Oral Medicine VI - Patel's Puzzle Flashcards
Chronological age is the number of years you have lived and the Functional Age is the age you are _______ to function at
perceived
Geriatric patients have ______ symptoms
More _____ responses on health questionnaires
Atypical
positive
With age, there are changes in both pharmokinetics and pharmodynamics
True
Drug related complications in Geriatric pts are separated into types by ________ list
Beer’s
Drug related complications can occur via what 5 mechanisms in geriatric pts?
DDI’s
Adverse drug rxn
Under medication
Polypharmacy
non-adherence
Criteria for potentially inappropriate meds in older adults
Beers
Types of chronic conditions in geriatric pts:
leading causes of death over 65
Heart disease
Cancer
Resp disease
Stroke
Alzheimers
Diabetes
Influenza
Pneumonia
3 Changes to CV system in elderly:
Stiffened aorta
Reduction max cardiac output
Coronary artery disease
Cellular and molecular alterations affecting both innate/adaptive immunity due to aging
Immunosenescence
Salivary gland hypofunction is a common age-related oral change
True
3 age-related Oral changes:
salivary hypofunction
mucosal fragility
impaired healing/immunity
Pulpal sensitivity _____ with increasing age
Increased prevalence of _______ disorders
decreases
neuropathic
TMJ affects what % of general population?
12%
Geriatric oral mucosa disorders (6):
Traumatic ulcers
Vesiculobullous disease
lichen planus
malignancy
candidiasis
denture stomatitis
Xerostomia vs. Salivary gland hypofunction
Subjective vs Objective
Whole stimulated flow rate, unstimulated flow rate =
Sialometry
Sialometry Hypofunction Unstimulated:
Stimulated:
less than 0.1 ml/min
less than 0.7 ml/min
Sore swollen tongue, cavities, metallic taste, bad breath, spicy/acidic food intolerance
Xerostomia/hypofunction
4 questions for dry mouth questionaire:
saliva seem too little?
difficulty swallowing?
when eating meal feel dry?
sip liquids to aid in swallowing?
Chronic GVHD and Sjogrens
Autoimmune
*salivary gland disorders
Salivary gland aplasia can happen _______
developmentally
4 infections that can affect the salivary glands:
CMV
HIV
HepC
TB
Non-neoplastic condition causing salivary gland disorder
Sialolithiasis
4 Iatrogenic means of causing salivary gland disorder:
External beam radiation
Internal beam radiation
Post-surgical
Botox
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 ______
- 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