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Medicine II > sjogren's syndrome > Flashcards

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
Q

most prevalent side effect reported by patients receiving radiation therapy for head and neck cancer

A

xerostomia

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26
Q

mucositis

A
  • 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
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27
Q

oral bleeding

A

decreased platelets and clotting factors are frequently associated with the effects of chemotherapy and bone marrow transplantation

28
Q

a significant cause of death in immunosuprssed patients is oral infection

A

mucositis ?

29
Q

consequences of salivary hypofunction

A

increased infection
loss of remineralizatoin
decreased lubrication

30
Q

increased infection from salivary hypofunction

A

salivary gland infections, swellings, sialotliths, candidasis, periodontal disease

31
Q

loss of remineralization from salivary hypofunction

A

dental caries erosion

32
Q

decreased lubrication from hypofunction

A

trouble speaking and swallowing

33
Q

taste buds

A

need saliva to solubilize chemicals in food

34
Q

lubrication

A

mastication, swallowing, and speech

35
Q

what glands are the first to be affected by radiation

A

serous glands like parotid glands

36
Q

mucous is thick and viscous saliva

A

patients with sjorgren’s feel that they have lots of saliva in their mouth

37
Q

candidiasis

A

35% in autoimmune vs. 4% peer controls

38
Q

candida can penetrate deep into the tissue and bother nerve endings causing

A

burning sensation and irritated mucosa

39
Q

niastatin

A

medicine for candidasis, full of sugar so may cause caries

40
Q

angular cheilitis

A

chapped lips at the angle of the mouth

41
Q

sialoliths can lead to

A

retrograde infection

42
Q

protective factors in the mouth that remineralize

A

saliva, fluoride, chlorhexidine and other antimicorbials, calcium phosphate

43
Q

pathological factors that demineralize

A

saliva hypofunction, acid producing bacteria, frequent consumption of fermentable carbs and acidic drinks, GERD

44
Q

loss of saliva can lead to

A

demineralization

45
Q

post radiation therapy contains what 2 bacteria in the mouth

A

s. mutans + lactobacillus

46
Q

acid erosion is common from diet and

A

GERD

47
Q

red palate is seen in

A

GERD

48
Q

acid erosion caused by

A

sipping fruid drinks and eating acidic fruit with a dry mouth

49
Q

osteoradionecrosis is caused by

A

radiation tx

50
Q

trismus

A
  • secondary to surgery
  • fibrosis due to radiation therapy effect on masticatory muscles
  • occurs 6 mos post RT
51
Q

treatment for mucositis

A

stretching exercises, mechanical devices like therabite, saliva flow stimulants

52
Q

stimulate flow of saliva

A

xylitol gum
salagen
evoxac (take w/ food)

53
Q

pilocarpine effect on unstimulated parotid flow

A

given 1 hr prior to radiation may spare some salivary gland tissue

54
Q

percent of oncology patients that stop fluoride tray tx

A

70%, time consuming and reminds them of their cancer

55
Q

high fluoride toothpastes

A

1.1% , enamel pro, controlRx, Oral B neutraCare, PreviDent

56
Q

duraphat

A

high potency sodium fluoride varnish

57
Q

artificial saliva

A
  • duration of effect is short
  • do not provide same protective roles as saliva
  • removed during swallowing
58
Q

examples of artificial saliva

A

caphosol and neutrasal

  • 1 box has 30 doses
  • 1 dose is 2 ampules mixed together
59
Q

caphasol reduces the amount of ….intake

A

morphine

60
Q

other tx for mucositis

A

magic mouthwash

gelclair-oral gel for pain relief and oral lesions, no eating or drinking after one hour after use

61
Q

frequent use of what can paralyze vocal cords and interfere with swallowing

A

magic mouthwash, or gelclair-lidocaine

62
Q

biotene

A
  • does not have abrasives and irritans so is good to use toothpaste during tx
  • xylitol gum helpful in stimulating saliva without increasing caries
63
Q

MI paste

A

paste with lots of calcium and phosphate

64
Q

lubricants

A

vitamin E, borage seed oil, oil pooling

65
Q

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

A

fluroride varnish before any tx

  • no big sips of water
  • dental visit every 3 mos

Medicine II (8 decks)

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