - give lower doses of penicillin’s (except flucloxacillin & phenoxymethyl pen), metronidazole and cephaloridine to avoid toxicity CNS
diabetes mellitus symps/signs
-undiagnosed features
polyuria/polydipsia/tired/recent weight loss weakness/fatigue/mental confusion/acetone breath - Vomiting, nausea, abdominal pain Renal dysfunction Hyperventilation – metabolic acidosis Dehydration Hypovolaemia Pasasthesia(extremities) Dysaesthesia Gastrointestinal neuropathy Muscle wasting Shock Coma
oral manifestations of diabetes mellitus
Reduced salivary flow Xerostomia Burning mouth/tongue Candidal infection Altered taste Progressive periodontitis Dental caries Oral neuropathies Parotid enlargement Sialosis Delayed wound healing
diabetic hypo coma features
Mood change, irritability Strong bounding pulse Nausea and stomach ache Hunger Shaking, tingling around mouth Increased gastric motility Hypothermia •Disorientation •blurred vision •Lethargy •slurred speech •Sweaty skin
diabetic hyper coma features
Weak pulse Rapid deep breathing (Kussmaul’s respiration) Dry skin Acetone breath Increased frequency of micturition (to want to urinate) Thirst Severe hypotension Abdominal pain and vomiting Loss of consciousness (diabetic coma)
Asthma intra-oral features
- acidic inhalers: wear?
- dry mouth: caries risk
- gastric reflux: cough/laxity of lower oesophageal sphincter
Renal Failure/disease intra-oral features
- excessive plaque accumulation
- gingivitis/bleeding
- gingival hyperplasia
- enamel hypoplasia
- pulp obliteration
- ecchymosis/pallour
- reduced caries
Dental considerations for Renal failure
-when to treat
- bleeding tendency/haemostasis
- poorly controlled inf
- > risk of BBVs
- Inh sedation is OK but IV sedation has a risk of thrombophlebitis
- TREAT DAY AFTER DIALYSIS
