EFFECTS OF SYSTEMIC DISEASE ON NUTRITIONAL STATUS AND ORAL HEALTH CHAPTER 16 Copyright © 2010,...

EFFECTS OF SYSTEMIC DISEASE ON EFFECTS OF SYSTEMIC DISEASE ON NUTRITIONAL STATUS AND ORAL NUTRITIONAL STATUS AND ORAL

HEALTHHEALTH

CHAPTER 16CHAPTER 16

Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

22Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Effects of Chronic Disease on Effects of Chronic Disease on Dietary IntakeDietary Intake

Anorexia is a condition in which a person has a Anorexia is a condition in which a person has a poor appetite for various reasons (e.g., cancer poor appetite for various reasons (e.g., cancer treatment)treatment)Appetite may decrease because of pain, apathy, Appetite may decrease because of pain, apathy,

anorexia, drugs, inactivity, or other reasons anorexia, drugs, inactivity, or other reasons Malnutrition or other stresses such as infection, surgery, Malnutrition or other stresses such as infection, surgery,

or injuries resulting in anorexia deplete body stores of or injuries resulting in anorexia deplete body stores of kilocalories, macronutrients (e.g., protein), and kilocalories, macronutrients (e.g., protein), and micronutrients (e.g., vitamin C) needed to regenerate and micronutrients (e.g., vitamin C) needed to regenerate and repair cells and sustain immune systemrepair cells and sustain immune system


Effects of Chronic Disease on Dietary Effects of Chronic Disease on Dietary IntakeIntake

Taste and smell disordersTaste and smell disordersDramatically affects food intakeDramatically affects food intakeWith a loss of smell patients report eating With a loss of smell patients report eating

less (29%)less (29%)With loss of taste patient may require With loss of taste patient may require

greater amounts of sodium (11.6 times greater amounts of sodium (11.6 times higher) and sugar (2.7 times higher)higher) and sugar (2.7 times higher)


Effects of Chronic Disease on Effects of Chronic Disease on Dietary IntakeDietary Intake

Xerostomia affects nutritional status in several Xerostomia affects nutritional status in several ways: ways: Chewing is difficult because a bolus cannot be formed Chewing is difficult because a bolus cannot be formed

without additional moisturewithout additional moistureChewing is painful because the mouth is soreChewing is painful because the mouth is soreSwallowing is difficult because of loss of lubrication Swallowing is difficult because of loss of lubrication

from salivafrom salivaFood intake may decrease because of changes in Food intake may decrease because of changes in

taste perception due to lack of saliva for food solvencytaste perception due to lack of saliva for food solvencyAvoiding dry, crunchy foods may cause deficiencies in Avoiding dry, crunchy foods may cause deficiencies in

fiber, potassium, vitamin Bfiber, potassium, vitamin B66, iron, calcium, and zinc, iron, calcium, and zinc


Anemias: Anemias: Iron Deficiency Anemia (IDA)Iron Deficiency Anemia (IDA)

EtiologyEtiologyIncreased needs during Increased needs during

growth periods such as growth periods such as infancy or pregnancyinfancy or pregnancy

Excessive bleedingExcessive bleedingInadequate intakeInadequate intake

Oral manifestations:Oral manifestations:Atrophic glossitisAtrophic glossitisAphthous ulcersAphthous ulcersPallor of the gingiva, Pallor of the gingiva,

mucosa, and tonguemucosa, and tongueAngular cheilosisAngular cheilosisCandidiasisCandidiasisMay impair wound May impair wound

healinghealingFrom Cawson RA, Odell EW: Cawson’s From Cawson RA, Odell EW: Cawson’s Essentials of Oral Pathology and Oral Essentials of Oral Pathology and Oral

Medicine, ed 8. St. Edinburgh, UK: Churchill Medicine, ed 8. St. Edinburgh, UK: Churchill Livingstone, 2008.Livingstone, 2008.


