Oral Medicine VI - Patel's Puzzle Flashcards by Tim Agee

Chronological age is the number of years you have lived and the Functional Age is the age you are _______ to function at

perceived

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Geriatric patients have ______ symptoms

More _____ responses on health questionnaires

Atypical

positive

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With age, there are changes in both pharmokinetics and pharmodynamics

True

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Drug related complications in Geriatric pts are separated into types by ________ list

Beer’s

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Drug related complications can occur via what 5 mechanisms in geriatric pts?

DDI’s

Adverse drug rxn

Under medication

Polypharmacy

non-adherence

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Criteria for potentially inappropriate meds in older adults

Beers

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Types of chronic conditions in geriatric pts:

leading causes of death over 65

Heart disease

Cancer

Resp disease

Stroke

Alzheimers

Diabetes

Influenza

Pneumonia

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3 Changes to CV system in elderly:

Stiffened aorta

Reduction max cardiac output

Coronary artery disease

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Cellular and molecular alterations affecting both innate/adaptive immunity due to aging

Immunosenescence

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Salivary gland hypofunction is a common age-related oral change

True

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3 age-related Oral changes:

salivary hypofunction

mucosal fragility

impaired healing/immunity

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Pulpal sensitivity _____ with increasing age

Increased prevalence of _______ disorders

decreases

neuropathic

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TMJ affects what % of general population?

12%

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Geriatric oral mucosa disorders (6):

Traumatic ulcers

Vesiculobullous disease

lichen planus

malignancy

candidiasis

denture stomatitis

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Xerostomia vs. Salivary gland hypofunction

Subjective vs Objective

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Whole stimulated flow rate, unstimulated flow rate =

Sialometry

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Sialometry Hypofunction Unstimulated:

Stimulated:

less than 0.1 ml/min

less than 0.7 ml/min

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Sore swollen tongue, cavities, metallic taste, bad breath, spicy/acidic food intolerance

Xerostomia/hypofunction

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4 questions for dry mouth questionaire:

saliva seem too little?

difficulty swallowing?

when eating meal feel dry?

sip liquids to aid in swallowing?

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Chronic GVHD and Sjogrens

Autoimmune

*salivary gland disorders

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Salivary gland aplasia can happen _______

developmentally

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4 infections that can affect the salivary glands:

CMV

HIV

HepC

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Non-neoplastic condition causing salivary gland disorder

Sialolithiasis

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4 Iatrogenic means of causing salivary gland disorder:

External beam radiation

Internal beam radiation

Post-surgical

Botox

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Systemic conditions that involve the salivary glands (5):

Anorexia Bulimia Diabetes Alcoholism Sarcoidosis

Classification of Sjogren Syndrome is based on a weighted sum of _____ items First 2 are ___ points Last 3 are ____ points Primary Sjogren's must have a score of...

5 3 points each 1 point each 4 or greater

What are the 5 items

Anti-SSA/Ro or Anti-SSB/La antibody focal lymphocytic sialadenitis (more than 1 foci/4mm2) Abnormal ocular staining score (> 5) Shirmer's Test (<5) Unstimulated salivary flow rate <0.1 ml/min

The Sjogren's scoring system has high sensitivity and specificity (96% and 95%)

True

Clinical signs/symptoms of Sjogren's:

dry eyes, corneal ulcerations/infections, difficulty swallowing, hearburn, reflux, dry nose, nose bleeds, dry mouth, mouth sores, dental decay, etc

Oral complications of Sjogren's and Xerostomia:

Dry mouth Parotid swelling Sialadenitis Glossodynia Caries Candidiasis

6 Salivary gland disorders associated w/ HIV:

HIV SGC (pre-malignant) Acute sialadenitis neoplasms DILS (diffuse infiltrative lymphocytosis syndrome) Salivary gland enlargement (1-10% or pts) Changes in salivary flow rate/composition

More than 500 meds can cause dry mouth

True

7 drug classes that cause dry mouth:

Analgesics Antihistamines Antidepressants Cytotoxics Sedatives Anticonvulsants Antiretrovirals

5 clinical assessments for salivary gland disease:

Palpation Sialometry imaging biopsy serology

5 Red Flags for salivary gland disease:

Facial nerve paralysis multiple masses fixed masses presence of cervical lymphadenopathy smaller gland = higher risk of malignancy

Ulceration, induration , invation, dysphagia, otalgia, trismus, parasthesia, unintentional weight loss

signs salivary gland disease

Objective measurement of salivary flow

Sialometry

S;pitting, absorben sponge, draining, and suction are various methods for what?

Sialometry

Unstimulated salivary flow rate less than_______ is hypofunction Stimulated less than ______

0. 1 ml/min | 0. 7 ml/min

CT is good for, requires: MRI is good for:

hard tissue, dye injection soft tissue (no radiation)

What to use preventatively for xerostomia? Recall schedule?

Topical fluoride 3-4 months

chewing gum, sugar free lemon candies, palpation, moist heat application:

For xerostomia

Systemic drug for Salivary Stimulation: dosage:

Pilocarpine HCL 5-10 mg 3x/day

Pilocarpine is FDA approved for Tx of xerostomia following what? also for what?

Head and Neck radiation Sjogrens

What drug is FDA approved for the Tx of oral dryness in pts w/ Sjogrens? (but not radiation) dosage?

