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122 Cards in this Set
- Front
- Back
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Four different fulcrums:
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Intra Oral, Extra Oral, Assisted fulcrums, Combinations
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Standard Intra Oral fulcrums
Advantages and disadvantages |
Same arch
Advantage: Most control, most stablility, most powerful. Disadvantage: hard to get terminal shank parallel to tooth. |
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Advanced Fulcrums
Pros and Cons |
Pros: Increase 2nd and 3rd molar access, increase deep pocket access, maintains natural hand wrist.
Cons: Requires more muscle, increase risk of slippage/sticks, decrease tactile, increase muscle strain. |
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Different type of extra oral fulcrums:
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Knuckle rest, chin-cup, fulcrum on chin
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Finger Assisted fulcrum
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finger on finger
increase in parallelism index finger from nondominant hand can help increase lateral pressure. |
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Cancer Facts:
Ratio of death due to cancer |
1 out of 4
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Cancer Facts:
Is it more common in men or women? Does it increase or decrease with age? |
Increases with age
more common in men |
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Cancer Definition
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Uncontrolled growth of aberrant neoplastic cells
Destroy adjacent tissues Metastasize via blood, lymph, serosal surfaces (secrete serous fluid) Independent & aggressive |
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Cancer Identified
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Palpable mass
Increases in size over time Change in color surface Lump Enlarged lymph nodes Altered organ function Pain & paresthesia |
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Cancer facts:
How many individuals are diagnosed each day? More than 90% of cases are attributed to____? What race gets it the most? |
100
SCC African Americans |
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Cancer Facts:
High risk areas in the oral cavity? |
Tongue, floor of the mouth, soft palate and lower lip
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What are the two common head and neck cancers?
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Basal Cell Carcinoma (sun exposure) and SCC (non-healing red and white lesion)
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Common Oral Cancers
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kaposi's sarcoma, melanoma, Mucoepidermal,Leukemia,Lymphoma
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Kaposi's Sarcoma
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purple plaque or nodule, palate, gingiva, or face (HIV/AIDS)
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Melanoma
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deadly brown/black enlarging plaque, skin or palate
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Mucoepidermal
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dome-shaped swelling with carcinoma, central ulceration of palate or retromolar region.
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Leukemia
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gingival enlargement, bleeding, skin pallor, increased bruising
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Lymphoma
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enlarged non-painful lymph nodes, palatal or pharyngeal swelling, retromolar ulceration
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Which cancer is the most common?
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Breast cancer
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Leading cause of cancer deaths?
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Lung Cancer
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Different diagnostic stages of cancer
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Stage I – localized tumor
Stage II – regional in nearby structures Stage III – extensive beyond original site. Invades other surrounding tissues through several layers Stage IV – widely disseminated Staging of tumor will determine aggressiveness of treatment required |
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Chemotherapy
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Suppress immune system to deplete nutrients to cancerous tumor for growth
Depletes WBC overall and platelet count Bleeding, swollen gingiva Does not fight off bacterial invasion Schedule therapy after consultation with physician – 17 days after treatment or 2 days before next treatment CHX rinses (CloSys) and minimal home care with brushes, picks, oral irrigators, etc. |
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Radiation therapy
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ORN – osteoradionecrosis
BON – bisphosphonate-associated ORN Xerostomia daily fluoride gels & oral irrigators Frequent RDH appointments Fungal infection – prescribed treatment Tooth sensitivity – reduced saliva secretion & ↓pH of saliva Muscle trismus - exercises |
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Should prophlyaxis be before chemotherapy or after?
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before
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post cancer treatment
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Consultation with physician
Patient re-care 1-3 months during first 2 years 3-6 months thereafter |
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Red and White blood cells are more affected by men or women?