Anemias: Anemias: Iron Deficiency Anemia (IDA)Iron Deficiency Anemia (IDA)

Dental hygiene considerationsDental hygiene considerationsMay need to postpone invasive nonsurgical May need to postpone invasive nonsurgical

periodontal therapy until IDA improvesperiodontal therapy until IDA improvesEncourage iron-rich foods (e.g., meat)Encourage iron-rich foods (e.g., meat)Encourage vitamin C to enhanceEncourage vitamin C to enhance

absorptionabsorptionIf iron supplement is liquid, dilute withIf iron supplement is liquid, dilute with

water or juice and drink with straw to minimize water or juice and drink with straw to minimize tooth stainingtooth staining


Anemias: Anemias: Megaloblastic Anemia—Vitamin BMegaloblastic Anemia—Vitamin B1212

Also called pernicious Also called pernicious anemia anemia (small # of large RBC’s)(small # of large RBC’s)

EtiologyEtiologyIncreased needsIncreased needsInadequate intakeInadequate intake

BB1212 only in animal products only in animal products Vegans at risk of deficiencyVegans at risk of deficiency Also may be deficiency in Also may be deficiency in

folatefolate

MalabsorptionMalabsorption Common inCommon in

Oral symptomsOral symptomsAngular cheilosisAngular cheilosisRecurrent Recurrent

aphthous ulcersaphthous ulcersErythematous Erythematous

mucositis mucositis Pale or yellowish oral Pale or yellowish oral

mucosa mucosa Atrophic glossitis; beefy Atrophic glossitis; beefy

red color red color


Anemias: Megaloblastic Anemia—Anemias: Megaloblastic Anemia—FolateFolate

EtiologyEtiologyPoor dietPoor dietMedications that Medications that

interfere with absorption interfere with absorption (e.g., phenytoin or (e.g., phenytoin or methotrexate)methotrexate)

Oral manifestationsOral manifestationsAtrophic glossitisAtrophic glossitisUlcerationsUlcerationsGlossodyniaGlossodyniaAngular cheilitisAngular cheilitisFungal infectionsFungal infections


Anemias: Megaloblastic AnemiaAnemias: Megaloblastic AnemiaDental hygiene considerationsDental hygiene considerations

Encourage folate-rich food sourcesEncourage folate-rich food sources

and supplement to meet the RDA for folate (400 µg)and supplement to meet the RDA for folate (400 µg) Large doses of folate can negate effects of anticonvulsants, so Large doses of folate can negate effects of anticonvulsants, so

consultation with medical provider is necessaryconsultation with medical provider is necessary

Encourage intake of foods from animal sources high in Encourage intake of foods from animal sources high in vitamin Bvitamin B1212 for pernicious anemia for pernicious anemia For vegans encourage fortified foods or supplementsFor vegans encourage fortified foods or supplements

Patients with permanent gastric or ileal damage need Patients with permanent gastric or ileal damage need monthly intramuscular or oral vitamin Bmonthly intramuscular or oral vitamin B1212 supplementation for supplementation for

lifelifeRefer to a registered dietitianRefer to a registered dietitian


Other Hematological Disorders: Other Hematological Disorders: NeutropeniaNeutropenia

Diminished # of WBCsDiminished # of WBCsEtiologyEtiology

Drugs (e.g., Drugs (e.g., chemotherapeutics)chemotherapeutics)

Autoimmune disease (e.g., Autoimmune disease (e.g., rheumatoid arthritis)rheumatoid arthritis)

Hematologic disease (e.g., Hematologic disease (e.g., leukemia)leukemia)

Nutritional deficienciesNutritional deficienciesRisk for life-threatening Risk for life-threatening

bacterial or viral infectionbacterial or viral infection

Oral manifestationsOral manifestationsMucositisMucositisViral infectionsViral infectionsFungal infections (e.g., Fungal infections (e.g.,

candidiasis)candidiasis)


Other Hematological Disorders: Other Hematological Disorders: NeutropeniaNeutropenia

Dental hygiene considerationsDental hygiene considerationsInvasive dental treatment contraindicated until white blood Invasive dental treatment contraindicated until white blood

cell counts risecell counts risePalliative care such as nonalcohol chlorhexidine rinse may Palliative care such as nonalcohol chlorhexidine rinse may

help reduce bacterial load until patient can perform more help reduce bacterial load until patient can perform more thorough oral self-carethorough oral self-care