Cevimeline HCL 30 mg 3x/day

Anti-HTN

dry mouth

Oral candidiasis secondary to ______ in inhalers

steroids

Fe deficiency anemia oral manifestations:

mucosal pallor depapillated tongue generalized mucosal atrophy burning tongue angular chelitis aphthous ulcerations

Oral manifestations of Pernicious anemia:

burning tongue burning lips burning oral mucosa erythema/atrophy focal/patchy

Oral manifestations of bleeding disorders:

severe gingival bleeding ecchymoses petechiae hemoarthroses of TMJ

Oral manifestations Leukemia:

gingival enlargement bleeding ulceration infection

Oral manifestation Lymphoma:

cervical lymph nodes enlarged unexplained oral cavity swelling

Diabetes is related to Perio disease which means delayed wound healing, increased infection, ________ enlargement, ________ ________ disturbances leading to _______

parotid gland xerostomia sensory, burning mouth syndrome

Ulcerative Colitis oral manifestations:

aphthous pyostomatitis vegetans *lesions resolve after Tx

Crohn's disease oral manifestations:

atypical mucosal ulcerations diffuse lip swelling cobblestone mucosa

3 oral manifestations for liver disease/bleeding tendency:

hemorrhagic changes taste dysfunction sialadenosis

Candidiasis, bacterial infection, Kaposi, Hairy leukoplakia, HSV

HIV

2 types of Type IV hypersensitivity in the mouth:

Contact stomatitis Lichenoid mucositis

Amalgam may be a type ____ hypersensitivity Need to inquire about what?

IV contacts w/ matls around time allergy reported

2 Rheumatoid arthritis oral manifestations:

degenerative changes of TMJ Anterior open bitn

4 types of Dermatologic disorders:

oral lichen planus mucous membrane pemphigoid pemphigus vulgaris paraneoplastic pemphigus

What are the 3 types of Lichen Planus?

Reticular Erosive (ulcerative, bullous) Plaque-type

4 clinical features of Type IV hypersensitivity rxn:

Erythema Vesicles Ulcers Hyperkeratosis

Aconthosis, hyperkeratosis, heay lymphocytic inflammaotry infiltrate w/ variable histocytes, eosinophils, and plasma cells, dilated papollary vessels w/ perivascular lymphohistocytic infiltrate

Histopathological features Type IV sensitivity rxns

Drug induced oral rxns:

salivary gland rxn mucosal irritation/ulceration taste disturbance swelling discoloration trigeminal sensory distrubance motor distrubance malodor

4 diagnostic steps for diagnosing Drug-induced rxn:

Hx Allergic profile/risk Stop putative drug and observe Start putative drug again and observe

The only way to show causality in single subject trial: A-B only shows what?

A-B-A-B association

3 most common oral side effects of the most frequently prescribed drugs:

Xerostomia Dysgeusia (bad taste) Stomatitis (painful swelling in mouth)

5 types of salivary gland rxns:

Hypo swelling hyper pain discoloration of saliva

3 taste disturbances w/ definition:

Hypogeusia (loss of taste) dysgeusia (distortion) ageusia (loss)

Drug related oral ulcerations can cause the following:

Oral burns aphthous eruptions (fixed) mucositis neoplasm pemphigoid/bullous erythema multiforme epidermal necrolysis lupus like disorders

The highest frequency of allergic rxns in the mouth are seen in what 2 drugs?

Oral Abx NSAIDS

3 dental matls that can cause oral burns:

Silver Nitrate Formocresol Acid-etch matls

Repeated ulceration at same site in response to a particular drug. Can go from solitary to multiple w/ repeated exposure. Localized in mouth or associated with other mucocutaneous sites:

Fixed Drug Eruption

Drug-related mucositis caused by what?

Cytotoxic drugs

Stevens-Johnson Syndrome presents the same as...

Toxic Epidermal Necrolysis

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 4 features:

Flu-like prodromal Cutaneous lesions (erythematous macule on trunk) maculopapular exanthema then Mucocutaneous epidermolysis painful blistering intra-orally

7 drug-related white lesions:

burns lichenoid eruptions lupus-like rxns candidiasis papillomas hairy leukoplakia leukoplakia

3 drugs that cause gingival hyperplasia:

phenytoin (dilantin) cyclosporine calcium channel blockers

Class of drugs that cause Burning Mouth Syndrome: 3 drugs in this class:

ACE inhibitors enalapril, captopril, lisinopril

What is the most common oropharyngeal infection?

Candida albicans

Sjogren's is autoimmune and most common in peri and post menopausal women

True

Sarcoidosis is a noncaseating granuloma

True

TB is often unilateral in the mouth

True

Oral cancer is an example of a drug induced oral rxn

False

Swelling, ulcration, malodor are drug induced interactions

True

Repeat ulceration at the same site

Fixed drug eruption

Methotrexate is a chemo drug that causes oral ulcerations ___% of the time Exacerbated by... indistinguishable from...

14% folate deficiency mild dysplasia

Type I hypersensitivity is a true allergic rxn and can be caused by penicillin, ACE, aspirin, barbiturates, etc

True

What drug can turn a pt blue?

Minocycline

SSRI's and SNRI's can cause sleep bruxism

True