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women
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Anemia
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A reduction in the oxygen carrying capacity of the blood associated with:
A decreased number of circulating red blood cells (RBCs) An abnormality in the hemoglobin (Hb) within the RBCs |
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Anemia consists of hemoglobin levels less than
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12 g/dL for women
13 g/dL in men |
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Different types of anemia:
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Iron Deficiency anemia, Pernicous Anemia, sickle cell anemia
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Iron Deficiency
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Can be caused by
Excessive blood loss Poor iron intake or absorption Increased demand for iron Anemia in men is rare and may be from a serious medical problem |
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Oral Symptoms of Anemia
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Be aware of glossitis, smooth tongue, cheilosis, or loss of taste sensation as these have been described in patients with anemia
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Pernicious anemia
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Vitamin B12 deficiency
Vitamin B12 may be stored for several years Deficiency is rare Usually develops late in adulthood ( 40 years or older) Early onset in black American women has occurred Increased risk for developing gastric carcinoma in long term pernicious anemia |
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Sickle Cell Anemia
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Inherited as autosomal recessive traits
Affects African American populations RBC becomes “sickle” shaped Lowered oxygen tension Decreased pH Patient is dehydrated Delayed eruption of teeth and dental hypoplasia are often seen. |
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Sickle Cell Anemia Management
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Can have routine dental care during noncrisis periods
Long and complicated appointments should be avoided Preventive dental care to minimize risk of oral infection Avoid elective surgical procedures Avoid dehydration Local anesthetic is allowable Avoid prilocaine and general anesthesia Epinephrine is controversial Do not use concentrations stronger than 1: 100, 000 epi Nitrous oxide-oxygen may be used for short periods with at least 50% oxygen provided Avoid barbiturates, narcotics, and high doses of salicylates Pain control: acetaminophen and small doses of codeine |
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Should antibiotic prophylaxis be used with someone that has sickle anemia?
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No evidence for use but is recommended for surgical procedures
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White blood cell disorders may create:
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Delayed wound healing
Infection Mucosal ulceration May be fatal |
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Normal circulating white blood cells are:
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4,400 – 11, 000/uL in adults
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What does leukocytosis mean?
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an increase in circulating WBCs (> 11, 000/uL)
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Leukopenia:
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a decrease in circulating WBCs ( < 4400/uL)
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Leukemia
Definition and different types: |
Cancer of WBCs affecting bone marrow and circulating blood
4 types Acute lymphocytic leukemia (ALL) Chronic lymphocytic leukemia (CLL) Acute myelogenous leukemia (AML) Chronic myelogenous leukemia (CML) |
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Acute Lymphocytic Leukemia (ALL)
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Uncontrolled proliferation of immature lymphoid tissue
Most common form in children younger than 19 Predilection to boys Suppression of hematopoiesis Patients susceptible to excessive bleeding, anemia, poor healing, and infection after surgical procedures |
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Oral Manifestations of Acute Lymphocytic Leukemia (ALL)
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Oral manifestation
Gingival enlargement Ulceration Oral infection Gingival bleeding and fetor oris may occur from poor oral hygiene and gingival enlargement Good oral care, chlorhexidine, and chemotherapy are beneficial |
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Chronic lymphocytic leukemia (CLL)
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Most common type in adults
Signs and Symptoms: fatigue, anorexia, weight loss |
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Oral manifestations of Chronic lymphocytic leukemia (CLL)
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Oral manifestation
Generalized lymphadenopathy Pallor of oral mucosa Oral soft tissue infection (developing hypoglobulinemia) Incurable disease |
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Acute Myelogenous Leukemia
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Increase of immature WBC in bone marrow space and circulation
Disease of adults, incidence increases with age and rises after age 50 Sudden onset and leads to death in 1-3 months if untreated |
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Oral Manisfestations of acute myelogenous
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1/3 of patients will have:
Recurrent infections Oral ulcerations Fever Enlarged tonsils, lymph nodes, spleen, and gingiva |
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Chronic Myelogenous Leukemia
