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migraines affect women or men more?
dental aspects?
women,
tooth extraction
amalgam removal
occlusal splints
cranial arteritis:
women or men?
what mediated?
Dental aspects?
women
immune
pain on mastication (20%), limited mouth opening
multiple sclerosis: what subtype is most common?
relapsing-remitting most common
Epilepsies: What management?
prophylatic anticonvulsants
teratogenicity
thrombocytopenia
gingival hyperplasia
nephrotic syndrome: dental aspects
long term corticosteroid side effects
consider antibiotic prophylaxis
acquired heart disease:
hospital setting for tx
unstable angina
MI < 3 months prev
General anesthesia = essential
for hyper tension: when appointment? what other considerations?
short, late morning appointments
avoid EPi
Myocardial infarction:
MI < 6 months
MI 6-12 months:
MI > 12 months
All post
MI < 6; defer tx
MI 6-12: simple elective
anxiolytics
MI: > 12: elective dental care, minimize pain + anxiety
All post:
Risk proportional to procedure
minimize pain and anxeity
Appropriate monitoring
Arrhythmias: when? what is most aggresive
late AM/ early PM
tachycardia and ventricular fibrillation
pacemakers:
what is contradindicated
is prophylaxis necessary?
MRI, electrosurgery, diathermy, TENS
no
__ should be available at every appt with pt with heart disease
Nitroglycerin
3P model
predisposing → precipitating → perpuating
Measuring dental fear: physiological (3)
importnat but hard to detect:
perspiration
Increased respiration rate
high HR or BP
Measuring dental fear: behavioral (4)
leg swinging, bouncing
facial expressions
use of humor, speed of talking
escape behavior
decreased control + increased uncertainty = ?
increased perceived control + decrease uncertainty?
anxiety
calmer
Biophyscosocial pain: acute pain is a __ of the disease while chronic pain is _
symptom, disease itself
What are the 5 behavioral strategies
communication
information based strategy
tell show do
distraction
relaxation excercises
biofeedback
What are the factors that influence dental health care across communities? (5)
motivation
culture + community values
education and socioeconomic factors
societal norms
tech, info, options available
cultural humility
mindset of lifelong learning, self eval, self critique to ensure flexibility and openness to diverse perspectives
cultural competence
development process in which individuals achieve increasing levels of awareness, knowlegde, + skills along cultural competence continuum
primary vs secondary dimensions
primary: born into
like age, gender, race, sex
secondary: change:
like income, geo location, family status
HIV/AIDS: what to classifiy? how transmitted?
CD4 helper cells are under 200
Intimate contact, contaminated blood, tissue, needles
NOT air, water, saliva
Oral manifestations of HIV/AIDS (7)
candidiasis
chronic HHV-1 infection
herpes
cytomegalovirus infection
hairy leukoplakia
kaposi sarcoma
non-hodgkin lymphoma
neutropenia
decreased PNL due to disease or drugs (nuetrophols, basophils, eosinophils = granuloctyes)
Humoral Immunity: IgA, IgD, IgE, IgG, IgM
IgA: secretory and mucosal immunity (most common)
IgD: unknown
IgE; allergy and parasitic
IgG: bacterial infections
IgM: opsonization
cell mediated immunity: Antigen presenting cells
Macrophages and langerhans
ALL CN except ? checked on exam
I
CN VII: what features? stroke vs palsy
sensory + motor, sensory:taste to anterior 2/3
bells palsy: paralysis to one side of face: facial nerve out
stroke: facial nerve intact
Normal breath sounds: tracheal, broncial, vesicular
tracheal: over trachea
Bronchial; over hilum, high pitched, exhal > inhale
vesicular: over most of lung, low pitched, inhale > exhale
reference lines of post thorax
scapular line and vertebral line
PMI
point of max impulse (where you hear HR most)
feel for left ventricular impulse to find PMI
Normall at mid-clavicular line, if not: lateral displacement indicates large left ventricle, sign of chronic heart failure
water fluoridation level
0.7 ppm
mercury: high levels are ?
what is most common? metallic?