Stress importance of frequent oralStress importance of frequent oral

prophylaxis and meticulous oral hygieneprophylaxis and meticulous oral hygiene

care once muscositis pain subsidescare once muscositis pain subsidesRefer to a registered dietitianRefer to a registered dietitian

1212

Gastrointestinal Problems: Gastrointestinal Problems: Gastroesophageal Reflux Disease (GERD)Gastroesophageal Reflux Disease (GERD)

Lower esophageal Lower esophageal sphincter (LES) allows sphincter (LES) allows gastric contents to gastric contents to enter the esophagusenter the esophagus

EtiologyEtiologyHiatal herniaHiatal herniaObesityObesityPregnancyPregnancy

RecommendationsRecommendationsAvoid foods causing Avoid foods causing

GERD GERD (fatty foods, mints, (fatty foods, mints, coffee, alcohol, onions)coffee, alcohol, onions)

Eat small mealsEat small mealsSemisupine positionSemisupine positionNo nitrous oxideNo nitrous oxideAssist with tobacco Assist with tobacco

cessationcessationWeight loss as neededWeight loss as needed


Gastrointestinal Problems: Gastrointestinal Problems: Malabsorptive ConditionsMalabsorptive Conditions

EtiologyEtiologyCrohn’s diseaseCrohn’s diseaseUlcerative colitisUlcerative colitisCystic fibrosisCystic fibrosisGlutenGluten (wheat protein)- (wheat protein)-

sensitive enteropathy sensitive enteropathy (sprue or celiac disease)(sprue or celiac disease)

AIDSAIDSAbdominal pain, Abdominal pain,

cramping with intakecramping with intake

Oral manifestationsOral manifestationsSwollen, bleeding, Swollen, bleeding,

erythematous gingivaerythematous gingivaDiffuse pustular eruptions Diffuse pustular eruptions

on buccal gingivaon buccal gingivaOral ulcerationsOral ulcerationsSwelling of the lipsSwelling of the lipsCobblestone-like raised Cobblestone-like raised

hypertrophic lesionshypertrophic lesionsMetallic dysgeusiaMetallic dysgeusia


Gastrointestinal Problems: Gastrointestinal Problems: Malabsorptive ConditionsMalabsorptive Conditions

Dental hygiene considerationsDental hygiene considerationsConsult with health care provider about patient’s need Consult with health care provider about patient’s need

for supplemental steroids and prophylactic antibiotics for supplemental steroids and prophylactic antibiotics before the dental appointment before the dental appointment

Encourage patient to eat a nutrient-rich, well-balanced Encourage patient to eat a nutrient-rich, well-balanced diet to enhance healingdiet to enhance healing

Health care provider or registered dietitian may Health care provider or registered dietitian may recommend vitamin and mineral supplementationrecommend vitamin and mineral supplementation


Cardiovascular Conditions: Cardiovascular Conditions: Cerebrovascular Accident (CVA)Cerebrovascular Accident (CVA)

CVA or stroke results CVA or stroke results if occlusion or if occlusion or ischemia occurs in an ischemia occurs in an artery supplying the artery supplying the brain or if brain or if hemorrhaging in the hemorrhaging in the brain occursbrain occurs

Oral manifestationsOral manifestationsDysphagiaDysphagiaFacial muscle Facial muscle

weaknessweaknessSlurred speechSlurred speech


Cardiovascular Conditions: Cardiovascular Conditions: Cerebrovascular Accident (CVA)Cerebrovascular Accident (CVA)

Dental hygiene considerationsDental hygiene considerationsMonitor blood pressureMonitor blood pressureUsing water for rinsing or ultrasonic instrumentation Using water for rinsing or ultrasonic instrumentation

may be contraindicated during dental care if dysphagia may be contraindicated during dental care if dysphagia is presentis present

Neurological deficits may cause some to be unaware Neurological deficits may cause some to be unaware of the presence of food in the mouth, so the mouth of the presence of food in the mouth, so the mouth should be checked for any pocketed foods after mealsshould be checked for any pocketed foods after meals

Excellent oral self-care is needed to prevent caries; Excellent oral self-care is needed to prevent caries; patient may have a softer, more cariogenic dietpatient may have a softer, more cariogenic diet


