Concepts Ii

Front 1

_________ is inflammation of the joint, although it may not always involve a significant degree of inflammation.

Back 1

arthritis

Front 2

________ is an autoimmune disease of unknown etiology that is characterized by SYMMETRIC inflammation of LARGE joints: hand feet, knees. ("innocent by-stander effect", transferred through genetics)

Back 2

rheumatoid arthritis

Front 3

Rheumatoid arthritis occurs more frequently in _______ as a result of hormonal involvement. (male or female)

Back 3

female

Front 4

RA has an interrelationship with infectious agents-viral agent that alters the immune system (IgG) antibodies mediated form with antigens to form ______________.

Back 4

nodules

Front 5

RA is most progressive in the ______ years that may result in permanent crippling and disability. Life expectancy is shortened by 10-15 years in severe RA.

Back 5

early

Front 6

In RA changes in _______ ( inner lining of the joint capsule) such as edema, thickening, and folding occur. Plus marked infiltration of cells capsule _________ and plasma cells (B and T cells)

Back 6

synovium
lymphocytes

Front 7

Enzymatic activity of cells of RA destroys ________. Healling leads to ________ tissue "squeaking wheels"

Back 7

cartilage
granulation

Front 8

20% of Rheumatoid nodules are located in the ______ or ______.

Back 8

elbows
finger joints

Front 9

Type of treatment for RA is ______ to provide comfort because there is no cure for this. Goals are reducing swelling, relief of pain, and stiffness, and stop damage.

Back 9

palliative

Front 10

Drug therapy for RA include ______ used A LOT.

Back 10

Aspirin

Front 11

Other drug therapy of RA
1.aspirin= A LOT…. 5 tablets/ 4X day
2. NSAIDS
ibuprofen=Motrin, Advil,
3.COX 2 inhibitors =
Celebrex/
Vioxx (off the market now)
4. naproxen=Aleve
5. Injectable glucocorticoids- not long term
6. Gold compounds
7. Immunosuppressive= Methotrexate

Back 11

study

Front 12

Oral complications of RA are usually ________ and ________.

Back 12

TMJ involvement (75%)**
anterior open bite

Front 13

Dental management of RA
Short appointments
Allow patient to make frequent position changes for comfort
Sitting or semi supine***
Physical supports such as rolled towels**

Back 13

study

Front 14

_______ needed for joint replacements in RA patients.

Back 14

Pre medication

Front 15

In RA patients, Prolonged bleeding due to NSAIDS
Immunosuppressives may cause _________
Gold salts may cause _________

Back 15

oral ulcerations
stomatitis

Front 16

_______ is a degenerative joint disease and is the MOST COMMON form of arthritis.

Back 16

OSTEOARTHRITIS (OA)

Front 17

________ is the leading cause of disability among the elderly (60+) and affects hips, knees,
feet, spine, hands, TMJ

Back 17

OA

Front 18

Etiology of OA is Unknown,
May be the end result of normal wear and tear on joints over a long period of time,
Genetic predisposition,
Obesity*** leading to overloading of joints

Back 18

study

Front 19

Pathophysicology of OA Articular cartilage becomes _____
Joint ____ after a period
leading to softening of the cartilage
There is:
progressive splitting
and abrasion of cartilage down to the subchondral***bone
The exposed bone becomes “polished” and sclerotic**
New bone forms at:
the margin of _____ cartilage
in the non-weight-bearing part of the joint
This creates “spurs”, often covered by cartilage
This augments the degree of deformity

Back 19

thicker
thins
reticular

Front 20

Complications of OA include More favorable prognosis than RA
Pain
Disability
Has great economic impact:
68 million lost work days per year

Back 20

study

Front 21

Initial symptoms localized to one or two joints

Dull painful swelling of the joints lasting 15 minutes typically in the morning or after inactivity

Heberden’s nodes/Bouchard’s ***-painless bony growths

TMJ symptoms:
Crepitus
Stiffness
Pain during chewing
are signs and symptoms of _____

Back 21

OA

Front 22

Oral complications of _____ includeTMJ involvement= radiographic changes such as decreased joint space
Occasional pain
Crepitus***
Pain upon wide opening***

Back 22

OA

Front 23

Medical management of OA is ___________considered first line of defense
_________ if Acetaminophen is not effective
Narcotics for acute flare ups***
Joint replacements

Back 23

Acetaminophen (Tylenol)
Aspirin or NSAIDS

Front 24

Dental management of arthritis patients may need to obtain bleeding time __________.

Back 24

INR or PT

Front 25

Treatment plan modifications of OA
Dictated by severity of disability
Dictated by TMJ involvement
If severe:
Extensive treatment not needed- removable partial over a fixed bridge
Occlusal splints**
TMJ surgery** may be indicated
Encourage and facilitate oral hygiene with modified hand held devices

Back 25

study

Front 26

A long term complication of RA or OA resulting in the ultimate destruction of the particular joint structure, therefore a _________ is needed.

Back 26

prosthetic joint

Front 27

Made by the ADA and American Academy of Orthopedic Surgeons in 1997:
1.Scientific evidence does not support the need for antibiotic prophylaxis for dental procedures.
2.It is also not indicated for pins, screws, plates or total hip replacement.
3.It is only indicated for high risk patients.

