Week 10 Flashcards
HIV is an virus that attacks the
Immune system
In order to be infected by HIV, the virus must enter a persons
Bloodstream (HIV cannot survive outside the body)
- unprotected sexual intercourse
- shared needles or equipment
- unsterilized needles
- pregnancy, delivery and breast feeding
Occupational exposure in healthcare
Factors that affect the outcome of people with HIV include
-CD4 cell count (lower indicates poor immunity and chances of getting infections that may often turn life threatening)
-Vital load in blood (high number of viable viral RNA in blood is another indicator of poorer prognosis)
-Age of pt
HIV Prognosis: those who have developed a serious HIV related condition before starting the anti-HIV medication are also at a high risk of
Early AIDS progression and death
-concomitant infections with hep B or C virus
- those with liver or heart disease also have a poor prognosis as well
Signs and symptoms of early HIV infection may include
Fever
Chills
Joint pain
Muscle ache
Sore throat
Sweats (particularly at night?
Enlarged glands
Red rash
Tiredness
Weakness
Weight loss
Signs and symptoms of late-stage HIV infection may include
Blurred vision
Chronic dry cough
Fever of above 37C lasting for weeks
Night sweats
Permanent tiredness
Shortness of breath
Swollen glands lasting for weeks
Night sweats
Weight loss
White spots on the tongue or mouth
Esophagitis
Are there any drugs that can cure HIV/AIDS
NO
Although no cure for HIV/AIDS, there are retro antiviral drugs that can
Minimize the amount of HIV infection may the body, help you live longer and stops weakening the immune system
HIV First steps to treatment: your doctor/nurse may ask you to
Do a urinalysis
Test for other STDs
Test for hepatitis, tuberculosis
Liver and kidney function tests
3 main classes of antiretroviral drugs
-Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
-nonnucleoside reverse transcriptase inhibitors (NNRTSs)
-protease inhibitors
A combination of the 3 anti-HIV drugs is also known as a what? It requires constant monitoring, evaluation and testing by your doctor
HIV cocktail
-this combination prevent drug resistance and prolongs the life span of those infected with the disease
Clinical manifestations of HIV: what is commonly one of the first signs of HIV
Inflamed lymph nodes
Acute infection stage or primary HIV infection: Most infected people will suffer from what symptoms within the first couple of weeks of being infected?
Flu like symptoms
-symptoms at this time may be overlooked but the virus within the blood is high and hiv is spread more quickly in this stage
Clinical latent infection of HIV is often referred to as the “asymptomatic stage” virus is still what at this stage? Explain taking meds at this stage
-virus is still alive and reproducing but most people do not suffer from any signs or symptoms
-taking meds at this stage can slow the progression of the virus allowing people to stay in this stage for well over ten years
-not taking medication allows the virus to progress within ten years or sooner as well as lowering CD4 count
Without treatment an individual with AIDS had a life expectancy of
1-3 yrs
-immune system is extremely compromised in aids, body is susceptible to opportunistic infections, CD4 cells fall below 200/mm3 as opposed to 509-1600/mm3 in a healthy person
What Neoplastic lesion is seen in some clients with AIDS
Kaposis sarcoma
-kaposis sarcoma may resemble hematoma, Pyogenic granuloma
Herpes simplex
No clinical difference between herpes on an HIV & nonHIV pt
-sole difference is that recurrent herpes simplex infections may be more common in pts with the HIV disease and may manifest more severely
-usual healing time of herpes is 1-2 weeks without secondary infections. The healing time of herpes lesions often takes much longer in HIV positive clients, becoming more severe and persistent. They can also become secondarily infected by a bacteria or fungi
In an HIV client periodontal disease is not relative to the
Amount of calculus present in the mouth
Hairy leukoplakia and HIV
Becomes more common once the CD4+ T-cell count falls and is one of the first signs of HIV.
