Osteoarthritis and Crystal Deposition Joint Disease

Question 1

List some general dental implications of musculoskeletal disease:

Answer 1

• mobility may be affected by pain and disability - make adjustments
• manual dexterity may be affected by joint disease in hands - reducing ability to maintain oral hygiene
• potential TMJ disease and poor opening
• dry mouth affects people with connective tissue disease who have sjogrens
• potential C-spine problems - consider and assess for GA carefully
• complex drug regimens to be aware of in connective tissue disease

Question 2

What are the symptoms/signs of joint disease?

Answer 2

• inflammation - hot, red, swollen, painful
• destruction - immobility, deformity, instability

Question 3

What is osteoarthritis?

Which joints are affected?

Associations?

Answer 3

Osteoarthritis: degenerative joint disease where cartilage breaks down

Affected joints: hands and weight bearing joints (hips, knees, ankles, spine)

Associations:

• more common as we age
• genetic
• obesity (esp. knees)
• previously damaged joints or bones

Question 4

How is osteoarthritis diagnosed?

How is it managed?

Answer 4

Diagnosis:

• clinical - history and exam
• radiology - plain X-rays

Management:

• losing weight helps with pain on weight bearing joints
• physiotherapy
• analgesia
• steroid injection: temporary relief

Surgery: joint replacement e.g. hip, knee

Question 5

List some dental considerations associated with osteoarthritis:

Answer 5

• reduced dexterity for OH
• reduced mobility - getting up on couch/dental chair
• C-spine mobility - GA
• associated medication

Question 6

What is gout caused by?

Acute presentation:

Chronic presentation

Answer 6

Gout - accumulation of urate crystals in joints

• more common in males

Acute presentation: extremely painful joints

Precipitants: starvation, excess alcohol, foods, drugs

Chronic presentation:

• tophi deposition - urate crystals deposited in soft tissues and joints

Question 7

Name some crystal deposition joint diseases:

What is psoriatic arthritis?

Answer 7

• Gout
• Pseudogout - calcium phophate crystals
• Hydroxyapatite crystal deposition disease

Psoriatic Arthritis:

• destructive arthritis associated with psoriasis
• can affect TMJ but rare