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DMD3 sem 2 > Neurodegenerative Diseases > Flashcards

Neurodegenerative Diseases Flashcards

1
Q

What is dysphagia?

A

Difficulty swallowing +/- pain

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2
Q

What causes dysphagia?

A

Associated with damage to CN IX - XII

Oral/pharyngeal pain, dryness, irritation

Tumours

Irradiation

Infection

Any condition that damages or weakens nerves or muscles involved

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3
Q

Who most commonly gets dysphagia?

A

Neurodegenerative conditions

Head and neck cancer

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4
Q

What are the potential complications of dysphagia?

A

Malnutrition/dehydration

Increased risk of aspiration (majority of people get some aspiration but more common in people with dysphagia)

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5
Q

How does dehydration lead to increased risk of dental caries?

A

Dehydration causes increased mucosal dryness and mucosal fragility. Mucosal dryness and decreased salivation cause an increased risk of dental caries

Dehydration also causes malnutrition which causes increased consumption of sugars which icnreases risk of dental caries.

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6
Q

Why does dysphagia cause patients to use more sugar?

A

Aerated drinks help in swallowing

Syrup is used for medications high in sugar

Thicker liquids are often used

Tablets are crushed and added to pureed fruit

Fruit juice used to breakdown thick saliva

Food pouching

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7
Q

What thickening agents are used for dysphagic patients?

A

Methyldextrose

Xanthan gum (lower caries risk)

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8
Q

How are patients with dysphagia managed?

A

Oral debridement

Reduced saliva/xerostomia

Oral pain management

Dietician (High sugar thickening agents)

Speech pathologist

Medical doctors

Multidisciplinary team approach

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9
Q

What is aspiration pneumonia?

A

Foreign material originating from either oral cavity or oropharynx descends into the bronchial tree and alveoli with colonisation of bacteria resulting in an infective process.

Dependent on amount and type of aspirant, frequency, and host immune response.

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10
Q

What is the burden of aspiration pneumonia?

A

Leading cause of death and hospitalisation in nursing homes.

Represents 1% of Australian deaths

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11
Q

Is dysphagia the main cause of aspiration pneumonia?

A

No, it is a risk factor but insufficient to be a sole cause.

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12
Q

What are the risk factors for aspiration pneumonia?

A

Immobile patients

Altered consciousness

Dysphagia

Comorbidities

Increased age

Oral health (may be a predictor of resp related deaths)

Nocturnal denture wearing (2 - 3x increase in risk)

Perio disease increases risk by 3.9x

Improved oral hygiene could prevent 1 in 10 deaths.

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13
Q

Can dentists make a difference in risk of ventillator associated pneumonia?

A

8-hourly oral hygiene reduced the incidence of ventillator associated pneumonia to 0 in stroke and neurologic ICU.

Cochrane review of 38 RCTs found chlorhex mouthwash or gel reduced ventilator associated pneumonia in critically ill patients from 24 - 18% no difference found for toothbrushing.

43 survivors of mild to moderate stroke had poorer periodontal condition on discharge from hospital after six months.

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14
Q

What should the dentist do for the patient with dysphagia?

A

Should aim to remove plaque from teeth

Increase protective factors against dental disease.

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15
Q

How often should oral hygiene practices be done in patients with dysphagia?

A

Should be completed at least daily after the last meal of the day

This includes the removal and cleaning of dentures daily.

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16
Q

How should mechanical cleaning be done for patients with dyspahagia?

A

Same as healthy patients.

Clean teeth and oral soft tissues including the tongue.

Brush around teeth at the gum level and in between teeth and chewing surface.

Use toothbrush, floss, interdental brushies, oral swabs, and gauze

Use less toothpaste (pea size)

Use higher fluoride products

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17
Q

How can protective factors be increased against oral disease?

A

Increased fluoride exposure

Address dry mouth issues

Use chlorhexidine based products for periodontal disease

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18
Q

How should patients with mild to moderate dysphagia be treated?

A

Where possible encourage normal oral hygiene: 2x a day brush. 1x interdental

If physical limitations supervise/assist, electric toothbrush, modified dental appliances, and suction/swab oral cavity to remove excess once completed.

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19
Q

How should patients with severe dysphagia be treated?

A

Risk is lower for decay but much higher for perio

Mechanical cleaning is still essential with brushing, interdental cleaning, and chlorhexidine + fluoride are useful.

Where maintaining some oral intake should complete oral hygieve after each meal.

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20
Q

Which people most commonly get MS and how slow does it progress?

A

usually females between 20 - 50 years of age and progresses for 15 years.

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21
Q

What are the common symptoms of MS?

A

Depends on region of the brain affected:

Bladder problems

Fatigue

Weakness

Muscle hypotonicity

Loss of sensation

Dizziness

Visual disturbances

Depression and emotional instability

22
Q

How is MS treated?

A

Symptomatic management:

Interferon

Corticosteroids

Immunosuppressants (methotrexate)

23
Q

What are the dental implications of interferon use for MS?

A

Can cause flu like symptoms, xerostomia, neutropenia, thrombocytppenia)

24
Q

What are the dental implications of corticosteroid use for MS?

A

Affects healing of infections, can cause adrenal crisis (very low risk)

25
Q

What are the dental implications of immunosuppressant use for MS?

A

Causes oral ulcerations, xerostomia, gingivitis, candidiasis, mucositis, anaemia, leukopaenia, thrombocytopaenia, and increased infections)

26
Q

What are the oral manifestations of MS?

