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PHAY 1 > self care conditions > Flashcards

self care conditions Flashcards

1
Q
  1. look at notion notes in week 8 for images and extra notes on gum disease, headaches, oral conditions
A
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2
Q

Gum diseases are (…) conditions

A

inflammatory

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3
Q

examples of gum diseases:

A

gingivitis
-> then leads to chronic periodontitis

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4
Q

characteristics of gingivitis

A

Mostly caused by bacteria build up in dental plaque
Dental plaque
Calculus
Does not affect support for teeth
Usually mild
Can be reversible

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5
Q

Characteristics of chronic periodontitis

A

Involves supporting tissues around teeth
Largely irreversible tissue damage
Slowly progressive
Tissue and bone damage, tooth loosens

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6
Q

gingivitis progression?

A
  • Normally we build up of plaque each day
    (and normal brushing should remove each day)

But if you don’t brush…
- Bacteria produces calculus if built up over a few days
- Sticks to teeth holding bacteria close
- Enzymes and toxins released cause inflammation in gingiva (gum)
- Over years mild damage results in a pocket forming between tooth and gum
- Then tooth root erodes and tooth comes loose-periodontitis

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7
Q

signs and symptoms - gingivitis

A

Inflammation of gum
Swollen, red and sore
Bleeds easily on mild trauma – bleedings with brushing, flossing, or eating hard food.
Plaque visibility
No fever, or malaise.

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8
Q

when do we Suspect periodontitis rather than just gingivitis

A

if
Halitosis, foul taste in mouth, difficulty eating, pain
Gum recession or root sensitivity.
Loosening or drifting of teeth
Sign of infection – abscess/puss

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9
Q

Halitosis is what?

A

bad breath

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10
Q

epidomology behind gingivitis

A

Different studies show varying percentages
Some degree of gingivitis in 50-90% of adults
Increased risk:
Poor nutrition
Ineffective oral hygiene
Pregnancy
Diabetes
Smoking
Immunocompromised
Age
Drugs causing dry mouth
Stress
Local factors

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11
Q

questioning 2 deal with gingivitis

A
  1. Confirm symptoms – consistent with gingivitis?
  2. Bleeding – with or without trauma
  3. No trauma = likely periodontitis so refer
  4. Toothbrushing technique
  5. Too vigorous = gums bleed
  6. Other medicines E.g. warfarin, heparins, NSAIDs / phenytoin s/e = gum hypertrophy
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12
Q

differential diagnosis options rather than gingivitis:

A
  • oral malignancy
  • hepatic gingivostomatitis (viral)
  • allergic reactions
  • platelet disorder
  • denture associated trauma
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13
Q

epidemiology of headaches:

A
  • affects everyone occasionally
  • higher in women than men
  • most common a&e reason
  • most self-manage
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14
Q

aetiology headaches (causes)

A

most people have headaches occasionally which
resolve relatively quickly
Usually a physiological response to circumstances

DIFFERENT CAUSES FOR DIFF TYPES (see below, mainly medication overuse)

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15
Q

symptoms of headaches

A

pain:
- acute or chronic (>3 months/beyond expected)
- subjective, emotional symptom: defined as unpleasant sensory or emotional
experience associated with actual or potential tissue damage
4 types: Nociceptive (stimulation of specific pain receptors), Somatic (musculoskeletal pain), Visceral (internal organs), Neuropathic (peripheral or central nervous system)

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16
Q

Questions to ask – other symptoms: headaches

A
  1. N+V = migraine, space-occupying lesion, meningitis
  2. Fever = sinusitis, temporal arteritis, viral infection
  3. Nasal congestion = sinusitis, cluster headache
  4. Insomnia = severe headache
  5. Visual disturbances = migraine, glaucoma, temporal arteritis, stroke, intraocular pathology
  6. Neck stiffness = injury, meningitis
  7. Rash =meningitis (non-blanching), viral
  8. Weight loss = cranial arteritis, malignancy (unusual)
  9. CNSsymptoms
    - –General – loss of coordination, drowsiness, irritability, personality
    changes, convulsions
    - –Localised lesions – slurred speech, limb muscle
    weakness, disturbances in smell or hearing
    - space-occupying lesions e.g. tumours, haemorrhage
  10. Tendertemples
    - –Inflamed temporal arteries – may see red, congested vessel in temple
    area
    - –Pressure applied to area is painful, possible jaw ache
    - –Usually in older people
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17
Q

primary headaches symptoms

A

not associated with underlying condition
most common type
patients present OTC
migraine, tension type, cluster etc

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18
Q

secondary headaches symptoms

A

precipitated by another condition or disorder
origins include:
trauma, injury, drug induced, psychiatric
require referral