Cardiovascular Conditions: Cardiovascular Conditions: HypertensionHypertension

Dental hygiene considerationsDental hygiene considerationsMinimize stress for the appointmentMinimize stress for the appointmentMonitor blood pressureMonitor blood pressureManage medication-induced xerostomiaManage medication-induced xerostomiaRecommend fruits and vegetables, low-fat/nonfat dairy Recommend fruits and vegetables, low-fat/nonfat dairy

products; to limit sodium, alcohol, caffeine; tobacco products; to limit sodium, alcohol, caffeine; tobacco cessation; exercise; lose weight; reduce stresscessation; exercise; lose weight; reduce stress Direct to information about the DASH diet on the NHLBI Direct to information about the DASH diet on the NHLBI

websitewebsite


Cardiovascular Conditions: Cardiovascular Conditions: HyperlipidemiaHyperlipidemia

Dental hygiene considerationsDental hygiene considerationsRecommend reducing total fat, saturated fat, dietary Recommend reducing total fat, saturated fat, dietary

cholesterolcholesterolEncourage noncariogenic, low-fat snacksEncourage noncariogenic, low-fat snacksLong-term use of bile acid sequestrants Long-term use of bile acid sequestrants

(cholestyramine and colestipol) to lower serum lipids (cholestyramine and colestipol) to lower serum lipids may cause malabsorption of fat-soluble vitamins and may cause malabsorption of fat-soluble vitamins and folic acidfolic acid Encourage food sources rich in these nutrientsEncourage food sources rich in these nutrients


Skeletal SystemSkeletal SystemEtiologyEtiology

OsteoporosisOsteoporosis Bisphosphonates used to treat Bisphosphonates used to treat

osteoporosis and multiple myeloma osteoporosis and multiple myeloma increases risk for osteonecrosis (bone increases risk for osteonecrosis (bone death of the jaw) death of the jaw)

HyperparathyroidismHyperparathyroidismPaget’s disease or fibrous Paget’s disease or fibrous

dysplasiadysplasia

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Pathology for the Dental Hygienist, ed 5. St.

Louis: Saunders, 2009.Louis: Saunders, 2009.


Skeletal SystemSkeletal SystemOral manifestationsOral manifestations

Increase in size or alteration in contour of maxilla or Increase in size or alteration in contour of maxilla or mandiblemandible

Alteration in radiographic patternAlteration in radiographic patternMobility of individual teeth without significant Mobility of individual teeth without significant

periodontal diseaseperiodontal diseasePain or discomfort in jaw without obvious dental Pain or discomfort in jaw without obvious dental

pathologypathologyIncreased sensitivity of teeth without obvious dental or Increased sensitivity of teeth without obvious dental or

periodontal diseaseperiodontal diseaseChanges in the occlusion of the teethChanges in the occlusion of the teethAbnormal sequence of deciduous tooth loss or eruption Abnormal sequence of deciduous tooth loss or eruption

of permanent molars in youngof permanent molars in young


Skeletal SystemSkeletal SystemDental hygiene considerationsDental hygiene considerations

Provide guidance to ensure that Provide guidance to ensure that the patient obtains adequate the patient obtains adequate calcium and vitamin Dcalcium and vitamin D

Avoid alcohol consumptionAvoid alcohol consumption


Metabolic Problems: Metabolic Problems: Diabetes MellitusDiabetes Mellitus

SymptomsSymptomsFruity-smelling breath Fruity-smelling breath

(more prevalent in type (more prevalent in type 1 diabetes)1 diabetes)

3 P’s3 P’s Polydipsia: increased thirstPolydipsia: increased thirst Polyphagia: hungerPolyphagia: hunger Polyuria: frequent urinationPolyuria: frequent urination

Unexplained weight lossUnexplained weight loss

Oral manifestations in Oral manifestations in poorly controlled DMpoorly controlled DMPoor healing Poor healing More severe More severe

periodontal diseaseperiodontal diseaseTissue necrosis from Tissue necrosis from

minor traumaminor traumaXerostomiaXerostomiaCandidiasisCandidiasis




Metabolic Problems: Metabolic Problems: Diabetes MellitusDiabetes Mellitus

Dental hygiene considerationsDental hygiene considerationsEncourage frequent periodontal Encourage frequent periodontal

maintenance/meticulous oral self-caremaintenance/meticulous oral self-carePrevent hypoglycemia by treating patient in Prevent hypoglycemia by treating patient in

the morning, ensuring patient ate at usual the morning, ensuring patient ate at usual time and took medicationstime and took medications

