Systemic Disease Cont. Flashcards
Chronic Obstructive pulmonary disease (COPD)
Chronic airflow limitation/obstruction from lungs not fully reversible. Ex: Bronchitis and emphysema
Bronchitis
Excessive tracheobronchial mucus to cause productive cough w/ sputum production for at least 3 months in at least 2 consecutive years
Emphysema
Presence of permanent enlargement of the air spaces distal to terminal bronchioles with destruction of alveolar walls/septa without obvious fibrosis
Questions to ask pt w/ COPD
How severe? How long have u has it? when were you diagnosis? what meds? does it bother you to recline? will the rubber dam be a prob?
A pt with COPD needs
to monitor vitals, minor vital, low-flow O2 (depends on elevated arterial CO2 levels stimulate breathing)
Congestive heart failure (CHF)
Heart failure - cannot pump enough blood.
Usually >65 yr - complex of symptoms: no actual diagnosis, end stage of many CV diseases
Sign and symptoms of CHF
Fatigue, weakness, ankle swelling (edema), clubbing digits, syncope, angina, breathing difficulties, increased urination at night.
CHF respiratory
Dyspnea, orthopnea, sleep apnea.
“How many pillows slept on?” - Under head, 2 = caution bc cannot lay flat
Shortness of breath (SOB)
Look at respirations - how well chest is expanding, counting respirations, nice breathes, labored, wheezing?
Questions to ask - How many blocks can u walk before tiring? Can you walk 2 flights of stairs w/o having to stop?
Alzheimer’s disease
Memory loss, cognitive decline, behavioral and personality changes.
Dementia
Disorder of cognition that consequently interferes w/ daily functions & results in loss of independence.
Common causes and prevalence of Dementia
Alzheimer/s disease, vascular dementia, Parkinson’s disease.
Increases with age: 65 yo 7%, 85 yo >40%
Cause of Alzheimers
Unknown - most likely involve loss of cholinergic neurons, genetic profisposition contributes to <20% of all cases (not as big of a part of it now)
Ave lifespan after Dx of Alzheimers
8yr - long term care insurance if needed for assisted living
Dental Management of Alzheimers
Knowledge of stage of disease, meds, cognitive abilities of pt - do they have POA or spouse for decision making?
- Pt mild moderate maintain normal systemic organ function/can receive routine dental treatment: as progresses -antipsychotics, antidepressants, anxiolytics used to manage behavioral disturbances. May contribute to xerostomia w/increased risk for caries
Adrenal Glands
Small endocrine glands located bilaterally at superior pole of kidneys
Adrenal medulla and cortex
Functions as sympathetic ganglion & secretes catecholamines (mostly epinephrine)
Secretes secret steroid hormones
Primary adrenal insufficiency
Addison’s disease - caused by progressive destruction of adrenal cortex due to autoimmune disease and chronic infectious disease (TB, HIV, Cytomegalovirus infections, and fungal infections)
Secondary Adrenal insufficiency
Caused by pituitary disease or long-term critical illness
tertiary adrenal insufficiency
Caused by processes that impair function of hypothalamus, most common is chronic use of coticsoteriods
Secondary adrenocortical insufficiency
More common a problem and may be caused my mutual lesion of hypothalamus or pituitary gland, administration of exogenous corticosteroids, and ability to handle stress
Adrenal insufficiency
inability to increase cortisol production w/ stress
Tired, fatigue, weak, orthostatic hypotension, poor healing (increased infection), anxiety, inability to tolerate stress
Maybe from oral steroid use – How much? How often or long?
Alcohol & drug abuse
Diagnosis of substance abuse requires
recurrent use of a substance over the past 12mon w/ subsequent adverse consequences – failure to fulfill major role @ work, school, home, legal problems, persistent interpersonal problems
Alcohol abuse
Missed appointments, alcohol breath,
enlargement of parotid glands & spider angiomas are novices (due to increase in estrogen that is common, in alcoholics due to liver disease but also in
pregnancy due to increase in estrogen – not just liver sclerosis)
• Liver/bone marrow damage, cirrhosis, vit K deficiency, reduced effect of
local anesthetics & benzodiazepines, nutritional deficiencies, candida infections
• Binge drinking (>5 oz/4 hr)
Drug abuse may cause issues/what you should look for
interactions w/ Rx, anesthetic, liver damage, infectious diseases if share needles
Drinking + Smoking = Cancer risk:
▪ excessive drinking =
▪ combination
- increased cancer of mouth, larynx, esophagus
- greatly increases the chance of oral cancer; alcohol can act as irritant & damage cells which could alter DNA changes
Oral complications and manifestations due too drug and alcohol abuse
- Usually more plaque, calculus, caries, gingival inflammation (alcoholics too)
- Cocaine-gingival recession & erosion of facial aspects, Meth mouth-xerostomia, rampant caries, bruxism & m. trismus
(grinding) - Should not provide extensive care until homecare improves
Anema
Reduction of O2 carrying capacity of blood. Most common blood condition in US
Anema is usually associated with
decrease # of circulating RBCs, abnormality in Hb
Anema affects sexes how
Affects F>M, maybe caused by underlying disease especially in M, > 3mil US cases per year
Types of Anemias
Iron deficiency, Folate
deficiency, Hemolytic anemia, Sickle cell anemia
Oral signs or symptoms of Anemia
Pale (pallor), fatigue, low BP, SOB, rapid heart rate
Oral signs: smooth, burning red tongue,
bleeding gums, delayed healing, increase infections
Pagophagia
Craving & chewing ice associated ice associated with iron deficiency, w/ or w/o anemia
Eating disorder
2 major types - F 90% of cases
Anorexia nervosa
Bilimia nervosa
Anorexia nervosa
- What is it?