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Slow progression of disease for 3 -5 years and then accelerates, followed by a crisis ( blast phase)
Treatment in accelerated or blast phase have poorer prognosis |
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Oral Manisfestations of Chronic Myelogenous Leukemia
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Oral manifestations are less likely to be observed compared to AML
Generalized lymphadenopathy Pallor of oral mucosa Soft tissue infection |
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Lymphomas
definition types |
Cancer of the lymphoid organs and tissues
7th most common malignancy worldwide More than 20 types Hodgkin lymphoma Non-Hodgkin lymphoma Multiple Myeloma |
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Hodgkin lymphoma
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Neoplasm of B lymphocytes
Most common in young adults 1.4 : 1 male to female ratio |
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Sign and symptoms of hodgkin lymphoma
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Signs and symptoms:
Painless mass, firm, enlarged lymph node Fever, weight loss, night sweats |
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Non- Hodgkin lymphoma
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6th most common cancer in men and 5th in women in US
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Oral signs and symptoms of Non- Hodgkin lymphoma
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Signs and symptoms:
Enlarged lymph nodes, fever, weight loss Intraorally, involves Waldeyer’s ring on the soft palate and oropharynx. |
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Multiple Myeloma
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Lymphoproliferative disorder
Overproduction of cloned malignant plasma cells Affects men more than women Involves bone resorption and bone marrow replacement that can lead to anemia Infections are common Primary cause of death Radiographs: Multiple “punched-out” lesions at tumor sites 30 % of patients have osteolytic lesions on the jaw Commonly on posterior body of mandible Bisphosphonates are used to maintain bone strength and reduce bone pain |
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Dental Management of anemia
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May treat patients with anemia if hemoglobin levels are above 11 g/dL and is free of symptoms.
Patients below 11 g/dL, has abnormal heart rate or oxygen saturation less than 91 % should have treatment postponed until health improves. |
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Dental Management for chemotherapy
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Extractions before chemotherapy
Minimum of 10 -14 days between extraction and start of chemotherapy Avoid invasive procedures if platelet counts are less than 50,000/uL |
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Heart Failure
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Represents a symptom complex that may be caused by a number of specific diseases.
Represents the end stage of cardiovascular diseases Caused by an inability of the heart to function efficiently |
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Incidence and prevalence of heart failure
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5 million people in the USA have Heart Failure
550,000 new diagnoses each year Primary condition of the elderly 80% patient hospitalized are older 65 years of age Heart Failure is major cause of morbidity HF patients have poor prognosis 35% men, 50% women live past 5 years after diagnosis |
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The top four most common causes of heart failure:
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Most Common Causes
Coronary heart disease Hypertension Cardiomyopathy Valvular heart disease |
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Complications of the right and left ventricles
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Left Ventricular
Begins at Left Ventricle Manifestations: Dyspnea Fatigue Result Acute pulmonary edema Pulmonary hypertension Right Ventricular Follows LV pulmonary hypertension Manifestations Dyspnea Orthopnea Pulmonary edema Result Pulmonary hypertension |
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Symptoms and signs of the left ventricular failure
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Dyspnea
Fatigue Orthopnea Paroxysmal nocturnal dyspnea Exercise intolerance signs:Rapid shallow breathing Hyperventilation Inspiratory rales (Crackles) Heart murmur Pulsus alterans |
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Symptoms and signs of the right ventricular failure
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Venous congestion
Peripheral edema signs: Distended jugular veins Large tender liver Ascites Clubbing of fingers Weight gain |
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AHA/ACC Classifications
A |
Predisposed heart failure factors: No HF symptoms
Coronary artery disease Hypertension Diabetes |
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AHA/ACC Classifications
B |
Same as A
Demonstrates LV hypertrophy or dysfunction |
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AHA/ACC Classifications
C |
Present symptoms of heart failure and underlying heart disease
Most Common |
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AHA/ACC Classifications
D |
Present symptoms of heart failure and underlying heart disease
Most Common |
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Medical management of Stage A heart failure:
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STAGE A, (high risk for HF but without structural heart disease or symptoms)
Treat: Hypertension, Lipid disorders Encourage: tobacco cessation, exercise, good diet Discourage: alcohol and street drug use Medications: ACE inhibitors, Angiotensin receptor blockers for patients with diabetes & vascular disease. |