Have access to a glucometer and glucose Have access to a glucometer and glucose source source

Recognize and treat hypoglycemia quickly Recognize and treat hypoglycemia quickly with the with the rule of 15’s rule of 15’s (ingest 15g of carbohydrate, (ingest 15g of carbohydrate, check blood sugar after15 mins of rest)check blood sugar after15 mins of rest)


Metabolic Problems: Metabolic Problems: HypopituitarismHypopituitarism

EtiologyEtiologyCongenitalCongenitalTumorTumorHead traumaHead traumaStrokeStrokeRadiationRadiationBrain infectionBrain infection

Oral manifestationsOral manifestationsDecreased skeletal Decreased skeletal

growth results in growth results in disproportionate disproportionate retardation of retardation of mandibular growthmandibular growth

Delayed eruptionDelayed eruptionMalocclusionMalocclusion


Metabolic Problems: Metabolic Problems: Cushing’s SyndromeCushing’s Syndrome

SymptomsSymptomsHigh blood pressureHigh blood pressurePrediabetes or diabetesPrediabetes or diabetesObesityObesityMuscle weaknessMuscle weaknessBruise easilyBruise easilyAcneAcneHirsutismHirsutismOsteoporosisOsteoporosisDepressionDepression

Oral manifestationsOral manifestationsDiabetes and Diabetes and

osteoporosis may osteoporosis may affect management of affect management of periodontal disease periodontal disease and associated bone and associated bone lossloss


Metabolic Problems: Metabolic Problems: HypothyroidismHypothyroidism

EtiologyEtiologyInadequate consumption of Inadequate consumption of

iodineiodineInborn error of metabolismInborn error of metabolismHigh intake of goitrogenHigh intake of goitrogenTreatment of Treatment of

hyperthyroidismhyperthyroidismThyroid gland disorderThyroid gland disorderDeficient secretion of TSHDeficient secretion of TSH

Oral Oral manifestationsmanifestationsIn childrenIn children

Short statureShort stature Intellectual disabilitiesIntellectual disabilities Delayed eruptionDelayed eruption Severe malocclusionSevere malocclusion Risk for cariesRisk for caries

MacroglossiaMacroglossia


Metabolic Problems: Metabolic Problems: HyperparathyroidismHyperparathyroidism

Hypersecretion of the Hypersecretion of the parathyroid hormone parathyroid hormone (PTH), leading to (PTH), leading to alterations in calcium, alterations in calcium, phosphorus, and bone phosphorus, and bone metabolismmetabolism

Oral manifestationsOral manifestationsIncreased osteoclastic Increased osteoclastic

bone resorptionbone resorptionBrown tumors occur in Brown tumors occur in

the head and neck, the head and neck, especially the mandibleespecially the mandible May affect ability to May affect ability to

consume an adequate consume an adequate dietdiet


Metabolic Problems: Metabolic Problems: Renal DiseaseRenal Disease

EtiologyEtiologyPrimary glomerular Primary glomerular

diseasediseaseSecondary glomerular Secondary glomerular

disease (hypertension, disease (hypertension, diabetes, lupus)diabetes, lupus)

Vascular diseaseVascular diseaseTubulointerstitial disease Tubulointerstitial disease

(e.g., polycystic kidneys)(e.g., polycystic kidneys)

Oral manifestationsOral manifestationsPlatelet abnormalities Platelet abnormalities

may cause gingival may cause gingival bleeding bleeding

Gingival pallorGingival pallorSlow wound healingSlow wound healingBad taste (from urea)Bad taste (from urea)MalodorMalodorStomatitisStomatitisHairy leukoplakiaHairy leukoplakia

From Ibsen OAC, Phelan JA: Oral Pathology for the From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Louis: Saunders, 2009.Dental Hygienist, ed 5. St. Louis: Saunders, 2009.


