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ORAL PHYSIOLOGY > Topic 12 (Stress and Anxiety in Dental Treatment) > Flashcards

Topic 12 (Stress and Anxiety in Dental Treatment) Flashcards

1
Q

It is masked by the patient through fainting.

A

Anxiety

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2
Q

But may be manifested by other signs: sleep loss, hunger, pain, excessive analgesic consumption, sweating, palpitation, talkativeness, etc.

A

Anxiety

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3
Q

Anxiety may be manifested by other signs:

A
  • sleep loss
  • hunger
  • pain
  • excessive analgesic consumption
  • sweating
  • palpitation
  • talkativeness
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4
Q

The body reacts in a number of ways when in an adverse or threatening:

A
  1. Anorexia
  2. Over –eating
  3. Gonadal functional disturbance
  4. Disease
  5. Decreased host response
  6. Altered pain sensitivity
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5
Q

Is related to a patient’s fears and phobias, developed mainly as a result of childhood experience.

A

Stress

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6
Q

The physiological responses to emotional stimulation are autonomic and controlled by a complex system involving limbic structures, especially the amygdala, hypothalamus and reticular formation.

A

Stress

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7
Q

The physiological responses to emotional stimulation are ____.

A

Autonomic

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8
Q

The physiological responses to emotional stimulation are autonomic and controlled by ____.

A

Complex System

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9
Q

The physiological responses to emotional stimulation are autonomic and controlled by a complex system involving ____.

A
  • limbic structures
  • amygdala
  • hypothalamus
  • reticular formation.
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10
Q

In stressful situations, these will increase:

A
  • Catecholamine level and adrenal medullary secretion
  • This is the “ flight or fight” reflex
  • Vasodilation of skeletal muscle and coronary arteries
  • Increased cardiac output with increased blood pressure
  • Increased cerebral blood flow
  • Mobilization of sugar from hepatic
    glycogen storage
  • Increased cellular metabolism
  • Increased susceptibility of the cardiac
    ventricular muscle to extra systole or ventricular fibrillation
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11
Q

In stressful situations, will catecholamine level and adrenal medullary increase or decrease?

A

INCREASE

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12
Q

In stressful situations, the “flight or fight” reflex results with vasodilation of skeletal muscle and coronary arteries?

YES OR NO?

A

YES

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13
Q

In stressful situations, the “flight or fight” reflex results will increase or decrease cardiac output with increased blood pressure?

A

INCREASE

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14
Q

In stressful situations, the “flight or fight” reflex results will increase cardiac output with increased or decrease blood pressure?

A

INCREASE

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15
Q

In stressful situations, the “flight or fight” reflex results will increase or decrease cerebral blood flow?

A

INCREASE

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16
Q

In stressful situations, the “flight or fight” reflex results with mobilization of sugar from hepatic glycogen storage?

YES OR NO?

A

YES

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17
Q

From hepatic glycogen storage there will mobilization of ____.

A

Sugar

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18
Q

In stressful situation, the “flight or fight” reflex results with increase or decrease of cellular metabolism?

A

INCREASE

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19
Q

In stressful situation, the “flight or fight” reflex results with increase or decrease of susceptibility of the cardiac ventricular muscle to extra systole or ventricular fibrillation?

A

INCREASE

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20
Q

In stressful situations, the “flight or fight” reflex results with activation of pituitary?

YES OR NO?

A

YES

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21
Q

Activation of pituitary

A

Adrenocortical

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22
Q

In stressful situation, the “flight or fight” reflex results with increase or decrease of 17 hydroxycoticosteroid secretion and glucosteroid secretion?

A

INCREASE

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23
Q

In stressful situation, the “flight or fight” reflex results use and mobilization of fat from storage deposits?

YES OR NO?

A

YES

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24
Q

In stressful situation, the “flight or fight” reflex results with increase or decrease of muscular efficiency?