-diagnosis of HL is almost always an indication of both HIV infection and immunodeficiency
-can be seen in HIV clients or immunocompromised clients with out HIV
-Important to differentiate with oral candidiasis
Oral condylomas
They occur more frequently and more extensively in people with HIV infection than in those with normal immune function. Especially in patients with advancing immune suppression. Oral warts may be refractory to therapy
Patients with HIV infection often suffer from persistent painful
Aphthous ulcers that commonly occur on the soft palate, buccal mucosa, tonsillar area or tongue
What is lichen planus
Benign chronic disease affecting the skin and oral mucosa
-commonly found on the flexor surfaces of the upper extremities on the genitalia and on the mucous membranes in the oral cavity and other parts of the body
Oral lichen planus description
Presents as white striations, white papules, white plaques, erythema, erosions, or blisters affecting predominantly the buccal mucosa, tongue and gingiva although other sites are occasionally involved
Symptoms oral lichen planus
Ongoing inflammatory condition that affects mucous membranes inside your mouth
-may appear as white, lacy patches, red swollen tissues or open sores
-these lesions may cause burning, pain or discomfort
Clinical manifestations lichen planus
Lesions are typically bilateral. Any location in the oral cavity may be involved with the most common site being the posterior buccal mucosa. Other common locations include tongue, gingiva, Retromolar/tuberosity area, vestibule, palate, floor of the mouth and lip
Reticular form of lichen planus
Most common type
Consists of slightly raised slender whitish lines in an interlocking lace-like pattern called “wickhams striae” this lace like network is often interspersed with papules or rings
Plaque like form of lichen planus
May be difficult to distinguish from leukoplakia but in oral lichen planus there is usually no change in the flexibility of the affected mucosa
-another distinguishing feature may be the presence of a reticular periphery
Erosive / Bullous oral lichen planus
Often presents as erythematous and ulcerative areas surrounded by keratotic striae. Gingival involvement with this form produces desquamative gingivitis
-associated with increased malignancy
Prevalence of oral lichen planus
Chronic inflammatory skin condition affecting about 1-2% of the adult population
-usually affects individuals ranging in age from 13-78 years
-slightly more common in women than men
-affects 50% of patients with skin lichen planus but may occur without skin lesions elsewhere
Treatment of lichen planus
No known cure exists for oral lichen planus
-Trx is indicated when lesions are symptomatic (pt complaining about burning pain)
-antihistamines and corticosteroids medication can help relieve the itching
-in severe cases a prescription of oral corticosteroids (prednisone) may be given to suppress the immune system
Trx of lichen planus medication to alleviate symptoms include
Antihistamines
Topical corticosteroids
Corticosteroid pills
Retinoic acid
Lichen planus prognosis
Chronic disease with no known cure
-lesions may be improved with treatment
-regular oral soft tissue examination and biopsy of any lesions not consistent with lichen planus is recommended
Oral lichen planus differential diagnosis
Oral candidiasis
Leukoplakia
Aspirin burn
Frictional keratosis
Linea alba
Chronic cheek chewing
Pemphigus
Lupus
Cleft lips is repaired with surgery. The surgery is done when
In the first few months of life and recommended within the first 12 months of life
What challenges may a child born with cleft lip have
Feeding
Speech
Appearance
Why does a cleft palate interfere with speech
Children with a cleft palate often experience hearing loss because of middle ear problems
-since children learn a language by hearing it spoken thus can cause a speech delay
-children with clefts should be taken to an audiologist and an ear nose and throat specialist to prevent a speech delay
What is a submucosal cleft
Cleft in the soft tissue and or bone of the palate with a mucus membrane lining the cleft
-may be difficult to notice this cleft, signs of a split or “bifid” uvula can help diagnose a submucosal cleft
Signs and symptoms:
-difficulty feeding, difficulty swallowing, nasal sounding speech
What causes cleft lip / palate
Occurs very early in pregnancy while baby is developing
-exact cause is unknown
-most scientists believe that the condition results from a combination of genetic and environmental factors
There are many potential causes that may be related to cleft lip/ palate which include
Inherited genes
Environmental risks
Smoking
Medications
Alcohol
Obesity and nutrition
Pierre robin syndrome
Environmental risk factors of cleft lip and palate: lack of folic acid during pregnancy
Folic acid is taken to help reduce the possibility of birth defects
Exposure to various toxins during pregnancy such as certain medications, drugs, viruses, smoking and alcohol
A mother who __ during pregnancy may increase babies chance of being born with a cleft palate or lip
Smokes
What medications taken by the mother during pregnancy may cause cleft palate or lip
Anti seizure / anticonvulsant
Acne drugs (accutane)
Methotrexate
Drugs used for cancer , arthritis or psoriasis
What is Pierre robin syndrome
Rare condition where a baby is born with a small lower jaw and tongue which is positioned further back in the mouth
-most infants with this syndrome will also have cleft palate
Cleft palate and lip prevalence
Among the most common congenital anomalies worldwide
-approx 1 case occurs in every 500-550 births
CP & CL prevalence among races
Reported rates for clefts vary widely both within and between geographic areas and for different racial or ethnic groups
-cleft lip and palate occurs in about 1-2 per 1000 births in the developed world