A

Trigeminal neuralgia (>40 year old females) can be bilateral or unilateral

Sensory neuropathy (Paraesthesia, dysaesthesia, and anaesthesia)

Paralysis (Similar to Bell’s Palsy - Usually a late symptom)

27
Q

Why is it important to understand MS?

A

Patient may present with initial symptoms to the dentist

28
Q

How can dentist help early detection of MS? What signs should a dentist look out for?

A

Question suspicious complaints about abnormal facial pains (20 - 35 year olds):

Mimicking trigeminal neuralgia

Numbness of extremities

Visual disturbance

Muscle weakness

Afternoon tiredness

If there is relapsing remitting pattern

Refer for neurological assessment

29
Q

When should patients with MS be treated?

A

Ideally when in remission

With mild disease routine dental care is a good idea

When more severe: Transfer to clinic/dental chair, ensure good oral hygiene, prosthetic/reconstructive treatment, use short morning appointments.

30
Q

What are the side effects of medications that commonly are used for MS?

A

Dry mouth

Some may cause bleeding problems

31
Q

What should be considered for treatment of MS patients?

A

Stage of disease

Advice from other health professionals in multidisciplinary team

Implications of medications

Oral hygiene, risk factors

Access to dental clinic, transfer to chair

Short appointments in morning

Rational treatment planning

32
Q

What brain regions are affected by parkinson’s disease?

A

Dopamine producing neurons in the substantia nigra.

33
Q

Who most commonly has parkinson’s disease?

A

Men and more common with older ages. over 75 1 in 100 people

34
Q

What are the symptoms of parkinson’s disease?

A

Abnormal shuffling gates. Difficulty initiating movements and stopping movements. Arms carried in front of body.

Bradykinesia (stiffer and slower movements) Pill rolling tremor.

Mask like face due to difficulty creating facial expressions

Dementia

Orthostatic hypotension

35
Q

How is Parkinson’s disease treated?

A

Generally symptom management

Monoamine oxidase inhibitors used to improve early symptoms

Levodopa or dopamine agonists which are most effective and widely used. They replenish dopamine and improve motor functions.

Anticholinergics

NMDA receptor inhibitors (amantadine)

COMT inhibitors

36
Q

What side effects are commonly seen in medications used to treat Parkinson’s disease?

A

Weight loss: Undernutrition

Altered speech: Slow, slurred, monotone

Abnormal swallowing/dysphagia

Change in taste sensation

Dementia

Angular cheilitis predisposition due to drooling.

37
Q

When should dental treatment ideally be done for parkinson’s?

A

Earlier treatment is preferable because the condition does progress

38
Q

What should be done to prevent discomfort caused by dysphagia?

A

High volume suction, patients come in the morning

39
Q

What is huntington’s disease?

A

Progressive neurodegenerative disorder affecting the CNS.

Characterised by unwanted choreatic movements, cognitive decline and psychiatric disturbances.

40
Q

Who does Huntington’s disease typically affect?

A

Males and females equally

6 -7 per 100000 in Australia

41
Q

What causes mortality in people with Huntington’s typically?

A

Mortality is typically aspiration pneumonia and suicide

42
Q

How is Huntington’s disease diagnosed?

A

Clinical sign with known history

Confirmed with genetic testing.

43
Q

What are the symptoms of Huntington’s disease?

A

Triad of clinical symptoms:

Motor impairment (dysphagia and dysarthria)

Cognitive impairment (decline in cognition and memory)

Personality and psychiatric disorders (emotional) (Dysphoria, anxiety, sleep disturbances)

44
Q

How is Huntington’s disease managed?

A

Symptom based and often moved to long term care in nursing homes and specialist unit daycare services.

45
Q

Why is dental treatment so important to treat for patients with Huntington’s disease?

A

Aspiration pneumonia is a common method of death so dental treatment is important.

46
Q

How is dental treatment applied to patients with Huntington’s?

A

Aggressive preventative measures and restorative treatment in the early stages.

Later stages: Domiciliary care and palliative care.

Oral hygiene techniques: Allow to maintain independence, carer assistance, individual tailoring of strategies, reminder posters.

47
Q

What is motor neurone disease?

A

A quick neurodegenerative disease caracterised by selective degeneration of upper and lower motor neurones.

Also referred to as ALS or Lou Gehrig’s disease.

1900 affected in Australia

48
Q

What are the challenges to dental care people with motor neurone disease face?

A

Patients with this condition require non-invasive ventillation meaning they might have a mouthpiece. Nasally delivered NIV is the only one that allows dental care.

Salivation and drooling with dry mouth and increased viscosity.

Dysphagia

Communication

Cognitive and behavioural changes (Can go from verbal to non-verbal)

49
Q

What arrangements for dental management is required for patients with motor neurone disease?

A

Access to care: accessible facilities vs domiciliary visit.

Patient positioning: Upright and support head/body with cushions.

Communication

Treatment planning appropriate to disease

High volume suction for treatment

Appropriate oral hygiene and preventive measures

50
Q

What should be discussed with other specialists involved in the treatment of patients with motor neurone disease?

A

Management of saliva issues (drooling and dry mouth)

Oral hygiene

Collaboration with speech pathologist regarding dysphagia management

Consultation with dietician regarding diet

DMD3 sem 2 (69 decks)

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