A

INCREASE

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25
Q

Patients taking steroids or whose adrenal cortices are either dormant or have undergone atrophy as a result of disease or therapy are extremely susceptible to the damaging effects of various stimuli that demand compensatory responses including:

A
  1. Trauma
  2. Hemorrhage
  3. Fasting
  4. Anesthetics
  5. Changes in environment temperature
  6. Therefore, consult with physician OF THE
    PATIENT FIRST
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26
Q

Physical and emotional trauma associated with dental treatment affects:

A

Hypothalamus and Pituitary Activity

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27
Q

Trauma releases ____.

A

Corticotrophin (ACTH)

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28
Q

Trauma releases corticotrophin ( ACTH ) which enhances the production of ____.

A

Adrenocortical Hormones

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29
Q

What hormones is important to accommodate stressful situations.

A

Adrenocortical Hormones

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30
Q

The secretion of ____ is dependent on a neurohormonal substance.

A

Corticotrophin (ACTH)

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31
Q

corticotrophin-releasing factor ( CRF ) which is produced by ____.

A

Thalamus

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32
Q

41-amino-acid peptide stimulates the release of:

A
  1. ACTH
  2. Cortisol
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33
Q

Increase in cortisol starts to increase in the
____ hours.

A

Early morning

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34
Q

In the early morning hours, what starts to increase?

A

Cortisol

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35
Q

Acute trauma stimulates the secretion of:

A
  1. Corticotrophin (ACTH)
  2. B-endorphin / B lipotrophin ( B –LPH )
  3. Prolaction
  4. Vasopressin
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36
Q

Also produces other pituitary hormones: (which may be increased, decreased or unaffected)

A
  1. Growth hormones
  2. Thyrotrophin
  3. Gonadotrophins
  4. Oxytocin
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37
Q

What are the 3 stress hormones:

A
  1. Prolactin
  2. Vasopressin
  3. ACTH (Corticotrophin)
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38
Q

Results from reduced blood pressure

A

Vasopressin

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39
Q

From reduced blood volume (in hemorrhage)

A

Vasopressin

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40
Q

Hypovolemia, common seen in nausea and hypoxia

A

Vasopressin

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41
Q

From emotional trauma, pain, various drugs including anesthetic agents

A

Vasopressin

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42
Q

But secretion is inhibited by catecholamines and alcohol

A

Vasopressin

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43
Q

Hypovolemia, common seen in ____ and ____.

A

Nausea and Hypoxia

44
Q

Vasopressin secretion is inhibited by ____ and ____.

A

catecholamines and alcohol

45
Q

It is released in response to all noxious stimuli

A

ACTH (corticotrophin)

46
Q

if this is released, ADRENOCORTICAL steroid is produced.

A

ACTH (corticotrophin)

47
Q

If ACTH (corticotrophin) is released, what is produced?

A

ADRENOCORTICAL steroid

48
Q

Physical stress results in:

A
  1. Increased ACTH
  2. Increased growth hormone
  3. Increased prolactin secretions
  4. Inhibition of thyroid stimulating hormone
  5. Inhibition of luteinizing hormone
  6. Inhibition of follicular stimulating hormone
49
Q

Physical stress results in increased of:

A
  • ACTH
  • Growth Hormone
  • Prolactin secretions
50
Q

Physical stress results in inhibition of:

A
  • Thyroid stimulating hormone
  • Luteinizing hormone
  • fFollicular stimulating hormone
51
Q

These hormones are beneficial because:

A
  1. They increase vascular tone
  2. Increase energy substrate
  3. Slow down the basal metabolic rate
  4. Shunt energy away from temporarily unneeded
    activities
52
Q

In non-stressful conditions the corticosteroids in our blood play an important role in regulating the release of ____?

A

ACTH (corticotrophin)

53
Q

In non-stressful conditions, what steroids are in our blood that plays an important role in regulating the ACTH release?