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Medical management of stage B heart failure:
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STAGE B, (Structural heart disease no signs or symptoms)
All measures for STAGE A + Medications: ACE inhibitors or ARB’s & Beta-blocker. |
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Medical Management of stage C heart failure
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STAGE C, (structural heart disease with prior or current symptoms)
All measures for STAGES A & B + Dietary salt restriction Medications: Diuretics, ACE inhibitors, Beta-blockers. Selective patients may use: aldosterone antagonist, digitalis, ARB’s, and nitrates. Devices: pacemakers and defibrillators. |
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Medical Management of stage D heart failure
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Structural heart disease no signs or symptoms of HF
All measures for STAGE A, B, C + Heart transplant, chronic isotropes, permanent mechanical support, experimental drugs or surgery. Provide compassionate end-of-life care. |
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Dental Management for heart failure
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Thorough medical HHX
Address underlying conditions Hypertension, atherosclerotic disease, diabetes, obesity Address and encourage tobacco cessation Stages A – C Out weight risks of treatment (Stage C contact physician) Routine care depending on severity Early, short, low stress appointments Seat patient semi-supine or upright Stage D Treatment confined to hospital setting (contact physician |
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Different types of Neurologic Disorders
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Epilepsy
Stroke (Cerebrovascular Accident) Parkinson’s Disease Alzheimer’s Dementia Multiple Sclerosis Cerebrospinal Fluid Shunts |
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Epilepsy
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Abnormal electrical activity in the brain (seizure)
Changes in neurologic function 10% of population will have a seizure in their lifetime Seizures most common in childhood In a practice of 2000 patients; between 2-5 patients will experience seizures. SEIZURES DO NOT ALWAYS INDICATE EPILEPSY |
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Epilepsy Signs and Symptoms
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Irritability
Aura (momentary sensory alteration) Muscle rigidity Pupil dilation Eyes rolling upward or to the side Loss of consciousness Breathing spasms Tonic-Clonic (Grand Mal) |
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Epilepsy Management
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Anti-seizure drugs
Phenytoin---dilation Tegretol Valproic acid |
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Side effect of antisiezure medications
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Gingival overgrowth
Xerostomia Increased incidence of infection Leukopenia Osteoporosis |
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Epilepsy Dental Management
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Thorough medical history
Date of last seizure, medications, severeness of seizures,etc. Propoxyphene and Erythromycin should NOT be administered to patient’s taking carbamazepine. Aspirin should NOT be prescribed for patients on valproic acid. Valprioic acid -Chemical compound found in some anticonvulsant and mood stabilizer drugs |
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Seizure Management in Dental Chair
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Supine position
Prevent patient from injury Remove all instruments from area Administer oxygen after seizure has ceased |
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Stroke definition
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Interruption of oxygenated blood to the brain.
Can be fatal or debilitating 5% of United States population over 65 has had a stroke. Risk greater in African Americans More women then men affected. TIA (transient ischemic attack), RIND (reversible ischemic neurologic deficit), CVA (cerebrovascular accident) Stroke in evolution |
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Stroke Signs and Symptoms
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Hemiplegia (half of the body is paralyzed)
Trouble speaking Loss of vision/dimness of vision Dizziness Unsteadiness Sudden fall |
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Stroke Management non DH
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#1 treatment is PREVENTION
Eating healthy Exercise Blood pressure under control Carotid endarterectomy (remove plaque from carotid artery) Stabilize patient with anticoagulants Surgical Intervention |
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Stroke Dental Management
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Identify risk factors in patients and educate on prevention
No dental treatment for 6 months INR assessment if taking anticoagulant (must be 3.5 or less) No metronidizol or tetracycline – may ↑INR No aspirin – acetomynephen for pain control Short mid morning stress free appointments Vitals monitored If stroke occurs- administer oxygen and activate EMS |
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Parkinson’s Disease definition
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Alteration in the neurons that produce dopamine
Affects 1 in 300 people per year Affects more men than women No racial predilection exists |
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Signs and Symptoms of parkinson disease
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1st noticeable sign is tremor “pin rolling” of one hand (thumb and forefinger rubbing together)
Muscle rigidity Slow movement Facial impassiveness |
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Medical Management of parkinson disease non DH