neurotoxic and nephrotoxic
organic mercury most common
metallic: no consistent evidence of adverse effects
most drug allergies/hypersenstivities are __ mediated
IgE
Pencillin allergy: type ?
latex allergy:: type?
type I
type IV (contact)
hypogeusia vs dysgeusia
hypo: loss of taste acuity
dys: distortion of tase function
most common cancer and lethal cancer in women adn men
women:
common: breast, lethal: lung
Men
common: prostate, lethal: lung
microbial carcinogenesis: 4
parasitic: bile and bladder
oncogenic DNA: HPV, EBV, HBV
oncogenic RNA: human t cell luekemia, hep C
H pylori: gastric adenocarcinoma
systole vs diastole
systele: vent contraction, dysole: relaxed
causes of iron deficiency anemia
blood loss, diet, absorption issues, menstrual, pregnancy
osteogenesis imperfecta
abnormal formation of bone
can be associated with dentinogenesis imperfecta (abnormal formation of dentin)
translucent teeth, obliterated pulp chambers
Fibrous dysplasia: where/who common, what lesions
more common in maxilla > mandible, more F > M
cafe au lait skin lesions
butterfly rash on mid face?
lupus erythematous
Sjorgens primary and secondary
primary: dry mouth and dry eyes
secondary: dry mouth and dry eyes, rheumatoid arthritis, increased risk of parotid lymphoma
scleroderma
hard skin, mask like face, restricted movements, limited tongue movement
Crohn’s syndrome apparence
cobblestone intenstinal lining
MEasles presents with
kolpik spots
kaposi sarcoma
HIV/AIDS patients, hole in palate, aggressive cancer of mouth
actinomycosis
sulfure granules most charateristic feature
Cocaine/drug use in mouth
Hyperstimulation and mimics adrenaline effects
Ischemic necrosis (perforated septum and hard palate)!!!
CIMDL - cocaine induce midline destroctive lesions
Dental Aspects
Dental erosion
Blood-borne infections
Bruxism
Xerostomia
Avoid epinephrine for 2 hours after use
Best to treat 6 hours after last
BCC
where often?
appears?
does it metastaize?
most common type of skin, head, neck
Pink, pearly papule rolled edge
rarley
Actinic keratosis
where occur?
appearance?
what can progress to?
sun damaged areas (scalp, face, tops of ears)
rough or gritty pink to red macule or papule with anglular border
invasive SCC
SCC
how appear?
How common?
appearance>
metastasis?
Second most common, most in AA
most often on head, neck
pink to red scaly or ulcerated enlarging papule
Metastases higher in these groups
high risk: lip ear
immunosuppresion
arising in scars or sites of chronic inflammation
Malignant melanoma
risk factors (6)
family history of MM
personal history of MM
presence of atypical nevi
numbers of banal nevi
history of excessive UV and sunburns
fair skin type
Seborrehic dermatitis (dandruff)
what?
where?
appearance?
sebum production and commensal yeast malassezia
sebum rich areas
sharply demaracated, greasy, pink-yellow to red-brown patches
chronic
lichen planus
inflammatory disease of skin, hair,, nails,
flat topped, polygonal
Flexural lower legs, ankles, wrists, genitalia
Stevens-Johnson Syndrome
what?
what implicated?
Characterized by?
mortality rate
risk factor?
rare, potentiall fatal acute rxn
meds implicated in majority
illness and meds in children
Characterized by mucosal and skin lesions due to extensive keratinocyte death
1-5%
immunsuppression (lymphoma!) risk factor
Ectodermal dysplasia
what kind of disorder? affects?
depening on mutation…
inherited disorders
affects hair, teeth, nails, sweat glands
Depending on mutation
X-linked, AD, or AR
immunodeficiecy, digit abnormalities
Basal cell nevus syndrome
what kind?
affects?
gorlin syndrome
autosomal dominant inheritance
affects PTCH gene (checkpoint to stop growth)
transmembrane protin
cancer cell movement
seedin in cavity, blood, lymph, neuron
Bells palsy vs facial
eyebrows wont move but it could it stroke pts
impacted teeth = ?
gardners syndrome
isograft
identical twins give each other perfect mouth transplant
CN testing: whats tested together
3,4,6 together, 9+10