Special Needs Patients pt 1 Flashcards
Diabetes Mellitus Type I
- Prevalence in pediatric population?
- Cause?
- Peak onset>
- Susceptibilty?
- 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
Diabetes types I : twin studies demonstrate?
- coinfection? or environmental changes?
- Chromosomal anomalies with increased risk?
- Increased risk for what diseases?
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
Signs and symptoms of Diabetes type I
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
Blood glucose fasting and random test values for diabetes type I?
fasting >120mg/dL
random >200mg/dL
Type II DM :
- What is it?
- Prevalence in children?
- Risk factors?
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
Physical symptoms of DM type II
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
Acanthosis Nigricans:
- what is it?
- Assoc w/?
- where is it found?
Acquired or inherited pigmentation skin
- assoc w/diabetes, obesity, other endocrine disorders malignancies,
- sites: flexural places (knees, neck, elbows), lips
Metformin: what does it do?
Metformin reduces hepatic glucose production and increases insulin sensitivty
Diabetes : oral manifestations?
- 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)
Localized Juvenile Spongiotic GIngival hyperplasia:
- what is it?
- Origin?
- Cause?
- Age/gender/race
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
Periodontitis in children:
- Prevalence in the US?
- Risk factors?
- Relationship to DM 1 and 2?
- nutrition?
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
GERD: prevalence? peak age? symptoms?
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
Signs and symptoms of GERD
Chronic heartburn, acid regurgitation, vomiting, belching, painful swallowing, chronic sore throat, sour taste, wheezing, poor appetite, halitosis, oral ulcers/erosion, dental erosion
Causes of GERD: physical? Meds? etc?
Anatomic factors, angle, hiatal hernia
- Medicines: theophylline, almotriptan- migraine meds, bisphosphosphonates), obesity, overeating, late night eating, greasy foods, etc
Lifestyle treatments, medicines and foods to avoid for GERD, possible consequences of treatment?
- 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)
Surgical tx for GERD and inications for sx
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
Dental considerations for GERD
- Children w/ GERD have increased risk of erosion
- Higher salivary micro-organism colonization in GERD children increases caries risk; INCREASED BACTERIAL LOAD
- Consider evaluation for GERD when dental erosion is present in asymptomatic children
- Do not brush after vomiting
Prevalence of Anorexia, bulimia? ED-NOS?
Gender?
Anorexia : 1% Bulimia Nervosa 1-4%
50% of all teens w/ED
90% are female
Oral signs/symptoms of eating disorders
- Sore throat, painful swallowing
- palatal erythema, ulcers, petechiae
- Angular cheilitis +/- xerostomia
- Dental erosion, tooth sensitivity, mucosal palor
- nutritional deficiencies, osteopenia, uni/bilateral parotid enlargement
Russell’s Sign?
Chapped/calloused fingers from vomiting
Anorexia nervosa: prevalence? genetics? Consequences? Most common cause of death? Prognosis? Mortality rate?
- 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
Bulimia nervos: prevalence by gender? diagnostic criteria? prognosis? Major complications? Mortality rate?
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
Treatment for ED pharma?
- SSRI’s (fluoxetine)
- Sodium bicarbonate and water mouth rinse to neutralize gastric acids
Gastric Feeding Tubes: population in need of them? oral findings?
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
Children w/HIV worldwide and in the US? Maternal transmission?
- 5 million worldwide; 3,000 children
- HAART therapy has reduced maternal transmission to less than 1% in the US (6000 pregnant HIV+)
HIV general info: virus type? targets? what occurs to the immune system?
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
Pediatric HIV Sources and risk potential where applicable
Perinatal transmission (risk potential 25%)
- postnatal transmission from breastfeeding and pre-mastication of foods
- Blood products
- IV drug abuse
- Unprotected sexual activity
- Child abuse
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
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%)
When to treat HIV?
Asymptomatic or mild symptoms and CD4 350 and viral load of >100,000 copies/uL
Pediatric HIV Oral disease: oral lesions- prevalence? significant for? typical etiology?
- 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
Dental considerations : Cell counts?
Neutropenia : 10% in asymptomatic kids, 50% w/AIDS
Anemia : 20-80% during course of disease
Thrombocytopenia: 10% during course of disease
Oral manifestations of HIV infection in children?
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
Linear gingival erythema
- 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
Hairy Leukoplakia: looks like? occurs w/? due to? mortality?
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
Apthous stomatitis : prevalence? Cause? factors? site?
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
Treatment for apthous ulcers?
Pain mgmt : topical anesthetics
- Ulcer mgmt: triamcinolone .1% paste
Fluocinonide .05% gel
clobetasol, dexamethasone, beclomethasone, prednisone, thalidomide
An oral disease that has increased with HAART and improvement in HIV symptoms?
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
Molluscum Contagiosum
Common viral infection for HIV/immunocompromised patients that mimics warts
Cancer in Children w/HIV
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
Lyphoma in Children w/HIV: prevalence? what are they usually? causes? site? oral site? Tx?
- 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
Kaposi’s Sarcoma : pediatric prevalence? Causes? Oral site? Tx?
- 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
Prevalence of children w/ the criteria for special health care needs? Causes of disability?
13-20% of all US children,
Causes: congenital disorder, acquired disorders (accidents, disease); extreme pre-term birth (<26 weeks)
Asthma: prevalence, leading causes, other influences (meds, physical condition)
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
Pathogenesis of asthma?
- 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)
Mild vs Moderate vs Severe asthma
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
