Neurological and special senses dentally relevant questions Flashcards
What anti-thrombotic medication is used?
Antiplatelet –> aspirin, clopidogrel, dipyramidamole
Antocoagulation –> wafarin
DOACs –> dabigatran, apixaban, rivaroxaban
What is the scale used to diagnose a stroke?
Rosier scale
What are the dental aspects to be aware of with a stroke?
OH Denture fitting problems Reduced airway protection, gag reflex Medications being taken Avoid adrenaline in LAs - hypertension risk
What are the 3 D’s of speech?
Dysarthia –> difficult articulating speech (slurred)
Dysphonia –> loss of voice (hoarse)
Dysphasia –> loss of cerebral language skills
What is the difference and parts of the brain that cause 1.receptive and 2.expressive/motor dysphasia?
- Patient can not comprehend - Wernike’s
2. Patient can not form words/sentences - Broca’s
What is the neurological assessment of ACVPU?
Rapid assessment:
- Alert
- Confusion (new onset)
- Voice (response)
- Pain (response)
- Unresponsive
What is the Glasgow Coma Scale used for? and whats its scale?
Assess neuro condition - response with eye, response to verbal and pain
Scale from 3-15 (3 dead –> 15 fully alert)
What is conductive and sensory neural deafness?
Conductive –> air not transported through war (due to wax?)
Sensory neural –> mediated by CN VIII
What is the rinne test used for?
Can test conductive deafness when bone conduction is greater than air conduction with a vibrating tuning fork
What is the weber test used for and how does it work?
Tuning fork in the middle of the back of the head
Conductive deafness = sound same side as problem
Sensory neural deafness = sound from opposite side
What is Otitis externa?
Painful ear infection with serous discharge, can have swelling which can block ear canal
What is the treatment for otitis externa?
Gentamicin and steroid ear drops
If not working, might be fungal, therefore use anti-fungal
What is another name for Glue ear?
Otitis media
What is otitis media?
When the eustachian tube blocks (between middle ear and oropharynx) cause pain/pyrexia/hearing loss, usually from an ascending URTI, can become chronic infection with effusion
Why do ear infections need to be managed quickly?
Can track up to the brain or back to the mastoid
What is acoustic neuroma? and what symptoms can present?
Rare tumour of vestibulocochlear N
Unilateral deafness, facial palsy due to proximity to facial N
What dental pain can arise from earache?
TMD
How can glaucoma lead to optic N damage?
Increased intraocular pressure
How can a dentist identify temporal arteritis?
Patient complaining of headache and visual problems
Temporal A enlarged (especially unilateral)
MEDICAL EMERGENCY
What are the triad symptoms of Bechet’s disease?
Oral ulceration
Genital ulceration
Uveitis
What is the treatment of Bechet’s disease? And who should you not give this certain treatment to?
Immunosuppression, IV methylprednisolone, oral steroids, azathioprine, cyclosporin
Never give steroids if diabetic, osteoporosis, undiagnosed red eye
If patient has orbital cellulitis, what dental disease could this be caused by?
Could be due to sub periosteal abscess formed due to tooth infection
What is Ramsay hunt? What causes it? What tx?
Herpes zoster on the geniculate ganglion
Associated with nerve palsy and can not close eye properly
Treatment IV aciclovir
What 5 tests can be used to test CN II?
Optic nerve
Visual acuity, pupillary reflexes, visual fields, colour vision, fundoscopy
What tests can be used to test CN V?
Sensory - sensation in all 3 divisions
Motor - open against resistance and jaw jerk
What tests can be used to test CN VII?
Motor of each branch - raise eyebrows, close eyes, puff nose
Taste
Schimer test - lacrimal test
What tests can be used to test CN IX and X?
Gag reflex Voice Cough Puff checks Swallow
What tests can be used to test CN XI?
Shoulder shrug - trapezius
Head turn - SCM
What can anti-convulsant medication treat?
Epilepsy
Neuralgia
Neuropathic pain
What is the difference between generalised 1.motor and 2.non-motor epilespy?
- Body moves in own way with no control, tonic-clonic seizures (LOC, m. contract, jerk)
- Stop and stare or repetitive movements (e.g. lip smacking)
What is the difference between generalised and focal epilepsy?
Generalised - affects both sides of the brain
Focal - develops in 1 side of the brain
What is focal epilepsy?
Aware of seizure, confused, emotional changes
What are some first line anti-convulsant drugs?
Phenytoin/carbamazepine –> block na and ca channels
Na valporate
Gabapetin and pregablin
BZDs
What is status epilepticus? What is its best treatment?
Fits always happen, rapid firing of nerves, rapid movements
Best treatment = BZDs
What is MoA of anti-convulsants?
Inhibit rapid repetitive firing that characterises seizures by inhibiting ion channels or enhancing GABA mediated neurones
Decrease neuro inflammation for pain
Decrease central trigeminal activation
What drug is used to treat trigeminal neuralgia? and what doses are given
Carbamazepine
100-200mg 1/day
Then can slowly increase to TDS, max 1600mg
What body interactions can occur with carbamazepine?
Steven-johnsons - rashes/ulcers
Blood dyscrasis - decreased WBC therefore decreased immunity
Liver disorder - bruising/ yellow skin
What is the general impact of anti-convulsant drugs on dental treatment?
Have haematological effects: anaemia, decreased WBCs, decreased platelets
Therefore need to know if patient has normal blood tests
What is seen in patient on phenytoin, dentally?
Gingival overgrowth
Root shortening/resorption
Hypercementosis
Can have teratogenic effect cleft lip and palate
What is seen in patient on carbamezapine, dentally?
Xerostomia
Glossitis
Oral ulceration
Can have teratogenic effect cleft lip and palate
What is the pathology of parkinsons disease?
Loss of dopaminergic neurones of substania nigra
Presence of Lewy bodies and neurites within neurones
Therefore decreased dopamine and increased ACh
What are the effects of dopaminergic drugs on mouth and perioral structures?
Dry mouth Taste disturbance Stomatitis Oral ulceration Head ache Dyskinesias
When to treat a patient on dopaminergic medication?
When patient is in ON time: medications working (treatment within 60-90 mins of meds), therefore good for dental treatment
Morning often better and shorter appointments
Not good in OFF time: medications not working, more tremor and decreased movement
What is the dental side effect of anti-muscarinic drugs?
Dry mouth
What is the function of fluoxetine?
Blocks serotonin reuptake, increases availability, increases mood
What types of antipsychotic drugs are there?
1st and 2nd generation
What is the drug interaction of alcohol and BZDs?
Increased sedation
What is the drug interaction of erythromycin and antipsychotics?
Ventricular arrhythmias –> asystole –> cardiac arrest
What is the drug interaction of SSRIs and TCAs?
Ventricular arrhythmias
What is the dental relevance of patients of antipsychotics?
Xerostomia
Postural hypotension
What is the MoA of antidepressants?
To increase monoamine
What types of antidepressants are there?
SSRIs, SNRIs (selective noradrenaline), TCAs, MAOIs (monoamine oxidase inhibitors)
What interaction occurs between SSRI and SNRI?
Serotonin syndrome
What dental use can be used for SSRI?
Burning mouth syndrome
What dental side effects do most antidepressants cause?
Postural hypotension and xerostomia