Metabolic Problems: Metabolic Problems: Renal DiseaseRenal Disease

Dental hygiene considerationsDental hygiene considerationsMedical consult needed because of bleeding tendency Medical consult needed because of bleeding tendency

and to determine need for antibiotic prophylaxis to and to determine need for antibiotic prophylaxis to prevent endocarditis and/or infection of vascular prevent endocarditis and/or infection of vascular access site for dialysisaccess site for dialysis

Minimize water due to fluid restrictionsMinimize water due to fluid restrictionsSchedule dental appointment day after dialysis Schedule dental appointment day after dialysis

treatmenttreatmentMeticulous oral self-care and frequent careMeticulous oral self-care and frequent care


Neuromuscular Problems: Parkinson’s Neuromuscular Problems: Parkinson’s DiseaseDisease

SymptomsSymptomsInvoluntary muscle tremorsInvoluntary muscle tremorsBradykinesia (slowness of Bradykinesia (slowness of

movement)movement)Muscular weaknessMuscular weaknessRigidityRigidityStooped postureStooped postureDecreased fine motor Decreased fine motor

coordinationcoordinationOrthostatic hypotensionOrthostatic hypotension

Oral manifestationsOral manifestationsAbnormal chewing Abnormal chewing

and swallow patternand swallow patternHolding food in Holding food in

mouth for extended mouth for extended periodsperiods

Frequent droolingFrequent droolingTremor of mandible, Tremor of mandible,

lips, tonguelips, tongue


Neuromuscular Problems: Parkinson’s Neuromuscular Problems: Parkinson’s DiseaseDisease

Dental hygiene considerationsDental hygiene considerationsEducate patient and/or caregiver on use of electric Educate patient and/or caregiver on use of electric

toothbrush if difficulty holding conventional toothbrushtoothbrush if difficulty holding conventional toothbrushAfter supine positioning, sit patient upright for >2 After supine positioning, sit patient upright for >2

minutes before standing to avoid orthostatic minutes before standing to avoid orthostatic hypotensionhypotension

Minimize use of water due to swallowing problemsMinimize use of water due to swallowing problemsEncourage adequate protein intake and overall healthy Encourage adequate protein intake and overall healthy

diet to maintain weight and bone healthdiet to maintain weight and bone health


Neuromuscular Problems: Neuromuscular Problems: Developmental DisabilitiesDevelopmental Disabilities

Cerebral palsy, muscular dystrophy, Down Cerebral palsy, muscular dystrophy, Down syndrome may be associated with abnormal oral-syndrome may be associated with abnormal oral-motor developmentmotor developmentOral-motor impairment is associated with:Oral-motor impairment is associated with:

Tongue retractionTongue retraction Tongue thrustTongue thrust Tonic bite reflexTonic bite reflex Oral hypersensitivityOral hypersensitivity Hyperactive gag reflexHyperactive gag reflex

All make feeding difficult as well as performing dental All make feeding difficult as well as performing dental and self-careand self-care


Neuromuscular Problems: EpilepsyNeuromuscular Problems: Epilepsy

Epilepsy does not usually result in any specific Epilepsy does not usually result in any specific oral or feeding problems, but the phenytoin used oral or feeding problems, but the phenytoin used to treat it can affect oral health as well as to treat it can affect oral health as well as nutritional statusnutritional statusGingival hyperplasia makes oral self-care challengingGingival hyperplasia makes oral self-care challengingPhenytoin increases the need for vitamins D, K, and Phenytoin increases the need for vitamins D, K, and

folate and can affect bone mass long termfolate and can affect bone mass long term Refer to health care provider for nutrition counseling because Refer to health care provider for nutrition counseling because

supplements can affect effectiveness of phenytoinsupplements can affect effectiveness of phenytoin


NeoplasiaNeoplasiaNutritional requirements for persons with Nutritional requirements for persons with

neoplasms generally increased to maintain lean neoplasms generally increased to maintain lean body mass and immune responsesbody mass and immune responsesOral symptoms or signs may be secondary to Oral symptoms or signs may be secondary to

malnutrition or nutrient deficiencies (e.g., changes in malnutrition or nutrient deficiencies (e.g., changes in taste perception)taste perception)

