Musculoskeletal disorders dentally related questions Flashcards
What is osteoarthritis? and what joints are affected?
Inflammation causing joint pain, wearing cartilage that covers and cushions joint
Affecting distal inter-proximal pharyngeal joints
What radiographic changes are seen in osteoarthritis?
Scerlosis - whitening
Subchondral bone cysts
Joint space narrowing
Osteophytes - benign outgrowths of bone
How is osteoarthritis managed?
Analgesics, NSAID, coxibs with omeprazole, steroid/hyaluronan injections
Quad exercises, <25 BMI, aids/supports
Surgical replacement of knee/hip
What is the ARA criteria for rheumatoid arthritis?
Symmetrical arthritis (every joint except distal inter-pharyngeal joints) Hand joints At least 3 area Morning stiffness >60 minutes Rheumatoid nodules Xray changes
What does rheumatoid arthritis look like on a radiograph?
Early: Thin black bone, peri-articular erosions
Late: Joint space narrowing, subluxation/dislocation, ankylosis
What extra-articular manifestations are there of rheumatoid arthritis?
Lymphadenopathy Lung = pleurisy, effusion, fibrosis Heart = pericarditis Muscle atrophy Vasculitis Osteoporosis of the bone
What drugs can be offered for rheumatoid arthritis management?
DMARDs –> disease modifying anti-rheumatic drugs, slowing progression not curing, slow action which needs monitoring
What are the triple therapy conventional DMARDs used for rheumatoid arthritis management?
Methotrexate
Sulphasalazine
Hydroxychloroquine
In dentistry when a patient is taking biologic therapy drugs, what should you be aware of?
Less likely to notice disease symptoms of disease - ‘abscess’
What other systems are affected in ankylosing sponylitis?
Iritis and conjunctivitis
Pulmonary fibrosis
Fatigue
Aortic valve disease
What drug treatments can be used in ankylosing spondylitis?
NSAIDs/ coxibs
DMARDs - for peripheral arthritis
Anti-TNF drugs for peripheral and spinal disease
What is the moll and wright classification?
- Distointerpharyngeal joints
- Arthritis mutilans
- Clinically indistingushable from rheumatoid arthritis
- Asymmetrical oligoarthritis
- Ankylosing spondylitis
What drug treatment is involved for psoriatic arthritis treatment?
Analgesics
DMARDs: arthritis - sulfasalazine, arthritis and psoriasis -methotrexate/anti-TNF
Who is affected by reactive arthritis?
Commonly affecting young people
How does reactive arthritis occur?
10-14 days after infection:
- GI: campylobacter, salmonella
- Urogential - chlamydia
What is reiter’s syndrome?
Reactive arthritis + conjuctivitis/urethritis
What is the recurrence rate of reactive arthritis?
50%
What is the F:M of sjogrens syndrome?
9:1
What are the oral features of sjogrens syndrome? and what can be given to overcome this?
Xerostomia
Oral sprays/gels/lozanges
What are the 3 LeFort fractures?
I –> Palate
II –> Through nasal bridge
III –> Passes through zygomatic bone
What is ORIF?
Open reduction internal fixation
What are the 5P’s of compartment syndrome?
Pale, Pulse, Paraesthesia, Pain, Paralysis
How much calcium is in the body?
1kg
What happen in chronic high PTH?
Bones deteriorate and release calcium
How is calcium transported around the body?
1/2 bound to albumin in the blood
1/2 ionised in the blood
What scan is used to diagnose osteoporosis
DEXA
What does a vitamin D deficiency in 1.adults and 2.kids cause?
- osteomalacia
2. rickets
What is paget’s disease?
Uncoordinated bony remodelling and disorganised bone turnover in localised areas
What treatment is used for paget’s disease and how does it work? give an example.
Bisphosphonates by inhibiting osteoclast activity and prevent bone resorption
E.g. alendronate/risedronate orally weekly, can also get other injective treatment quarterly/annually
Can also treated with monoclonal –> Denosumab
How does phossy jaw occur?
Exposed to phosphorus
What is myeloma?
Malignancy of plasma cells in bone marrow
When a patient presents with blue sclera, what could this be?
Impact on collagen formation
What to do for an extraction if patient is on 1.IV or 2. oral bisphosphonates?
- Refer to a specialist
2. Can treat in primary care if bone is stable
What is osteopetrosis?
Spongy bone not there, all compact bone
Marrow absent, less haematopoiesis = anaemia
What is pagets disease of the bone?
Periods of bone deposition/resorption - mosaic appearance
What do patients complain of to the dentist when they have pagets disease of the bone?
Dentures don’t fit due to bone deposition
Why do people need to be dentally fit before starting cytokine inhibitor treatment?
Affects immune response
How long should extractions be avoided for after radiotherapy? and why?
6 months to 1 year
Osteoradionecrosis
What should be considered when doing an extraction on a patient post radiotherapy?
Minimal trauma - small flap for increased blood perfusion
No vasoconstrictor used
Trim sharp bone edges
Prophylaxis 1month/until socket heals
What does a marfan’s syndrome palate look like?
High arched palate is typical
What are the dental abnormalities of cleidocranial dysostosis?
Delay/non-eruption or supernumerary teeth
How do NSAIDs protect against periodontal disease?
Prostaglandin synthesis interference
What oral side effects can arise from cox 2 inhibitors?
Stomatitis and taste disturbances
What oral side effects can arise from the anti-rheumatic drug, penicillamine?
Lichenoid reactions
Oral ulceration
What oral side effect occurs from allopurinol and what does it treat?
Gout treatment
Taste disturbances
What is baclofen used for and what oral side effect does it have?
Antispasmodic agent
Causing xerostomia
