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Pediatric Dentistry Boards > Special Needs Patients pt 1 > Flashcards

Special Needs Patients pt 1 Flashcards

1
Q

Diabetes Mellitus Type I

  • Prevalence in pediatric population?
  • Cause?
  • Peak onset>
  • Susceptibilty?
A
  • Most common form of pediatric diabetes at 70%
  • Chronic metabolic disorder caused by absolute deficiency of insulin due to absence or destruction of pancreatic beta cells
  • Peak onset: 10-12 (girls) 12-14 yo (boys)
  • Susceptibilty: genetics, environment, autoimmune factors
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2
Q

Diabetes types I : twin studies demonstrate?

  • coinfection? or environmental changes?
  • Chromosomal anomalies with increased risk?
  • Increased risk for what diseases?
A

60% chance if identitical of both having, not identical 8% share.

  • Environment: viral infection, breastfed has a lower risk
  • Downs, Turner, Klinefelter
  • DM1 has increased risk for Celiac disease and hypo or hyperthyroid disease
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3
Q

Signs and symptoms of Diabetes type I

A

Polyuria, polydipsia, polyphagia

  • weigh tloss, FTT (gluconeogenesis)
  • Ketoacidosis (15-40%): dehydration, ketone breath, acidotic breathing, abdominal pain
  • Immune impairment: recurrent infection and candidiasis
  • Symptoms develop over a short period of time
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4
Q

Blood glucose fasting and random test values for diabetes type I?

A

fasting >120mg/dL

random >200mg/dL

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5
Q

Type II DM :

  • What is it?
  • Prevalence in children?
  • Risk factors?
A

Insulin resistance w/relative deficiency

  • Characterized by hyperglycemia, vascular disease, and neuropathy (burning mouth syndrome)
  • 30% of pediatric diabetes but increasing
  • Risk factors: >10yo obesity family hx, ethnicity, physical inactivity, alcohol/drug use
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6
Q

Physical symptoms of DM type II

A

Increased appetite/thirst

  • Increased urination
  • Fatigue
  • Blurred vision
  • Dry, itchy skin. Tingling or numb extremities
  • non healing skin infections
  • Candidiasis
  • Acanthosis nigricans: cutaneous marker of insulin resistance
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7
Q

Acanthosis Nigricans:

  • what is it?
  • Assoc w/?
  • where is it found?
A

Acquired or inherited pigmentation skin

  • assoc w/diabetes, obesity, other endocrine disorders malignancies,
  • sites: flexural places (knees, neck, elbows), lips
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8
Q

Metformin: what does it do?

A

Metformin reduces hepatic glucose production and increases insulin sensitivty

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9
Q

Diabetes : oral manifestations?

A
  • Increased risk for gingivitis, periodontitis
  • Prolonged infections, candiasis
  • Xerostomia, sialodenosis
  • Delayed wound healing
  • Altered sensation (burning mouth synd), taste issues
  • Odontalgia (microangiopathy)–can increase toothaches because they have small blood vessels that can be occluded
  • Lichen planus and acetone breath (DM 1)
  • Benign migratory glossitis (geographic tongue)
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10
Q

Localized Juvenile Spongiotic GIngival hyperplasia:

  • what is it?
  • Origin?
  • Cause?
  • Age/gender/race
A

Irritation in papilla at gingival margin
Site: sulcular/junctional epithelium especially anterior facial gingiva, esp maxilla
- Cause: unknown not strong bacterial plaque assoc
- Factors orthodontics (15%), tooth eruption, lip incompetence/mouthbreathing
- Do not see a lot of plaque on the teeth, does not necessarily respond to oral hygiene
Age/Gender/Race: 12 yo, F», white

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11
Q

Periodontitis in children:

  • Prevalence in the US?
  • Risk factors?
  • Relationship to DM 1 and 2?
  • nutrition?
A

20% of 14-17 yo have attachment loss of >2mm in 1 or more sites

  • Risk factors: teen who smokes, DM
  • DM1 : 10-15% risk, DM2: increased risk
  • Chronic vitamin C deficiency also risk
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12
Q

GERD: prevalence? peak age? symptoms?

A

Malfunctioning/week lower esophageal sphincter that results in retrograde flow of gastic contents into esophagus

  • Affects 5-7% of population; common in infants
  • Peak age: 1-4 months; most resolve at 8-10 months, chronic reflux if still occur beyong 18 months
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13
Q

Signs and symptoms of GERD

A

Chronic heartburn, acid regurgitation, vomiting, belching, painful swallowing, chronic sore throat, sour taste, wheezing, poor appetite, halitosis, oral ulcers/erosion, dental erosion

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14
Q

Causes of GERD: physical? Meds? etc?

A

Anatomic factors, angle, hiatal hernia
- Medicines: theophylline, almotriptan- migraine meds, bisphosphosphonates), obesity, overeating, late night eating, greasy foods, etc

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15
Q

Lifestyle treatments, medicines and foods to avoid for GERD, possible consequences of treatment?

A
  • Lifestyle: upright until meal digested, eat smaller meals/more often, restrict food choices, no exercise after meal, reduce body weight, elevate head of bed 30 degrees for children >2 yo, eliminate tobacco smoke exposure
  • Foods that aggravate: caffiene, carbonated, chocolate, peppermint, spicy, acidic, fried/fatty, alcohol
  • Meds: antacids, foaming agents (cover stomach contents), H2 receptor antagonist (inhibit acid production), proton pump inhibitors (total acid suppression - can lead to vit D/B deficiencies), prokinetics (strengthens sphincter)
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16
Q

Surgical tx for GERD and inications for sx

A

Fundoplication: wrap fundus around distal part of esophagus, distended stomach compresses on esophagus, curative for 90% of pts
- Indications for sx: failed drug tx (12 wks), complications

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17
Q

Dental considerations for GERD

A
  1. Children w/ GERD have increased risk of erosion
  2. Higher salivary micro-organism colonization in GERD children increases caries risk; INCREASED BACTERIAL LOAD
  3. Consider evaluation for GERD when dental erosion is present in asymptomatic children
  4. Do not brush after vomiting
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18
Q

Prevalence of Anorexia, bulimia? ED-NOS?

Gender?

A

Anorexia : 1% Bulimia Nervosa 1-4%
50% of all teens w/ED
90% are female

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19
Q

Oral signs/symptoms of eating disorders

A
  • Sore throat, painful swallowing
  • palatal erythema, ulcers, petechiae
  • Angular cheilitis +/- xerostomia
  • Dental erosion, tooth sensitivity, mucosal palor
  • nutritional deficiencies, osteopenia, uni/bilateral parotid enlargement
20
Q

Russell’s Sign?

A

Chapped/calloused fingers from vomiting

21
Q

Anorexia nervosa: prevalence? genetics? Consequences? Most common cause of death? Prognosis? Mortality rate?

A
  • 1%; 10:1 female:male ratio
  • Genetic predisposition
  • Amenorrhea, depression, cold hands/feet, headaches, lethargy, dry skin/hair loss, constipation, hypothyroidism, anemia, lekopenia, thrombocytopenia,
  • cardiac disease most common cause of death
  • Prognosis: 50% completely recover, 50% partially recover, w/20% having an ongoing problem.
  • 10-20% morality rate
22
Q

Bulimia nervos: prevalence by gender? diagnostic criteria? prognosis? Major complications? Mortality rate?

A

4% of population. 3% of women and .1% of men
- At least 2x/week for 3 months
-50% recover totally
-30% partially recover
15-20% ongoing problem
-Major complications: depression, suicide, substance abuse, cardiac arrhythmias/arrest, esophageal tears, esophagitis, pancreatitis, seizures,
- up to 3% die of the disease

23
Q

Treatment for ED pharma?

A
  • SSRI’s (fluoxetine)

- Sodium bicarbonate and water mouth rinse to neutralize gastric acids

24
Q

Gastric Feeding Tubes: population in need of them? oral findings?

A

Severe eating problems in 3-10% of children
- Oral findings: poor OH, gingivitis, increased calculus and plaque, increased salivary bacteria, reduced salivary flow, risk of aspiration pneumonia in some children, risk for GERD, delayed tooth eruption, eruption cyst/hemangioma, dental erosion, oral contact aversion, difficulty handling fluids and secretions, nutritional deficiencies

25
Q

Children w/HIV worldwide and in the US? Maternal transmission?

A
  1. 5 million worldwide; 3,000 children

- HAART therapy has reduced maternal transmission to less than 1% in the US (6000 pregnant HIV+)

26
Q

HIV general info: virus type? targets? what occurs to the immune system?

A

Retrovirus : HIV-1 (US), HIV-2 (W Africa)

  • HIV targets cells w/CD4 receptor proteins
  • Primary affects CD4+ helper T lymphocytes
  • Greatly decreased cellular immunity
  • Decreased humoral immunity
27
Q

Pediatric HIV Sources and risk potential where applicable

A

Perinatal transmission (risk potential 25%)

  • postnatal transmission from breastfeeding and pre-mastication of foods
  • Blood products
  • IV drug abuse
  • Unprotected sexual activity
  • Child abuse
28
Q 
Age 1-5 :
- Category 1 CD4 count
- Category 2 CD4 count
- Category 3 CD4 count
Age 6-12 :
- Category 1 CD4 count
- Category 2 CD4 count
- Category 3 CD4 count
A

Age 1-5 :

  • Category 1 CD4 count: 1000 cells/uL (>25%)
  • Category 2 CD4 count: 500-999 (15-24%)
  • Category 3 CD4 count: 500 (>25%)
  • Category 2 CD4 count: 200-499 (15-4%)
  • Category 3 CD4 count: <15%)
29
Q

When to treat HIV?

A

Asymptomatic or mild symptoms and CD4 350 and viral load of >100,000 copies/uL

30
Q

Pediatric HIV Oral disease: oral lesions- prevalence? significant for? typical etiology?

A
  • Most symptomatic children have at least 1 oral lesion (up to 80%)
  • Oral lesions signal decreased immunity and advancing disease
  • infection disease are very common
  • Most neoplasms are EBV driven: lymphoma, leiomyoma, and leiomyosarcoma
  • Immunologic disorders are common
31
Q

Dental considerations : Cell counts?

A

Neutropenia : 10% in asymptomatic kids, 50% w/AIDS
Anemia : 20-80% during course of disease
Thrombocytopenia: 10% during course of disease

32
Q

Oral manifestations of HIV infection in children?

A

Cervical lymphadenopathy and tonsillar hyperplasia
Candidiasis
Angular chelitis
Salivary gland disease: parotitis, xerostomia
Lingear gingival erythema
Necrotizing periodontal disease/stomatitis (2-5%)
Recurrent HSV/apthous ulcers
Varicella zoster infection
Orofacial warts

33
Q

Linear gingival erythema

A
  • Form of atypical gingivitis that is an immunologic response to the virus and w/a secondary candidiasis (looks like primary herpetic gingivostomatits w/lesions primary on the attached gingiva)
  • Not responsive to OH, redness is disproportionate to the amount of plaque
34
Q

Hairy Leukoplakia: looks like? occurs w/? due to? mortality?

A

White patches on the lateral border of the tongue which does not wipe off.

  • occurs w/HIV, topical steroids, lupus and other autoimmune disease
  • Due to expression of latent Epstein-Barr Virus
  • NOT precancerous
35
Q

Apthous stomatitis : prevalence? Cause? factors? site?

A

Pediatric prevalence: up to 15%

  • Cause localized immune dysfunction
  • Factors: trauma, drugs, hematologic disorders, nutritional deficiencies, xerostomia
  • Variants: minor/major/herpetiform
  • Site: primarily affects nonkeratinized oropharyngeal mucosa, esophagus
36
Q

Treatment for apthous ulcers?

A

Pain mgmt : topical anesthetics
- Ulcer mgmt: triamcinolone .1% paste
Fluocinonide .05% gel
clobetasol, dexamethasone, beclomethasone, prednisone, thalidomide

37
Q

An oral disease that has increased with HAART and improvement in HIV symptoms?

A

Oral and Perioral Warts

  • related to immune reconstitution syndrome
  • drug induced side effect: increase in CD4 count and decrease in HIV viral load (when they are getting better they develop these infections)
  • Often has a florid and refractory presentation
38
Q

Molluscum Contagiosum

A

Common viral infection for HIV/immunocompromised patients that mimics warts

39
Q

Cancer in Children w/HIV

A

Prevalence 2% of HIV infected children

  • Viral associated causes: EBV, HHV-8, HPV
  • Types: Non-Hodgkin’s Lymphoma, leiomyosarcomas, leiomyomas, leukemia, lymphoblastic and myeloid, Kaposi’s sarcoma, Hodgkin’s lymphoma, vaginal carcinoma
40
Q

Lyphoma in Children w/HIV: prevalence? what are they usually? causes? site? oral site? Tx?

A
  • Prevalence: s lymphoma
  • Cause: EBV, HHV-8 and immunosuppression
  • Site: 80% are extranodal; GI and CNS
  • Oral site: tonsils, palate, and gingiva
  • Tx: multiagent chemo +/- radiation
41
Q

Kaposi’s Sarcoma : pediatric prevalence? Causes? Oral site? Tx?

A
  • Pediatric prevalence–rare except for Africa
  • Cause: HHV-I and immune suppression
  • Rare vertical transmission, except Africa
  • Red to purple macule or nodule; single or multiple, usually asymptomatic
  • TX: HAART, chemo
42
Q

Prevalence of children w/ the criteria for special health care needs? Causes of disability?

A

13-20% of all US children,

Causes: congenital disorder, acquired disorders (accidents, disease); extreme pre-term birth (<26 weeks)

43
Q

Asthma: prevalence, leading causes, other influences (meds, physical condition)

A

7-10% of children have asthma

  • Leading cause of hospitalizations in children
  • Other influences: Meds like NSAIDS/aspirin; products w/sulfites; obesity: increases risk of asthma, severity and difficulty in controlling ashtma
44
Q

Pathogenesis of asthma?

A
  • Exposure to trigger,
  • Mast cell degranulation to bronchoconstriction (takes 30 min)
  • Decrease in expiratory airflow
  • Progressive shortness of breath
  • Airway inflammation (late phase 8-12 hr later)
  • Bronchial hyper-responsiveness (ultra-late phase days to weeks later)
45
Q

Mild vs Moderate vs Severe asthma

A

Mild (no night, tolerates exercise, wheeze <2 day/wk
Mod (some night, limited exercise, wheeze 2-5 d/week
Severe (frequent night, poor exercise, wheezy erryday

Pediatric Dentistry Boards (23 decks)

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