Intake reduced in those with cancer of the oral cavity, Intake reduced in those with cancer of the oral cavity, pharynx, or esophagus because of odynophagia (pain pharynx, or esophagus because of odynophagia (pain on swallowing) or dysphagiaon swallowing) or dysphagia


Neoplasia: Kaposi’s SarcomaNeoplasia: Kaposi’s Sarcoma

Highly malignant tumor of blood Highly malignant tumor of blood vessel origin that occurs on the vessel origin that occurs on the skin and oral mucosaskin and oral mucosaRed-purple macular lesions in the Red-purple macular lesions in the

mouth may progress to raised, mouth may progress to raised, indurated lesions with central areas indurated lesions with central areas of necrosis and ulcerationof necrosis and ulceration

Appear in many HIV-positive Appear in many HIV-positive patientspatients




Neoplasia: Acute LeukemiaNeoplasia: Acute Leukemia

Generalized malignant Generalized malignant disease characterized disease characterized by distorted tissue by distorted tissue proliferation and proliferation and development of white development of white blood cells (WBCs)blood cells (WBCs)

Oral manifestationsOral manifestationsGingiva may become Gingiva may become

severely inflamed with severely inflamed with tissue hyperplasia, tissue hyperplasia, areas of ulcerations, areas of ulcerations, necrosis, and necrosis, and spontaneous bleedingspontaneous bleeding

Delayed wound healingDelayed wound healingIncreased susceptibility Increased susceptibility

to infectionto infectionFrom Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral

Pathology for the Dental Hygienist, ed 5. St. Pathology for the Dental Hygienist, ed 5. St. Louis: Saunders, 2009.Louis: Saunders, 2009.


Neoplasia: Cancer TreatmentsNeoplasia: Cancer TreatmentsChemotherapy effects Chemotherapy effects

include:include:Stomatitis or mucositisStomatitis or mucositisOral ulcerationsOral ulcerationsDecreased absorptive Decreased absorptive

capacitycapacityChanges in taste Changes in taste

sensationsensation

Radiation therapy to Radiation therapy to head and neck affects:head and neck affects:General appetite lossGeneral appetite lossNausea, vomiting, Nausea, vomiting,

diarrhea diarrhea Loss of taste sensationLoss of taste sensationXerostomiaXerostomiaDifficulty in swallowingDifficulty in swallowingBurning sensation in the Burning sensation in the

mouthmouth


Neoplasia: Cancer TreatmentsNeoplasia: Cancer Treatments

Dental hygiene considerationsDental hygiene considerationsUsing antimicrobial mouth rinse (nonalcohol Using antimicrobial mouth rinse (nonalcohol

chlorhexidine), meticulous oral self-care, frequent carechlorhexidine), meticulous oral self-care, frequent careSoft and/or bland diet may be necessary; encourage Soft and/or bland diet may be necessary; encourage

protein intakeprotein intakeAvoid alcohol and hot, spicy, and acidic foods when Avoid alcohol and hot, spicy, and acidic foods when

oral lesions are presentoral lesions are presentCaution against eating hard candy or drinking Caution against eating hard candy or drinking

beverages containing fermentable carbohydrates to beverages containing fermentable carbohydrates to relieve the xerostomiarelieve the xerostomia


Acquired Immunodeficiency Acquired Immunodeficiency Disease Disease

SymptomsSymptomsWith HAART, classic With HAART, classic

wasting is less evident, wasting is less evident, although wasting and although wasting and anorexia may be anorexia may be presentpresent

Opportunistic infectionOpportunistic infectionMultiple nutrient Multiple nutrient

deficienciesdeficienciesProtein-energy Protein-energy

malnutritionmalnutrition

Oral manifestationsOral manifestationsOral candidiasisOral candidiasisOral hairy leukoplakiaOral hairy leukoplakiaHerpetic ulcerationsHerpetic ulcerationsKaposi’s sarcomaKaposi’s sarcomaMay have moreMay have more

severe periodontitissevere periodontitisXerostomiaXerostomia

From Ibsen OAC, Phelan JA: From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Oral Pathology for the Dental

Hygienist, ed 5. St. Louis: Hygienist, ed 5. St. Louis: Saunders, 2009.Saunders, 2009.


