Systemic disease in the Elderly Flashcards
What are the effects of ageing on oro-facial tissues?
Atrophy, reduced epithelial thickness, collagen flexibility, innervation, blood supply. which ? predispose to oral discomfort / poor healing ?
What does atrophy of salivary glands or increased drug use predispose to?
Xerostomia.
What does an increase in skin creases predispose to?
Angular cheilitis.
What are the dental aspects of neurological disease in elderly patients?
Pain, sensory loss, facial palsy, drooling, tremor, communication problems, mental/physical impairment, loss of protective reflexes, adverse drug effects
What dental aspects need to be considered in patients with cardiovascular disease?
Dental aspects:
- GA and LA risks
- Effects of anxiety
- Positional breathlessness
- Postural hypertension
- Valve defects
- Pain – usually temporal, rarely tongue pain/ ischaemic necrosis.
What are some potential dental drug interactions in cardiovascular patients?
Miconazole/fluconazole and warfarin/statins.
What are the dental aspects of respiratory disease in elderly patients?
effects of steroid inhalers (candidiasis), systemic steroids (complications, steroid cover needed?), positional breathlessness, GA risks, anxiety
Where does candidiasis related to steroid inhaler present
Affects dorsum of tongue, palate (depapillated with creamy white patch)
How can candidiasis from steroid inhalers be prevented?
Rinse mouth after use and use a spacer device.
What else predisposes pts to candidiasis
smoking
What are the dental aspects of musculoskeletal/bone disease?
- Mobility problems (neck/ back pain and chair positioning)
- TMJ pain/ dysfunction (may also be related to denture problems, missing teeth, lack of denture support)
- Effects of medication (analgesics, anti-inflammatories: oral ulcers, lichenoid reactions. Bisphosphonates: impaired bony healing/ MRONJ)
- Jaw lesions, hypercementosis, post-extraction bleeding, osteomyelitis.
What oral problems are associated with bisphosphonates in musculoskeletal disease?
Impaired bony healing, MRONJ.
What are the dental aspects of genitourinary disease?
- Xerostomia: drugs are the most common cause, pt may also have restricted fluid intake
- Leukoplakia, halitosis/ taste disturbance, bleeding tendency, jaw metastases (prostate cancer), effects of medication (eg bisphosphonates in prostate cancer)
What are the dental aspects of hepatic disease?
Lichen planus, salivary gland swelling/ sialosis, xerostomia, secondary Sjogren’s syndrome, bleeding tendency (severe liver disease)
What are the dental aspects of diabetes mellitus?
Candidiasis, xerostomia, periodontal disease, sialosis, lichen planus.
What oral side effects of medications for diabetes cause orally?
Lichenoid reactions.
What are the dental aspects of connective tissue disease?
xerostomia, salivary gland swelling (can be chronic), candidosis, caries, TMJ arthritis, white lesions (lichenoid/desq ging) ulcers, facial sensory loss, reduced mouth opening (limited dental care) telangiectasia, widening of PDL
What are the effects of medications used to treat connective tissue disease?
Effects of medications: eg NSAIDS, antirheumatics, immunosuppressants
Lichenoid reactions, ulcers, ciclosporin – gingival hyperplasia.
What are the dental aspects of mucocutaneous diseases?
White/red lesions, ulcers, blisters, desquamative gingivitis, risk of malignancy.
dental aspects of mucocutaneous diseases?
Solar keratoses, BCC
Solar keratosis/ actinic chelitis
Risk of SCC if recurrent/ persistent and crusting
Bleeding
Swelling
On lip
Lichen planus
Pemphigoid diseases (mainly MMP)
Pemphigus (p. vulgaris, paraneoplastic p.)
Erythema multiforme
Dental aspects: white/ red lesions, ulcers, blisters, desq ging, blood stained crusting of lips (in erythema multiforme), risk of malignancy
What mucocutaneous condition presents a risk of squamous cell carcinoma (SCC)?
Solar keratosis/actinic cheilitis.
What are common adverse reactions to drugs in elderly patients?
- side effects: undesirable pharmacological effects at the recommended doses
- GIT with NSAIDs - Secondary effects: indirect consequences of pharmacological action of the drug
- Candidosis with use of steroid inhalers - Intolerance: a low threshold to the normal pharmacological action of the drug
- Interactions: effects of drugs prescribed in dentistry on drugs for medical treatment
- Aspirin, metronidazole on anticoagulants
What are common oral adverse effects of drugs on the oral cavitiy?
- Fixed drug eruption
- Contact stomatitis
- Erythema multiforme
- Oral ulceration
- Lichenoid reactions
- Discolouration of mucosa and teeth
- Gingival hyperplasia
- Xerostomia
- Taste disturbances