A

Corticosteroids

54
Q

In non-stressful conditions, the corticosteroids inhibits the secretion of ____ by acting on receptors found in adeno-hypophysis.

A

ACTH

55
Q

In non-stressful conditions, what inhibits the secretion of ACTH?

A

Corticosteroids

56
Q

In non-stressful conditions, Corticosteroids suppress the body’s normal defense mechanisms, preventing the normal responses to trauma, resulting to ____ and ____.

A

tissue damage and threatening homeostasis

57
Q

It suppress the body’s normal defense mechanisms, preventing the normal responses to trauma, resulting to tissue damage and threatening homeostasis

A

Corticosteroids

58
Q

ACUTE STRESS, even without trauma, can also produce a transient change.

A

Haemostatic Response

59
Q

ACUTE STRESS, even without trauma, can also produce a transient change ( a few hours ) in the hemostatic mechanism, including:

A
  1. Thrombocytosis
  2. Increased clotting activity
  3. Increased plasminogen activator activity
60
Q

In the following days after injury, the hemostatic mechanism changes to hemostatic security.

A

Haemostatic Response

61
Q

Platelet count increases, platelet adhesiveness increases, increase in plasma fibrogen, and formation of thrombin and fibrin occurs.

A

Haemostatic Response

62
Q

In the following days after injury, the hemostatic mechanism changes to ____.

A

Hemostatic security

63
Q

In heamostatic response what were the things that increases and what formation occurs?

A
  • Platelet count increases
  • Platelet adhesiveness increases
  • Increase in plasma fibrogen
  • formation of thrombin and fibrin occurs.
64
Q

What happens during anxiety?

A
  • Elevated heart rate
  • Increased BP
  • Increased forearm blood flow during emotional stress
  • Increased palm sweating
  • Decreased saliva secretion
  • If associated with anger and aggression, increased
    noradrenaline and adrenaline production and free fatty acids are increased associated with increase coronary artery narrowing due to plaque deposition.
  • If not associated with anxiety, fear or aggression causes raised adrenaline levels, with no vascular changes.
65
Q

During anxiety for defensive patients, will the secretion of saliva be increased or decreased?

A

DECREASE

66
Q

During anxiety for aggressive patients, will the secretion of saliva be increased or decreased?

A

INCREASE

67
Q

If associated with anger and aggression, there will be and increased of ____ and ____.

A

noradrenaline, adrenaline production

68
Q

If associated with anger and aggression, there will be an increased or decreased of noradrenaline and adrenaline production?

A

INCREASE

69
Q

If associated with anger and aggression what were the things that increased?

A
  • noradrenaline
  • adrenaline production
  • free fatty acids are increased associated
  • with increase coronary artery narrowing
70
Q

The increase of coronary artery narrowing is due to ____.

A

Plaque Deposition

71
Q

If not associated with anxiety, fear or aggression causes raised of ____, with no vascular changes.

A

adrenaline levels

72
Q

Feelings of anxiety may often be translated to physiological manifestations:

A
  1. Changes in facial expression
  2. Trembling
  3. Palmar sweating
  4. Cold extremities
  5. Pallor
  6. Nausea
  7. Palipations
  8. Diarrhea
  9. Micturition frequency
  10. Breathlessness
73
Q

May be defined as “the development of hypotension and brachycardia associated with typical clinical manifestations of pallor, sweating and weakness“

A

Vasovagal Reactions

74
Q

This results in FAINTING OR SYNCOPE, cerebral ischaemia, loss of consciousness due to sudden severe fall of blood pressure

A

Vasovagal Reactions

75
Q

This results in FAINTING OR SYNCOPE, cerebral ischaemia, loss of consciousness due to sudden severe fall of ____.

A

blood pressure

76
Q

Physiologically, ____ is associated with initial sudden increase in B/P associated with apprehension.

A

Syncope

77
Q

Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension…which stimulates the ____ of the aorta and ____.

