DH206: Pharmacology Chapter 21: Diabetes Mellitus Lisa Mayo, RDH, BSDH.
DH201 CLINICIAL SCIENCES III Lisa Mayo, RDH, BSDH “You must learn a new way to THINK before you...
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Transcript of DH201 CLINICIAL SCIENCES III Lisa Mayo, RDH, BSDH “You must learn a new way to THINK before you...
MUSCULO-SKELETAL
DISORDERSDH201 CLINICIAL SCIENCES III
Lisa Mayo, RDH, BSDH
“You must learn a new way to THINK before you can master
a new way to BE.”Marianne Williamson
SUBJECTS FOR TODAY1. Scoliosis2. Muscular Dystrophy3. Arthritis4. Scleroderma
SCOLIOSIS
SCOLIOSIS
Curving of spine as a ‘C’ or ‘S’ shape more than 10◦ Wedging & rotation of the vertebrae
Secondary scoliosisResult of a neuromuscular conditions (ex: spina
bifida, CP) May see radiopacity in center of a pano Best results = tx’d when young
SCIOLIOSIS
People having reached skeletal maturity are less likely to have a worsening case
S&SUneven musculature on one side of the
spineA rib prominence or a prominent shoulder
blade, caused by rotation of the ribcage Uneven hips, arms or leg lengthsDiminished lung capacityPressure on heart
MUSCULAR DYSTROPHY
MUSCULAR DYSTROPHY (MD)
Atrophy of skeletal, striated muscles Types
1. Duchenne type2. Limb-girdle dystrophy3. Facioscapulohumeral dystrophy
4. Becker: Similar to Duchenne type, but more benign with a later onset (5–15yrs)
5. Emery–Dreifuss: 5–30yrs, severe cardiomyopathy and risk for sudden death
6. Oculopharyngeal & myotonic dystrophies: Rare, 20–50yrs, slowly progressive, extensive involvement of orofacial muscles
MUSCULAR DYSTROPHY (MD) Characteristics
Swelling of affected muscles, destruction of striated bands, cytoplasm & fatty deposits replace muscle
Muscular weakness and pain
Oral characteristics Mastication problems Speech problems Mouth breathing – HALITOSIS Drooling, excessive salivation Increased perio, caries
DUCHENNE MUSCULAR DYSTROPHY
Males (transmitted by female carriers) Present at birth – apparent 2-5yrs of age Weakness of hips, lordosis, waddling gait,
balance issues, muscle wasting Arrhythmias and cardiomyopathy common
Cardiomyopathy makes it harder for your heart to pump & deliver blood to the rest of your body
Rarely live past 30 Fully disabled by puberty, confined to
wheelchair
FACIOSCAPULOHUMERAL MD Males:Females equal 6-20yrs (average age 13yrs) Oral side effects
Facial, eye muscle issuesGaping of lips - similar to mouth breathersMalocclusion, TMD
Systemic side effectsCardiac involvement rareScapulae prominent, shoulder muscles weak
= difficulty raising arms Progression slower than Duchenne &
progression may arrest
LIMB-GIRDLE DYSTROPHY Affects hips, shoulders, pelvis Progression varies: rapid vs slow Manifests in late childhood/early
adolescence Cardiomyopathy common May become wheeelchair bound
MUSCULAR DYSTROPHY (MD)Tx Considerations
Protect airway Powered oral hygiene devises may be
contraindicated Wheelchair transfer Premed if heart conditions present Consult with MD
ARTHRITIS
ARTHRITIS
Inflammation in a joint Most common causes of chronic illness in
USA Acute & chronic forms Contributing factors
Infectious agents, traumatic disorders, endocrine abnormalities, tumors, allergy and drug reactions, inherited
ARTHRITIS FORM1. Rheumatoid arthritis2. Juvenile RA3. Degenerative joint
disease/Osteoarthritis
RHEUMATOID ARTHRITIS
Chronic, immunologic systemic disease in which inflammation of the joints occurs in exacerbations & remissions
Etiology: Unknown Onset 20-40yrs More women than men
RHEUMATOID ARTHRITIS
S&S Joint pain & swellingFingers, hands, knees affected 1st Stiffness: morning, after periods of
inactivityWeakness, fatigue, loss of appetite, loss of
weight, anemia, low-grade feverSubcutaneous nodules in elbows, wrists,
fingersTMD commonDifficulty chewing
RHEUMATOID ARTHRITIS
Medical treatment1. Pain relief2. PT & OT3. Nutritional counseling4. Meds
NSAIDsTrexall(Methotrexate): autoimmune diseases
& cancerGold compounds(Ridaura)Imuran(azathioprine): immunosuppressiveCyclosporin: immunosuppressiveHumera: TNF (tumor necrosis factor)-blocker
(TNF-α causes joint swelling & inflammation)5. Joint replacement surgery
RHEUMATOID ARTHRITIS
Relationship to periodontal diseaseRA & perio are both chronic inflammatory
diseasesPathogenesis of both is similarExtent & severity of perio disease with RA
under research
JUVENILE RA Under 16yrs of age Differs from adult RA Onset more acute, prolonged fever,
enlargement of the spleen & lymph nodes Inflammation of many joints (esp knees,
wrists, spine) TMD, limited opening Progression: complete remissions or ↑
disability that continues for yrs Tx: meds, activity to maintain function
OSTEOARTHRITISDEGENERATIVE JOINT DISEASE
Affects weight-bearing joints Inflammation is not the joint problem like
RA Predisposing factors
Repeated trauma (athletes)ObesityAge-related change in tissuesMechanical/loading stressGenetics
85% cases >70yrs Progression of disease leads to pain,
deformity, limited movement TMJ usually not involved
ARTHRITIS & DH CARE Joint pain and impaired motor function Joint replacement and antibiotic
premedication Oral self care if hands involved
Offer home care aids that accommodate issues
NB QUESTIONA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:
a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus
NB ANSWERA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:
a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus
NB QUESTIONWhich of the following devises would you recommend for an arthritis patient?
a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush
NB ANSWERWhich of the following devises would you recommend for an arthritis patient?
a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush
SCLERODERMA
SCLERODERMA Chronic autoimmune disorder
Affects connective tissue – over production of collagen
Hardening, thickening, shrinking of ct Immobility & rigidity of skin Limits opening of mouth
Death = renal, cardiac failure, pulmonary insufficiency, intestinal malabsorption
Etiology Collagen synthesis irregularities, immunologic
disorders, microvascular abnormalities
RAYNAUD’S PHENOMENON
1st symptomEpisodic vasoconstriction of handsDiscoloration of fingers when cold
SCLERODERMA
Oral CharacteristicsXerostomiaWidened PDLThin, rigid lipsDifficulty in opening and closing mouthThin, pale, tender, rigid mucosa &
gingiva↑ mobilityDifficult masticationTongue may be immobileSpeech difficult
NB QUESTIONWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?
a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis
NB ANSWERWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?
a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis