Neurologic Disorders Exam 6 Flashcards
What are the different disorders and conditions when it comes to the neurologic disorders.
Neurological- epilepsy/seizures and cerebrobascular accident
Developmental- Autism
Genetic- Down syndrome
Degenerative- MS, Alzheimers disease, Parkinsons disease
What is cerebrovascular accident (stroke) ?
- Sudden interruption of oxygenated blood to the brain causing tissue necrosis
- Can comes to CVD
- Affects motor, speech and some cognitive disfunction
- Severe- death can occur within minutes
What are the predisposing factors for cerebrovascular accident (stroke) ?
- Hypertension- greatest risk factor
- Atherosclerosis
- Hypercholesterolemia, hypertriglyceridemia
- Tobacco use
- Cardiovascular disease
- Diabetes mellitus
- Oral contraceptive use
- Drug abuse
What are the etiological factors for cerebrovascular accident (stroke) ?
Thrombosis
Intracerebral
Ischemia
Cerebral Hemorrhage
What are stroke symptoms ?
B - balance
E - Eyes
F - Face
A- Arms
S- Speech
T-Time
What are the signs and symptoms Cerebrovascular Accident?
- Residual and Chronic effect- memory, speech, sensation and motion tem and perm loss.
- Right Hemiplegia- more difficult with verbal communication, cautious, anxious or disorganized
- Left Hemiplegia- more difficult with physical coordination, overconfidence.
What are the after symptoms after stroke ?
- Physical paralysis
- Articulation- aphasia
- Salivation and swallowing difficulty
- Increase pain, touch sensitivity
- Visual impairment
- Mental dysfunction possible
- Personlity changes
What are the medical management for a stroke (CVA)
Drugs- anticoagulant, antihypertensive, thrombolytic, vasodilator, steroid, antiepileptic
Surgical correction of aneurysm, clots, malformations, removal of small clots, graftling to bypass bloacked vessel.
Therapy physical therapy, occupational therapy, speech therapy.
What are the dental management for a stroke (CVA)?
- Timing- how long since stroke?
- Med-mgmt- control/ prevention
- Identify risk factors
- DONT NOT recommend aspirin for pain management
- Local anesthesia with epinephrine- modifications
- Appointment procedures- four handed, short appointmet
What are the oral manifestations of CVA?
- Facial paralysis- decrease tongue movement, decrease self cleaning.
- Lack of sensation of biofilm collection= inflammation
- May detect carotid calcifications on panoramic
What is autism spectrum disorders?
- neurobiological disorders affecting how a person interacts communicates, relates, plays, imagines and learns
What are the unknown cause for autism?
possibe: pyschogenic, genetic, biochemical, neurophysiologic
What does autism include:
Autistic disorder
Aspergers syndrome
Rett syndrome
Childhood disintegrative disorder
Pervasive developmental disorder not otherwise specified
What are th clinical presentations for autism ?
delayed/abnormal; social interaction, Language, imaginative play
Social communication deficits
Restricted interests
Repetitive behaviors
Signs shown before 3
Male more likely to have it
What are the medical management for autism?
- psychotherapy
- dietary intervention
- speech and language therapy
- auditory therapy
- educational intervention
- behavorial therapy
- music therapy
- medications: Stimulants (Ritalin), Tranquilizers (Diphenhydramine), Anticonvulsants (Phenytoin), and Antipsychotic (Risperidone)
What are the dental management for autism?
- Before- rehearse verbiage
- limit wait time before seated
- quiet dental environment
- appointments short and organized
- use tell- show-do to alleviate fear
- provide short, clear commands
- positive reinforcement/praise
- carregiver encouragement
What are the oral manifestations of autism ?
- increased caries risk
- increased inflammation risk
- medication side effects
What is down syndrome: trisomy 21?
- Etiology- chromosmal abnormality; extra chromosome
- Clinical Presentation- short neck, flatten facial profile, slanted eyes with epicanthic fold covering inner eye corner
What are the cognitive and behavioral characteristics for down syndrome?
- short attention span
- impulsive
- show learning, delayed developmental milestones
What are the dental management for down syndrome?
- involve caregiver
- Communicatin techniques
- consider cognitive abilities
- minimize background noise
- more frequent recare
What are the oral manifestations for down syndrome?
- macroglossia
- macrosomia
- narrow vaulted palate
- Mouth breathing
- periodontal infections
- xerostomia
What is parkinsons disease?
- neurodegenerative disorder caused by deficiency of dopamine
- occur in middle ages and older persons, higher incidences in males
What are the medical management for parkinsons?
- Therapy- physical occupational
- Symptomatic control- replenish dopamine shortage with levodopa
- Surgical relief of symptoms- deep brain stimulation, ablation
What are the dental management for parkinsons?
- consider efffects of condition on patients ability to maintain oral health at home
- recommend alternative or modified oral aids
- anesthesia with epine
- help patient into and out of chair and assist with going to and from reception room
- raise chair slowly
- use techniques for effective communication
What are the oral complications for parkinsons?
- Excess saliva and drooling
- Decreased swallowing
- expression fixed, masklike,diminished blinking
- tremor in lips tongue, neck ,dysphagia
- Drugs side effects: xerostomia, nausea, tardive dyskinesia
What is multiple sclerosis?
- Autoimmune disease, unknow cause
- Chronic demyelinating disease
- Myeline sheath destroyed with white matter of CNS- MS plaques
- Occurs on: onset 20-40 years
- 2:1 ration; female to male
- Caucasion females more frequently affected
What are some characteristics of multiple sclerosis ?
- Visual impairment, diplopia, fatigue weakness
- Musclar coordination
- Transient tingling
- involuntary eye motion
- speech disorders
- Relapses and remission
- almost normal life span <50% non- ambulatory
What are the medical management for MS?
- Prompt diagnosis and early treatment within 6 months crucial to deter nurological damage
- prevent relapses and progression
- Treat exacerbations
- Symptom relef to improve function
- psychological therapy and support
- adequate nutrition rest, avoid stress/stain, prevent infections and injury, non-strenous excersie and activity encouraged
What are the medications for MS?
- IV corticosteroids
- Interferon injections
- Muscle relaxers
- Antidepressants
What are the Dental management?
- Delay treatment during relapsing episode; care during remission
- Address medication side effects- burning and dry mouth (saliva sub), pilocarpine prescription
- Examine for opportunistic infections from immunosuppressants
What are the oral complications for MS?
- Dysarthria (difficulty speaking)
- Paresthesia, facial numbness, trigeminal neuralgia
- decreases: motor, sensory, cognitive functions
- increase: medications
What is dementia: alzeimers disease
- Dementia- progressive intellectual decline
- Slow chronic inability to remeber, reason, learn and imagine
- Results in loss of independence
- Occurance: older than 65 years old increasing 85 plus
- Risk factors: Family history , age, genetics , down syndrome, periodontitis
- 8 years duration from symptoms to death
What are the medical management for dementia?
- slow disease progression
- Cholinesterase inhibitors- boost acetylcholine for cognition
- Memantine (namenda)- regulates glutamate, chemical messenger
- Manage symptoms
What are the dental management for dementia?
- Thorough medical history
- Include patient when speaking to caregiver
- use nonverbal communication
- Mild to moderate disease
- review medications and oral side effects
- short appointments and clam environment
What are the oral manifestions and complications for MS?
- Side effects of medication: xerostomia
- Caries
- Lesions
- Candidiasis
- Hard and Soft deposits
- Periodontal disease
- Caries
- Injuries from falls: broken teeth, ulceration