A

baroreceptors and carotid sinuses

78
Q

Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension…which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of ____

A

sympathetic tone

79
Q

Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension…which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of sympathetic tone, leading to ____ and ____, specially in skeletal muscles.

A

brachycardia and anterior dilation

80
Q

Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension…which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of sympathetic tone, leading to brachycardia and anterior dilation, specially in skeletal muscles. These changes result in the following:

A
  1. Reduced cardiac output
  2. Fall in total peripheral resistance
  3. Hypotension
  4. Syncope
81
Q

What are the other types of syncope:

A
  1. Carotid sinus syncope
  2. Cough syncope
82
Q

Overbreathing in anxious individuals usually starts insidiously but as rate and depth increases, increased volumes of carbon dioxide are expired through the lungs.

A

Hyperventilation

83
Q

In hyperventilation, there is an increased volumes of ____ are expired through the lungs.

A

Carbon dioxide

84
Q

Overbreathing in anxious individuals usually starts insidiously but as rate and depth increases, increased volumes of carbon dioxide are expired through the lungs. There is an effect:

A
  • Fall in partial pressure of arterial carbon dioxide.
  • Rise in bp resulting in respiratory alkalosis which induces cerebral arteriolar vasoconstriction.
85
Q

Heart rate and cardiac output rise, mark fall in peripheral vascular resistance.

A

Hyperventilation

86
Q

During these episodes , tetany often develops, with facial and lip stiffness, spasm of the hands and feet and increased motor nerve excitability.

The effects appear to be associated with increased blood and tissue fluid calcium ion concentrations.

A

Hyperventilation

87
Q

Numbness and tingling of the extremities, together with the tetanic spasm may further increase patient anxiety levels.

A

Hyperventilation

88
Q

What are the treatment of hyperventilation:

A
  • Carbon dioxide inhalation
  • By breathing into a bag or a paper cup
89
Q

Excess carbon dioxide in the blood

A

Arrhythmias

90
Q

Oxygen deficiency

A

Arrhythmias

91
Q

Reflex sympathetic stimulation

A

Arrhythmias

92
Q

Increased endogenous catecholamine secretion,
rendering the myocardium more excitable

A

Arrhythmias

93
Q

Atropine premedication to decrease saliva production

A

Arrhythmias

94
Q

Vasoconstrictor components of local anaesthetic
solutions, especially if injected directly into a vein

A

Arrhythmias

95
Q

Give the signs and symptoms of nausea

A
  • Excessive saliva production
  • Sweating
  • Increase heat rate
  • Variations in the rate, depth, regulation of
    respiration
96
Q

What stimulates nausea?

A
  • Anxiousness
  • Fear
  • Pain
  • Drugs
  • Hypoxia
  • Stimulation of afferent nerves of the soft
    palate & pharynx
97
Q

It is feeling an urge to vomit.

A

Nausea

98
Q

It is often called “being sick to your stomach.”

A

Nausea

99
Q

It is an act of ejecting matter from the stomach through the mouth.

A

Vomiting

100
Q

Vomiting is associated with:

A
  1. General anaesthesia due to drug reactions
  2. Respiratory obstruction
  3. Hypoxia
  4. Postoperative blood swallowing
101
Q

Happens if there is depression of the level of consciousness, where vomiting may result in laryngeal spasm, and vomitus enters the lungs to result in severe exudative edema and bronchospasms

A

Mendelson’s Syndrome

102
Q

Bronchopneumonia or lung abscess may then follow.

A

Mendelson’s Syndrome

103
Q

3 most important hormonal and neurorhormonal changes are:

A
  1. Secretion of glucocorticoids
  2. Secretion of catecholamines
  3. Secretion of vasopressin
104
Q

It is a potent stimulus for cortisol release

A

Hemorrhage

105
Q

It increase many times above baseline within minutes of onset of hemorrhagic shock.

A

Nor-adrenaline and adrenaline levels

ORAL PHYSIOLOGY (10 decks)

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