Myasthenia Gravis

Question 1

For myasthenia gravis, state:

- What it is

Answer 1

Antibodies activate reaction of the acetylcholine receptor which blocks the reception of nerve impulses

Question 2

For myasthenia gravis, state:

- Symptoms (6)

Answer 2

• Weakness & fatigability of symmetrical voluntary muscles
• Eye movement weakness with diplopia & ptosis (drooping eyelids)
• Speech & swallowing difficulties
• Lack of facial expression
• Severe cases, total paralysis or serious breathing problems
• Respiratory failure leads to death

Question 3

For myasthenia gravis, state:

- Dental management during a myasthenic crisis

Answer 3

• Due to deficiency of acetylcholine.

Characterized by:
• Sudden inability to swallow, speak or maintain airway

Emergency procedures include:
• Suctioning
• Opening airway
• Obtaining medical assistance

Question 4

For myasthenia gravis, state:

- Medical medical management (3 drugs given) and side effects of these drugs (3)

Answer 4

• Administration of anticholinesterase agents
• Immunosuppressive drugs
• Corticosteroids, Azathioprine & Cyclosporin

Side effects of drugs:
• Anticholinesterase: increased salivation
• Cyclosporin: gingival enlargement
• Immunosuppressive drugs: vulnerability to infection (which can worsen myasthenic weakness)

Question 5

For myasthenia gravis, state:

- Dental considerations (6)

Answer 5

• Short, frequent, early morning
• Stress reduction protocol
• Be prepared for possible respiratory emergency
• Assistant needed to suction & monitor
• Toothbrush modifications (power-assisted brush)
• Instructions to caregiver