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19
Q

Questions to ask when examining headaches

A
  • Location and spread of pain?
  • Speed of onset?
  • Duration? If headache does not improve or
    resolve over 1-2 weeks, refer (unless
    tension headache)
  • Intermittent or constant
  • Frequency? P resent on awakening may be serious but need further history
  • Severity? (pain scale) - If progressively getting
    worse or non-responsive, refer.
  • Other Symptoms
  • Aggravating or relieving factors → Establishing pattern to onset of headaches
    can show cause and recognise trigger
    factors.
  • Food, exercise, light, menstruation, fatigue,
    drugs e.g. oral contraceptives in migraine.
  • Guide to severity: Impact on daily living: Social, emotional and psychological impact?
    Medication?
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20
Q

HOW DOES the location of pain affect the headache? e.g. frontal, occipital, hemicranial, orbital, or temporal?

A

FRONAL - idiopathic headache, sinusitis, nasal congestion

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21
Q

HOW DOES the location of pain affect the headache? occipital

A

tension, anxiety (especially if pain radiates over the top and sides of head)

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22
Q

HOW DOES the location of pain affect the headache? hemicranial

A

migraine, sinusitis, shingles, trigeminal neuralgia etc

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23
Q

HOW DOES the location of pain affect the headache? orbital

A

sinusitis, migraine, shingles, pain from within the eye

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24
Q

HOW DOES the location of pain affect the headache? temporal

A

temporal arteritis (over 50 years, and sensitivity to touch on temples)

25
Q

sinus headache = pain where

A

behind brow bone / cheekbones

26
Q

cluster headache = pain where

A

pain in and around one eye

27
Q

tension headache = pain where

A

like a band squeezing the head
-> often a constant / nagging pain

28
Q

migraine headache = pain where

A

pain/nausea and visual changes are typical of classic form

29
Q

details of a migraine

A
  • characterised by unilateral, moderate - severe, throbbing pain
  • builds up over minutes - hours
  • usually occurs every few weeks
  • sensitivity to light and sound
  • limits daily activity/disabling
  • with or without aura
    theory: related to dilation of blood vessels within or around skull
30
Q

what does ‘aura’ mean - headaches

A

visual symptoms, sometimes sensory and speech disturbances
- usually disappears within an hour: followed by severe headache lasting 4-72 hrs

31
Q

characteristics of a tension headache

A
  • episodic or chronic
  • bilateral pain, generalised ache, tight band around head spreading to the top of the head
    theory: muscle spasm in neck & scalp/tension in muscles resulting in constricted capillaries, reducing blood flow = lack O2
32
Q

migraine vs tension headache:

A

migraine:
- mod-severe pain
- usually unilateral
- pulsating
- aggravated by normal activities
- often accompanied by symptoms: sensitivity to light N+/-V

tension:
- mild-moderate pain
- bilateral
- non-pulsating
- not aggravated by normal activities
- usually no symptoms. like the migraine ones

33
Q

cluster headache traits:

A
  • severe, unilateral pain within and above eye/temporal region
  • 15mins-3hours
  • occurrence: once every other day - 8 times a day (with circadian rhythm)
  • can occur same time of the day / clusters at same time each year
  • associated with autonomic symptoms e.g. lacrimation, rhinitis, facial sweating, sense of restlessness etc
34
Q

what are some other types of headaches

A
  • chronic
  • med overuse ones
  • secondary
  • new daily persistent ones
35
Q

what makes a headache ‘chronic’

A
  • 15=/+ days headache per month for 3 months
  • most result from the transformation of an episodic headache disorder
    should refer
36
Q

what’s a medication overuse headache

A

2ndary headache
- exaggerated response of receptors that are more frequent or potent analgesics do not stop
- vicious cycle
- usually due to analgesic overuse causing an inc in number of pain receptors switched on.

37
Q

refer to notion notes on: what a secondary headache is, and what to do when acting as a pharmacist for headaches

A
38
Q

what’s a new daily persistent headache

A
  • acute sudden onset ‘out of the blue’
  • occurs everyday after it starts: unremitting
  • may newly present in children and adults
  • often mimics clinical features of tension or migraine headache
  • often mild/moderate and doesn’t impact daily activities
39
Q

options for management of pain

A
  • rule out referral
  • remove causative factors
  • non drug therapy e.g. massages. acupuncture
  • stop analgesia
40
Q

med overuse headaches NICE guidance - 2012

A

1/50 = due to med overuse
- stop cold turkey all headache meds for a month
symptoms = worse before improving
some combos are bad and cause the headaches e.g. paracetamol, aspirin, or nsaid either alone or in combination for at least 15 days per month for over 3 months

41
Q

types of headache treatments - for details on all, check notion

A
  • opioid and non-opioid analgesics
  • antimigraine drugs
  • balance caffeine excess or withdrawal can cause headache
  • herbal supplements
42
Q

Describe the diagnostic signs of cold sores and mouth ulcers:

A
  • located around the mouth (nose less common)
  • Prodromal symptoms– Skin itches, burning, pain, tingling
    – 6-48 hours before
  • Skin eruption (10-14 day process)
    – Blister or vesicle
    – Fluid filled & appear anywhere on face
    – burst, Crust over into a scab, dry up, itchy, sore, red (24 hours)
    – Skin heals (7-10 days)
43
Q

cold sore differential diagnosis conditions - notion = more detail

A
  • impetigo
  • angular cheilitis
44
Q

contraction of cold sores:

A

virus particles pass to uninfected person via direct contact, and it then infects epidermal and dermal cells

→ after initial infection, sensory ganglia, then moves to dorsal root ganglia of the trigeminal nerve where it lies dormant in a latent state

  • activated or triggered by factors personal to the patient

→ once activated, moves from sensory ganglia to the outer layer of skin & the cold sore lesion apears again.

45
Q

cold sores epidemiology:

A
  • a viral infection (herpes simplex virus)
  • mainly HSV1<90% (HSV2 is genital herpes)
  • highly contagious, some have the virus but don’t manifest infection tho
46
Q

cold sores triggers for re-presentation:

A
  1. viral infection e.g. common cold
  2. menstruation
  3. dental/surgical procedures
  4. immunosuppression
47
Q

cold sores general advice:

A
  • look at triggers
  • hygiene is vital
  • no sharing/contact avoidance
48
Q

cold sores – referral criteria

A
  • when it lasts longer than 14 days
  • if symptoms worsen (e.g. lesion spreads, new ones develop, or persistent fever or difficulty taking fluids)
  • if no significant improvement is seen after 5-7 days
  • located anywhere else than the lips, e.g. mouth
  • widespread or very large
  • immunocompromised patients
  • frequently recurs
49
Q

treatment for cold sores usually=

A

gels / creams - on notion

50
Q

how many MAIN types of mouth ulcers are there

A

3

51
Q

the 3 main types of mouth ulcers are?

A
  • minor (Aphthous ulcers)
  • major (Aphthous ulcers)
  • herpetiform
52
Q
  • minor (Aphthous ulcers)
A

Very common – representing 75-85% of aphthous ulcers
Round or ovoid , grey-white in colour, lesions inside the mouth
Affect Non-Keratinized Mucosa (more delicate areas), e.g. Cheeks, tongue, inside lips
Small (diameter 2-4mm), shallow with clearly defined rim Very Painful – may impact eating and drinking
Can occur in groups of up to six ulcers at a time.
Usually heal within 7-10 days with little or no scarring.

53
Q

Mouth Ulcers: Aphthous ulcers – major

A
  • Less common – representing 10-15% of aphthous ulcers.
  • Diameter of 1-3cm
  • Longer duration – 10days – 6weeks or longer.
  • Significant Pain and dysphagia.
  • Can occur in groups of up to 6 ulcers
  • Can occur on any oral site including the palate and dorsum
    of the tongue.
  • More common in immunosuppressed, e.g. Patients with HIV.
  • Refer
54
Q

Mouth Ulcers: Herpetiform ulcers

A
  • Uncommon
  • Present as multiple “pinhead-sized” ulcers which come together to form a larger area of ulceration.
  • Very painful
  • Can involve any oral site including palate and dorsum
    of tongue.
  • > 10 days to heal.
  • Frequently recurrence may make ulceration seem constant.
  • More common in females, and later age onset
  • Refer
55
Q

Outline the main causes and triggers for these ulcers

A
  • cannot be passed from person 2 person: mainly unknown/often recurrent
  • some examples = genetics, stress, trauma, nutritional deficiencies, stopping smoking, etc… not all known
  • can occur with all ages, but freq and severity reduce with increasing age
56
Q

Compare the main drug treatments and essential non drug advice that should be given for mouth ulcers

A

main treatments:

  • gels, pastes, mouthwashes, liquids, pastilles
  • protective bases
  • antibacterials e.g. benzalkonium
  • local analgesic e.g. choline salicylate, or bonjela gel to the ulcer

patient advice:

  • wash hands before and after treatment
  • frequent application
  • avoid certain foods e.g. acidic, salty, spicy (worsens pain)
  • use soft toothbrushes, and certain tooth pastes
57
Q

mouth ulcers referral criteria

A
  • 14 days - 3 weeks + (must refer)
  • left a scar or elsewhere on the body
  • irregular shaped ulcers
  • multiple in mouth / one big
  • ulcer caused by major trauma
  • located towards back of mouth
58
Q

mouth ulcers differential diagnoses conditions - details on notion

A
  1. oral malignancy
  2. aphthous-like ulcers
  3. primary oral herpes simplex
  4. adverse drug reactions
  5. chicken pox or hand foot and mouth

PHAY 1 (6 decks)

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