Back 27

study

Front 28

PROSTHETIC JOINT HIGH RISK PATIENTS
Antibiotic premedication is indicated for those who:
* Immunocompromised or suppressed patients:
rheumatoid arthritis, systemic lupus, drug or radiation induced immunosuppression
* Insulin-dependent diabetes (Type 1 diabetes)
* First 2 years after joint replacement
* Previous prosthetic joint infection
* Malnourishment
* Hemophilia

Back 28

study

Front 29

Clinicians consider antibiotic prophylaxis for ALL total joint replacement patients prior to any invasive procedure that may cause bacteremia.
However, patients with pins, plates and screws,*** or otherorthopaedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by Microorganisms

Back 29

STUDY

Front 30

Two thirds of PJI were the result of _____ infections
4.9% caused by _______ of possible oral origin most likely by physiological factors

Back 30

STAPH
STREP

Front 31

________, cephradine, or amoxicillin would be recommended as premed for total joint replacements.

Back 31

cephalexin

Front 32

Prosthetic implants placed to restore esthetics or function
_____ considered at risk for bacterial seeding from oral invasive procedures and _____ require antibiotic coverage.

Back 32

ARE NOT
DO NOT

Front 33

__________
Usually begins:
before age ___
(most commonly between 18 months and 4 years)
Autoimmune disorder
May affect:
only one or a few joints.
Prognosis:
tends to be good
few children develop signs of systemic disease
Prolonged duration of RA in children:
generally leads to stunted growth.

Back 33

juvenile rheumatoid arthritis
6 years old

Front 34

signs and symptoms of JRA
Joint inflammation and damage
Joint stiffness
Muscle and soft-tissue weakness
TMJ more frequently involved
High fever and/or rash
High level of white cells in the blood
Enlarged:****
lymph nodes
liver
spleen

Back 34

study

Front 35

What are the two forms of LUPUS ERYTHEMATOSUS?

Back 35

Discoid Lupus Erythematosus (DLE)
affects the skin
Systemic Lupus Erythematosus (SLE)
which affects multiple systems

Front 36

_______ is characterized by:
chronic erythematous scaly plaques on:
Face
Scalp
ears
it also tends to be more benign

Back 36

Discoid Lupus Erythematosus (DLE)

Front 37

_________ Predominantly affects:
women in childbearing years
5:1(female:male) ratio
Most common and severe among:
Blacks
Hispanics

Back 37

LUPUS ERYTHEMATOSUS

Front 38

Pathophysiology of _______
Antibodies are formed in response to:
antigenic stimulus
The reaction between antigen and circulating antibodies forms:
antigen-antibody complexes
These are deposited in:
a wide variety of tissues
and organs (including the heart)

Back 38

LUPUS ERYTHEMATOSUS

Front 39

Arthritis:
the most common manifestation (76%)
Butterfly rash*** of:
nose
and cheeks
on areas of sun exposure
Recurrent pharyngitis**
Oral ulcerations**
Renal abnormalities
Neuropsychiatric symptoms
Pulmonary manifestations
Cardiac involvement
Pericarditis
Myocarditis
Endocarditis
Coronary artery disease
Valvular abnormalities
Predisposition to IE

are signs and symptoms of ______

Back 39

systemic lupus

Front 40

No cure for _____
Palliative treatment
No sun exposure
Drugs used
aspirin
NSAID’s
antimalarials
glucocorticosteroids

Back 40

SLE

Front 41

Oral lesions*** of lips and mucous membranes 5-25% of the time
Resemble lichen planus or leukoplakia****
Xerostomia
Hyposalivation
Dysgeusia and glossodynia (burning or painful tongue)
Occur mainly
due to exposure
to the sun***
oral manifestations of _______

Back 41

SLE

Front 42

1.Consultation with physician to establish:
Patient stability
Extent of systemic manifestations
2. Drug considerations:
Aspirin and NSAIDS-increased bleeding
Gold Salts- stomatitis
3. No need for antibiotic prophylaxis due to cardiac abnormalities in patients with SLE unless they have had a heart valve replacement
dental management of SLE

Back 42

study

Front 43

________ is a Autoimmune disease classified with the rheumatic diseases which affects the salivary and lacrimal glands. (Dry mouth and dry eyes)
Primarily a disease that effects women 90% of the time
Often accompanies the arthritic diseases because RA is a symptom
Occurs fourth or fifth decade of life
Unknown etiology- may result from complications from a viral infection
No cure exists- palliative treatment for symptoms

Back 43

SJOGREN’S SYNDROME

Front 44

These are oral signs of _______
Hyposalivation-less than 5% or normal quantity of saliva
Glossitis
Burning tongue-tongue become depapillated and fissured
Candidias of the tongue
Mucositis
Parotid gland hypertrophy
Angular cheilosis
Dysgeusia- taste dysfunction

Back 44

SJOGREN’S SYNDROME

Front 45

Dental management of Sjogren's includes
Drink ____ constantly-8 to 10 glasses a day
Avoid ____ such as caffeine, tobacco, and alcoholic beverages
Artificial saliva products: Optimoist, Salivart, Biotene
Pharmacological stimulation of salivary glands: Salagen, Evoxac
Sodium Fluoride 5000 ppm- daily applied use
Over the counter fluoride rinses are _______

Back 45

water
diuretics
inadequate

Front 46

Salivart is otc and can be used whenever it is needed. t/f

Back 46

true

Front 47

Biotene is rx and should be used as prescribed. t/f

Back 47

false (otc/use as needed)

Front 48

______=
pilocarpine
1 tablet 3X times
A day
Rinses 1 teaspoon 4 X day

Back 48

Salagen

Front 49

For caries prevention use ________
1 drop per tooth in custom tray for 5 minutes daily
Prescription strength

Back 49

5000 PPM/ Sodium fluoride / Prescription

Front 50

0.4 % Stannous Fluoride
Apply to custom tray for 5 minutes
Don’t rinse or eat for 30 minutes
Prescription strength
caries prevention

Back 50

study