- Onset
- Mortality rate
- Signs/symptoms
Severe restriction of food intake & weight loss & medical sequelae of starvation
▪ Onset: 14-18yo, rare after 40
▪ Mortality rate: 5-20% by starvation, suicide, electrolyte imbalance
▪ Hair thin/brittle, neck/facial swelling, fainting, irritable, low BP, anemia, osteoporosis, amenorrhea
Bulimia nervosa
- What is it?
- Onset
- Mortality rate
- Oral sign
restriction of food by binge eating à various methods of ridding food (vomit, laxatives, diuretics)
▪ Onset: 20yo
▪ >30% abuse alcohol & stimulants, 1⁄2 have personality disorders
▪ Amalgam restoration are higher than surrounding enamel
Questions to ask when Abnormal bleeding happens?
When did it occur? After extraction? How long did it last? Have you been
diagnosed by a physician? – have appointments in the morning
What is an INR?
international normalized ration – standard measure
Levels/understand INR readings
- 2.0 = takes ~2x as long to clot – On blood thinner (Coumadin, Heparin) = 2.0-3.0
- Score too low= @ risk for blood clot
- Score too high= can experience bleeding issues
- Levels >4.9 considered critical values & increase risk of severe bleeding
Prothrombin time test
measures how quickly your blood clots, if taking blood- thinning medication the PT test will be expressed as a ration (INR)
Cancer causes
1/3 due to tobacco, 1/3 due to poor nutrition, obesity, physical inactivity
What dentists must be aware of when it comes to pt w/ cancer?
type & extent of cancer & prepare for complications (adverse bleeding, side effects of drugs, and infection).
Dentist will treating patients while undergoing various phases of treatment bc increased survival rates
What are the precautions if a pt has cancer?
chemo (immunocompromised), head & neck radiation therapy (xerostomia, mucosal irritation, cervical caries), med consult
What is Epilepsy?
No specific diagnosis but rather term that refers to group of disorders, characterized by chronic & recurrent, paroxysmal changes in neurological function (seizures), altered consciousness, or involuntary movements caused by abnormal & spontaneous electrical activity in brain
Symptoms of epilepsy?
aura (momentary sensory alteration,
unusual smell/vision), irritability, epileptic cry just before (diaphragm spasm), loss of consciousness, m. rigidity, organ transplant on lot of immunosuppressant drugs
Treatment of epilepsy?
Long-term drug therapy (Dilantin, Tegretol), 60-80% achieve complete control, gingival hyperplasia (Dilantin)
• “uncontrolled”: >1-2 seizures/month, med consult, avoid triggers
• “well-controlled”: <1-2 seizures/month, cleared to drive
Dental treatment of pt with epilepsy?
- Complete health history (type, age of onset, cause if known, frequency,
meds, date of last seizure) - Ask if they feel unusually tired? Ask to communicate if they sense seizure coming. Don’t shine light in eyes, may stimulate seizure.
What to do if a pt experiences a seizure in the chair?
1’- protect pt & try to prevent injury, don’t move to the floor instead place chair in supine position, instruments removed, no attempt to restain/hold pt, O2 if necessary, Call 4444
If pt is on medications ask
- medical history= Rx, OTC, herbal, natural, alternative, have pt bring list or all their pill bottles
- What prescribed meds are you currently taking? What self-prescribed (over the counter) meds are you taking? Are you allergic to any meds? Did you take your meds today? – How does the pt appear? Regular MD visits? Trauma?
What are the meds that cause xerostomia?
Antidepressants, antihypertensives, decongestants, sedatives, antihistamines (Benadryl, Sudafed, Tylenol, PM)
Ways to relieve xerostomia?
water, xylitol gum or mints, moisturizing gels, toothpaste, mouthwash, fluoride rinses (no alcohol)
What are true allergies?
itching, hives, rash, swelling, & wheezing
What is drug intolerance?
nausea, vomit, palpitations, not true allergy, & avoid using drug anyway