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Therapy to increase dopamine levels
Six different classes of drugs (pg 509 table 27-2) Carbidopa/levodopa (sinemet) used after 5-10 years of disease Physical therapy (to prevent patient from hurting themselves when doing daily tasks) |
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Dental Management of parkinson disease
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Minimize the adverse outcomes of muscle rigidity and tremor – be careful with sharp things
Avoid drug interactions OHI: rinses and electric tooth brush due to inability to perform adequate home care No EPI with patients on COMT inhibitors (enzyme catechol-O-methyl transferase) Erythromycin should not be given to patients on a dopamine agonist Assist patient in and out of the chair Schedule appointments 2-3 hours after medication is taken Soft arm restraints or sedation might be indicated if necessary |
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Dementia and Alzheimer’s definition /facts
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Slow progressive decline in intellectual abilities
Memory Abstract thinking Judgement Associated with aging Not easily cured or reversed May be no cure |
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Signs and Symptoms of Dementia and Alzheimer’s
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Short term memory loss
Change in personality Change in behavior Change in language |
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Alzheimer’s Etiology
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Unknown
Has been linked to environmental factors: Mercury Aluminum Viruses |
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Medical Management of Alheizmers
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Unknown
Has been linked to environmental factors: Mercury Aluminum Viruses |
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Dental Management for alheizmer
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Short words and sentences to communicate
Repeat if necessary Discuss OHI and treatment with patient AND loved one/care taker Short appointments Sedation if necessary (mostly for severe cases) Removable Prosthetics should be taken from patient for fear of self injury |
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Oral Manifestations of alheizmers
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Xerostomia
Poor home care Mucosal lesions Candidiasis Periodontal disease Root caries Increased plaque and calculus |
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Multiple Sclerosis definition
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Autoimmune disease
Most common autoimmune disease of the nervous system Inflammation leading to demyelination and axonal injury 1 in 850 persons have MS |
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Etiology of Multiple Sclerosis
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Unknown
Triggered by infections Rabies Measles Herpes virus Chlamydia |
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Signs and Symptoms of MS
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Begins in young adulthood
Disturbance in vision Abnormal eye movements Difficulty in walking Vertigo Tremor Paralysis of a limb Fatigue ALL SYMPTOMS ARE EXACERBATED BY HEAT |
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Medical Management of MS
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Anti-inflammatory medications (corticosteroids)
Methylprednisolone Avonex Betaseron Complications of MS involve treatment of: Spasticity Poor bladder control Fatigue Paroxysmal events (muscle movements similar to seizure) |
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Dental Management of MS
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If a patient is on corticosteroids, they may need to be altered for dental treatment
Consult physician before treating patients on corticosteroids Dental care should be provided during periods of remission Screen for xerostomia and burning mouth Schedule short morning appointments |
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Oral Manifestations of MS
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Oral Manifestations:
Dysarthria (slow irregular speech w/unusual separation of words) Parasthesia Numbness of orofacial structures Trigeminal neuralgia |
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Cerebrospinal Fluid Shunts definition
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Placed due to Hydrocephalus (increase fluid around brain)
Shunts placed to reduce fluid pressure 75,000 shunts placed in US per year In dentistry: small risk of infection Usually infection occurs the first 2 months after placement No antibiotic prophylaxis is needed (AHA) |
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BELL’S PALSY definition
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Paralysis of the seventh cranial nerve
Cause unknown Post Surgery Infections Viral or bacterial Herpes simplex Abrupt onset Eyelids Cannot close Risk of infection Mouth Drooping Drooling Speech Mastication |
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BELL’S PALSY symptoms
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Most symptoms last about 1 month
May have residual effects that could last for the rest of their life Some paralysis Speech Chewing Food retention |
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BELL’S PALSY dental management
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Treatment considerations
Safety glasses! Protect airway Caution with anesthesia Frequent rinsing or brushing Dental chair rinsing and suction Treatment modalities Drugs – especially prednisone |
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Psychiatric Disorders: the different types
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Mood disorders