Acquired Immunodeficiency Disease Acquired Immunodeficiency Disease Dental hygiene considerationsDental hygiene considerations

Encourage to maintain the highest possible level of Encourage to maintain the highest possible level of oral self-care and regular preventive dental careoral self-care and regular preventive dental care

To promote healing encourage attention to adequate To promote healing encourage attention to adequate nutrient intake (e.g., kilocalories, protein)nutrient intake (e.g., kilocalories, protein)

Use nutritional supplements or instant breakfast drinks Use nutritional supplements or instant breakfast drinks as snacks for those needing added nutritionas snacks for those needing added nutrition

Limit caffeine- and alcohol-containing beverages if Limit caffeine- and alcohol-containing beverages if xerostomia existsxerostomia exists

Refer to RD and/or medical provider as neededRefer to RD and/or medical provider as needed


Mental Health Problems: Mental Health Problems: Anorexia NervosaAnorexia Nervosa

Primarily affecting Primarily affecting adolescent and young adolescent and young adult females who adult females who have an exaggerated, have an exaggerated, intense fear of intense fear of becoming fatbecoming fatZealous self-imposed Zealous self-imposed

restriction leads to restriction leads to extreme weight lossextreme weight loss

Criteria for diagnosisCriteria for diagnosisWeight loss equal to or Weight loss equal to or

exceeding 15% below exceeding 15% below expected or original expected or original body weightbody weight

Amenorrhea Amenorrhea Excessive desire for Excessive desire for

slimness with distorted slimness with distorted body image body image


Mental Health Problems: Mental Health Problems: BulimiaBulimia

Eating disorder not Eating disorder not necessarily associated with necessarily associated with significant weight loss, may significant weight loss, may be slightly overweightbe slightly overweightBingeing and purgingBingeing and purging

Binges may occur several Binges may occur several times/day in late afternoon or times/day in late afternoon or eveningevening

Most common method of purging Most common method of purging is self-induced vomitingis self-induced vomiting

Oral manifestationsOral manifestationsErosion of enamel Erosion of enamel

(lingual maxillary (lingual maxillary anterior teeth)anterior teeth)

Palatal bruisesPalatal bruisesEnlarged parotid Enlarged parotid

glandsglandsDentin Dentin

hypersensitivityhypersensitivityPerimolysisPerimolysis




Mental Health Problems: Mental Health Problems: Mental IllnessMental Illness

Many types of mental illnesses: schizophrenia, Many types of mental illnesses: schizophrenia, depression, bipolar disorder or maniadepression, bipolar disorder or mania

Drugs frequently prescribed to treat the Drugs frequently prescribed to treat the conditions may have side effects that affect oral conditions may have side effects that affect oral statusstatusAntipsychotics (haloperidol, thioridazine) and Antipsychotics (haloperidol, thioridazine) and

anticholinergics (tricyclics, MAO inhibitors, trazodone) anticholinergics (tricyclics, MAO inhibitors, trazodone) frequently cause xerostomiafrequently cause xerostomia

Trazodone can cause unpleasant tasteTrazodone can cause unpleasant taste


Mental Health ProblemsMental Health ProblemsDental hygiene considerationsDental hygiene considerations

Increased caries rate indicative of high-carbohydrate Increased caries rate indicative of high-carbohydrate bingeing and low pH of saliva from vomitingbingeing and low pH of saliva from vomiting

Must recognize signs and symptoms of suspected Must recognize signs and symptoms of suspected eating disorder and refer patients to health care eating disorder and refer patients to health care provider or eating disorder facility for careprovider or eating disorder facility for care

Caution the patient against brushing immediately after Caution the patient against brushing immediately after vomitingvomiting

Rinse with sodium bicarbonate to neutralize the oral Rinse with sodium bicarbonate to neutralize the oral environment after vomiting environment after vomiting

Encourage daily fluoride and hypersensitivity productsEncourage daily fluoride and hypersensitivity products

EFFECTS OF SYSTEMIC DISEASE ON NUTRITIONAL STATUS AND ORAL HEALTH CHAPTER 16 Copyright © 2010,...

Documents

Transcript of EFFECTS OF SYSTEMIC DISEASE ON NUTRITIONAL STATUS AND ORAL HEALTH CHAPTER 16 Copyright © 2010,...