-rates for CL with ir without CP and cleft palate alone varies within different groups
-the highest prevalence rates for CL with or without CO are reported for native Americans, asians and Africans
Key interventions by age: prenatal (in utero)
Referred to cleft lip and palate team
-diagnosis and genetic counseling
-address psychological issues
-provide feeding instructions and feeding plan
- orthodontic intervention to bring upper jaw, lips and palate together
Interventions by age: post natal 1-4 months old
-check feeding and growth
Repair cleft lip
Check ears and hearing, sometimes tubes are placed for draining
Interventions by age 5-15 months old
Check feeding, development and growth
Checkers and hearing and consider ear tubes
Repair cleft palate
Provide OHI
Interventions by age 16-24 months
Assess hearing and ears
Evaluate speech and language
Check development
Interventions by age 2-5 yrs old
Evaluate speech and language; manage velopharyngeal (soft palate doesn’t close during speech and allows air out the nose instead of mouth)
-check ears and hearing
-consider lip and nose revision
-evaluate development and psychomotor adjustment
Interventions by age 6-11 years old
Evaluate speech and language
Ortho intervention
Alveolar bone graft
Evaluate school and psychosocial adjustment
Interventions by age 12-21 years
Jaw surgery, nose surgery as needed
Ortho, bridges and implants as needed
Genetic counseling
Evaluate school and psychosocial adjustment
What is pharyngeal flap surgery used to help
Help with speech and involves muscle tissue from the pharynx to the palate to narrow the nasal opening
Pharyngoplasty
Reduces space behind the palate to help with speech
Several causes of gingival enlargement and can be grouped into four categories which are
Inflammatory
Medication induced
Hereditary gingival fibromatosis
Systemic
Description of gingival enlargement
-free and attached gingiva increases in size especially interdental papillae
-no stippling, gingival margins are rounded
-erythematous to link depending on inflammation and vascularity
-may be generalized or localized- mild or severe covering crowns of teeth
-as the tissue enlarges it develops characteristically thickened and lobulated appearance
In what locations of the dentition is it more common or severe (gingival enlargement)
Tends to be more severe in areas where plaque accumulates (edges of filling and around ortho appliances)
-tendency for ging enlargement to be distributed symmetrically and for the anterior teeth to be more severely affected than posterior
-rarely seen in edentulous areas
Why is gingival enlargement a problem
Impedes effective plaque control
Regularly traps plaque or food
Produces halitosis or suppuration
Cosmetics
Interfere with eating and speech
Impede effective tooth cleaning
Force teeth out of alignment
Triggers / causes of gingival enlargement
Certain meds
Hormonal changes
Local irritants such as calculus and plaque
Certain drugs can trigger gingival enlargement those drugs include
Phenytoin
Cyclosporine
Calcium channel blockers (Nifedipine)
Prevalence of gingival enlargement
Very common
-bc there are so many factors that can contribute it can be found in a lot of people
-very common factor of many types of gingival diseases
Clinical manifestations of gingival enlargement
-No stippling
-Gingival margins bulbous and rounded
-Free and attached gingiva increases in size, especially interdental papillae
-tissue consistency can vary from soft to firm
-appearance may vary from erythematous to a normal pink colour
-may be generalized or localized, covering crowns of teeth
-tissue is inflamed and bleeds easily
Medications to Trx gingival enlargement: erythromycin
Most common drug prescribed
-treat infections caused by certain bacteria
-is a macrolide antibiotic
-works by slowing down the growth of or sometimes killing sensitive bacteria by reducing production of proteins the bacteria need to survive
FYI erythromycin only works against bacteria and will not treat viral infections
What vitamin deficiency plays a huge part in gingival overgrowth
Vitamin C
What is a gingivoplasty
Procedure in which the gum tissue is surgically reshaped and reconfigured for cosmetic, psychological or functional purposes. Gingiviplasty is the surgical reshaping of the outer surface of the gums and it’s usually done in combo with gingivectomy
There are 2 types of the heroes simplex virus, type 1 and 2. Type 1 affects what locations and type 2?
Type 1 affects usually the mouth and lips
Type 2 is a sexually transmitted infection that affects the genitals and rectum
Type 1 herpes simplex virus
Recognized as the “cold sore” which are painful blisters and ulcers around the mouth area
-may experience burning or itching sensation around their mouth
Intraoral herpetic lesion
Usually appears on thick, keratinized tissue of the hard palate or gingiva
-differentiates from aphthous ulcers or canker sores which are most commonly found on the movable mucosa (non keratinized tissue) throughout the mouth
Herpes Trx: acyclovir (Zovirax)
Helps sore heal faster, keeps new sores from forming and decreases pain/ itching sensation around this medication may also help reduce how long pain remains after the sores heal. In addition people with a weakened immune system, acyclovir can decrease the risk of the virus spreading to other parts of the body and causing serious infections
Herpes Trx: Abreva
Cream that shortens healing time like a prescription but without one. When used early it can knockout your cold sore in 2.5 days
Herpes viruses spread most easily from individuals with an active outbreak or sore. You as the clinician can catch this virus if you
Have intimate or personal contact with someone who is infected
-touch an open herpes sore or something that has been in contact with the herpes virus, such as infected razors, towels, dishes and other shared items
-parents can easily spread the virus to their children during regular daily activities