Depression Bipolar disorder Schizophrenia Somatoform disorders |
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Mood Disorders: Depression
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Depression:
Most common psychiatric illness, yet not always recognized and treated Occurs at any age (most commonly mid-20s) Occurs more frequently in women |
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Symptoms of depression
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Symptoms and manifestations vary considerably and include:
Apathy Fear Sadness Loss of energy |
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Dysthymia
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minor form of depression, common in elderly
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treatment for mood disorders (depression)
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Treatment:
Lifestyle changes Counseling & psychotherapy Antidepressants SSRIs- initial therapy More tolerable, safety in overdose Ex: Prozac, Zoloft, Paxil Tricyclic Antidepressants High risk of overdose Xerostomia Cardiac dose of Epinephrine MAOIs Older, typically not used as much |
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Dental Management of mood disorders (depression)
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Patients may have omission of health habits
Monitor medical history closely at each visit Know medication side effects, even if they aren’t apparent EO/IO, check for xerostomia |
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Two bipolar phases:
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2 phases:
1. Depressive 2. Manic – excessive elation, hyperactivity, accelerated thinking, speaking |
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Treatment for bipolar disorder
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Psychosocial therapy
Pharmacotherapy 3 pronged approach: Manic phase- antipsychotics Depression- antidepressants Maintenance therapy – Lithium is gold standard Side effects: GI irritation, thirst, muscle weakness Drug interactions with NSAIDS and Metronidazole Off label anticonvulsants |
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Dental Management for bipolar
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Dental Management:
Encourage adherence to drug regimens Patients have tendency to argue and become irritable. May especially be apparent if patient feels pressured Do not rush the patient Carefully review medical history and consult with physician as needed Take time to research patients drug effects Lithium may impart a metallic taste Rates of alcohol and drug abuse are high with these patients |
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Schizophrenia
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Complex, chronic mental disorder causing disturbances in feeling, thinking, and behavior that impairs function
Onset: usually 15-24 in males and 25-35 in women can be gradual or abrupt Symptoms include: disordered thinking, inappropriate emotional responses, hallucinations, delusions, bizarre behavior Unknown cause- possibly genetic and environmental factors in conjunction with dopamine disturbances |
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Treatment for schizophrenia
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Pharmacotherapy
Conventional antipsychotics block dopamine receptors Abilify Zyprexa Careful monitoring is essential because side effects can be severe Xerostomia Postural hypotension Drowsiness Reduced leukocytes Agranulocytosis – candida may be present Tardive dyskinesia – involuntary mouth and jaw movements Akathisis- restless foot Dystonia- abnormal muscle contraction |
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Schizophrenia dental management
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Dental Management:
Elective treatment should not be done during periods of exacerbation Plan a simple routine using a familiar and organized routine Decrease stimulation Plan for future oral health because it is a lifelong disorder |
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Somatoform Disorders
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Physical complaints for which no general medical cause is present
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5 different types of somatoform disorders
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Somatization Disorder ,Conversion Disorder,Pain Disorder ,Hypochondriasis,Factitious Disorder
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Somatization Disorder definition
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Multiple unexplained somatic symptoms including: pain, diarrhea, bloating, vomiting, weakness, blindness
Many patients also have anxiety, depression, or personality disorder |
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Conversion Disorder-
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Monosymptomatic somatoform disorder
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Pain Disorder definition
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Pain causes the patient distress in important areas of functioning however no disease/cause can be identified
Often the result of a stressful event |
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Hypochondriasis definition
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Preoccupied with fear or belief that they have a serious disease
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Factitious Disorder definition
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Intentional self-harm
Skin is most common site of injury |
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Treatment for somatic disorders; Medical and dental
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Treatment:
Multiple therapies including psychotherapy or group therapy Drug therapy not usually indicated Dental management: Do not administer unneeded medical, surgical, or medicinal therapies |
