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sjogren's syndrome Flashcards

1
Q

sjogren’s syndrome

A

a chronic, autoimmune, inflammatory disorder of exocrine glands, characterized by diminished lacrimal and salivary gland secretion in association with autoantibody production or a CT disorder

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2
Q

epidemiology of sjogren’s syndrome

A
  • one of the most common autoimmune rheumatic disease–9:1 ratio of women:men
  • 1-4 million individuals affected in USA
  • typical diagnosed patient in perimenopausal or postmenopausal female
  • documented pediatric cases exist
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3
Q

ACR criteria

A
  • positive sjogren’s specific antibody (Ro or La)
  • positive lip biopsy
  • positive eye test
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4
Q

signs + symptoms of sjogren’s

A
  • asymptomatic or complain of dry mouth
  • hoarse voice
  • may experience trouble eating/chewing/speaking/ swallowing or taste sensation
  • frequent need to sip water while eating dry food
  • awakening at night with oral dryness
  • difficulty in wearing oral prostheses
  • sore and painful mouth
  • pain in the ear due to blocked parotid glands
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5
Q

Sjogren’s syndrome associated with

A

GERD

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6
Q

as dry as a desert.. severe mucosal problems have a moderate to severe impact on a patient’s quality of life

A

-tongue fissuring occurs but creates spaces for microorganisms to reside

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7
Q

complications from radiation

A 
taste loss
mucositis
hyposalivation
radiation caries
susceptibility to osteoradionecrosis
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8
Q

door to all systemic infections

A

mucositis

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9
Q

mucositis

A

painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually an adverse effect of chemotherapy and radiotherapy

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10
Q

chemotherapy mechanism

A 
initiation
upregulation
signaling and amplification
ulceratoin
healing
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11
Q

reactive oxygen species

A

ROS created after radiation and chemo

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12
Q

outcome of chemotherapy

A

intact epithelium
tissue “appears” normal
residual angiogenesis
tissue you start with is NOT the tissue you end with

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13
Q

ibrutinib

A

med for leukemia

-complication; virus was activated and led to ulceration of the tongue

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14
Q

treatment duration

A

injury starts on day 1 of cancer therapy

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15
Q

acute oral toxicity

A

pain, mucositis, salivary and taste loss, infection

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16
Q

long term oral toxicity

A

pain, infection, tissue necrosis, caries, periodontal disease, candida, trismus, swallowing and speech problems

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17
Q

before treatment

A
  • consult the oncologist

- determine hematologic status within 24 hrs of tx (plateley count, clotting factors, absolute neutrophil count

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18
Q

use prophylactic antibiotic treatment if

A

-patient has catheter or ports, low absolute neturophil count

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19
Q

platelet count

A

can treat patients with count as low as 50-80,000

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20
Q

WBC count

A

can treat as low as 1000 with antibiotic coverage

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21
Q

indications for extractions

A
  • dental nonrestorable carious lesions
  • active periapical disease (not if chronic or well localized) symptomatic teeth
  • moderate to advanced periodontal disease
  • lack of opposing teeth
  • compromised hygiene
  • partial impaction/incomplete eruption
  • bifurcation involvement
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22
Q

after radiation tx, avoid

A

invasive surgical procedures like extractions and periodontal surgery

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23
Q

if an invasive procedure is required, use

A

hyperbaric oxygen therapy before and after surgery is advised

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24
Q

complications of systemic therapies in oral cavity

A

xerostomia
mucositis
oral bleeding
increased dryness and erythema

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25
most prevalent side effect reported by patients receiving radiation therapy for head and neck cancer
xerostomia
26
mucositis
- extremely painful often requiring morphine - a painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy tx of cancer
27
oral bleeding
decreased platelets and clotting factors are frequently associated with the effects of chemotherapy and bone marrow transplantation
28
a significant cause of death in immunosuprssed patients is oral infection
mucositis ?
29
consequences of salivary hypofunction
increased infection loss of remineralizatoin decreased lubrication
30
increased infection from salivary hypofunction
salivary gland infections, swellings, sialotliths, candidasis, periodontal disease
31
loss of remineralization from salivary hypofunction
dental caries erosion
32
decreased lubrication from hypofunction
trouble speaking and swallowing
33
taste buds
need saliva to solubilize chemicals in food
34
lubrication
mastication, swallowing, and speech
35
what glands are the first to be affected by radiation
serous glands like parotid glands
36
mucous is thick and viscous saliva
patients with sjorgren's feel that they have lots of saliva in their mouth
37
candidiasis
35% in autoimmune vs. 4% peer controls
38
candida can penetrate deep into the tissue and bother nerve endings causing
burning sensation and irritated mucosa
39
niastatin
medicine for candidasis, full of sugar so may cause caries
40
angular cheilitis
chapped lips at the angle of the mouth
41
sialoliths can lead to
retrograde infection
42
protective factors in the mouth that remineralize
saliva, fluoride, chlorhexidine and other antimicorbials, calcium phosphate
43
pathological factors that demineralize
saliva hypofunction, acid producing bacteria, frequent consumption of fermentable carbs and acidic drinks, GERD
44
loss of saliva can lead to
demineralization
45
post radiation therapy contains what 2 bacteria in the mouth
s. mutans + lactobacillus
46
acid erosion is common from diet and
GERD
47
red palate is seen in
GERD
48
acid erosion caused by
sipping fruid drinks and eating acidic fruit with a dry mouth
49
osteoradionecrosis is caused by
radiation tx
50
trismus
- secondary to surgery - fibrosis due to radiation therapy effect on masticatory muscles - occurs 6 mos post RT
51
treatment for mucositis
stretching exercises, mechanical devices like therabite, saliva flow stimulants
52
stimulate flow of saliva
xylitol gum salagen evoxac (take w/ food)
53
pilocarpine effect on unstimulated parotid flow
given 1 hr prior to radiation may spare some salivary gland tissue
54
percent of oncology patients that stop fluoride tray tx
70%, time consuming and reminds them of their cancer
55
high fluoride toothpastes
1.1% , enamel pro, controlRx, Oral B neutraCare, PreviDent
56
duraphat
high potency sodium fluoride varnish
57
artificial saliva
- duration of effect is short - do not provide same protective roles as saliva - removed during swallowing
58
examples of artificial saliva
caphosol and neutrasal - 1 box has 30 doses - 1 dose is 2 ampules mixed together
59
caphasol reduces the amount of ....intake
morphine
60
other tx for mucositis
magic mouthwash | gelclair-oral gel for pain relief and oral lesions, no eating or drinking after one hour after use
61
frequent use of what can paralyze vocal cords and interfere with swallowing
magic mouthwash, or gelclair-lidocaine
62
biotene
- does not have abrasives and irritans so is good to use toothpaste during tx - xylitol gum helpful in stimulating saliva without increasing caries
63
MI paste
paste with lots of calcium and phosphate
64
lubricants
vitamin E, borage seed oil, oil pooling
65
what should you do first in a patient who is a young female, history of smoking, B cell lymphoma on left tonsil, scheduled for therapeutic radiation and hemopoetic stem cell transplant
fluroride varnish before any tx - no big sips of water - dental visit every 3 mos

Medicine II (8 decks)

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