Population Diversity Lecture 3

when does paralysis occur

lack of blood supply to the nerve cells

pressure on spinal cord

what is affected by paralysis

both movement and sensation

what is quadriplegia

damage to cervical portion of the vertebrae

affects trunk and all 4 extremities

what is paresis

partial paralysis/ weakness

what is paraplegia

damage to the thoratic, lumbar, sacral vertebrae

affects lower trunk and lower extremities

what is hemiplegia

one side of the body

what is triplegia

hemiplegia with paralysis of one additional limb

The level at which the spinal cord is injured

determines the extent of sensory and motor deficits.

etiology of paralysis

spinal cord injury from car accident

occupational accidents

sports

gunshot wounds, stabbings

oral manefestations of someone with paraplegia

same dental concerns as the rest of us

hemiplegic OHI

face maybe numb on the affected side

• there will be pooling of food in the numbed area

• educate to rinse mouth after each meal

Individuals with higher spinal cord injury may have

impaired ventilation

reduced gagging nd coughing reflex

difficulty controlling fluids

ORAL HYGIENE AND THE DYSPHAGIC PATIENT

• All oral hygiene measures should be done in the most upright position possible.

• Patient’s head should be turned sideways when providing care

• Suction decreases the incidence of aspiration

• Toothpaste should be used on a case-by-case basis only.

BEFORE MAKING wheel chair TRANSFER

Assess the ability of the client to proceed

Determine the client’s needs

Ask client- preferred method, ability to help, use of special paddings or techniques, probability of spasms

COMPLICATIONS INVOLVED IN WHEELCHAIR TRANSFER

• moving ct may cause spams

• pressure sores

• bowel and bladder elimination

• autonomic dysreflexia - sudden spike in blood pressure

WHY DO WE NEED STABILIZERS?

for cts with tremors, muscle spasms, hyperflexive responses

examples of stabilizers

pillows

seat belt

towels

what is multiple sclerosis

chronic

autoimmune

degenerative & progressive

disease of the white matter in the myelin tissue of the CNS

eventually causes paralysis

what is the etiology of Multiple sclerosis

unknown and no known cure

THE DEMYELINATION In MS LEADS TO 4 IMPORTANT CNS DISTURBANCES 

• decreased nerve conduction velocity 

• differential rate of impulse transmission 

• partial conduction blocking 

• complete failure of impulse transmission

THE CARDINAL CLINICAL MANIFESTATIONS OF MS ARE CAUSED BY INJURY TO

• visual fibers

• motor systems

• sensory fiber systems

PATIENTS WITH MS MAY BE RECEIVING ONE OR MORE OF THE FOLLOWING MEDICATIONS

• Disease modifying therapies (DMT)s

• corticosteroids 

• muscle relaxants 

• antidepressants 

who mostly expiriences TRIGEMINAL NEURALGIA

women

near menopause

what is TRIGEMINAL NEURALGIA

• Compression of the superior cerebellar artery on the nerve

• Attacks- sudden, severe, unilateral pain

• Can be disabling

how to treat trigeminal neuralgia

• Anticonvulsants- carbamazepine, clonazepam, phenytoin, gabapentin

             2) Antispasmedics- baclofen

             3) Botox/glycerol injections

• Surgery to cut the trigeminal nerve 

ROLE OF THE DENTAL HYGIENIST in MS

• consider limitations of motor skills

• The dental professional must outline the role infection in the mouth plays in exacerbating multiple sclerosis

• short morning appointments

• rubber dam for respiratory problems

• seat them at 45 degrees

• sedation, gen anesthesia

what is muscular dystrophy

a combination of several chronic dieases involving atrophy of the skeletal muscles

Muscle fibres degenerate & are replaced by fatty and fibrous tissue

eventually fatal

most common types of muscular dystrophy

1. duchenne - most debilitating

2. limb gridle

3. Fascioscapulohymeral

At what age is Duchenne dystrophy evident?

By age 3.

Which extremities does Duchenne dystrophy involve?

All child’s extremities.

When does confinement to a wheelchair become necessary in Duchenne dystrophy?

By the age of 10.

What often results in death in Duchenne dystrophy?

Respiratory infections.

What other condition may also exist in Duchenne dystrophy?

Congestive heart failure.

What is the role of drug therapy in Duchenne dystrophy?

Drug therapy is used to treat symptoms, but no medication has been found to cure the disease.

What additional therapies are used for fascioscapulhumeral dystrophy?

Therapy, braces, and myofunctional therapy.

In muscular dystrophy, weakness of which muscles causes secondary malocclusion, decreased protective reflexes, and a decrease in the ability to swallow secretions?

Weakness of the facial and neck muscles.

In muscular dystrophy, what three problems are caused by weakness of the facial and neck muscles?

Secondary malocclusion, decreased protective reflexes, and a decrease in the ability to swallow secretions.

In muscular dystrophy, why may poor oral hygiene be present?

Due to an inability to provide self-care.

In muscular dystrophy, what must treatment plans consider?

The patient’s limitations of motor skills.

In muscular dystrophy, what may the preventive dental program require?

Involvement of a family member or caregiver.

OROFACIAL MANIFESTATIONS of duchenns dystrophy

• A loss of strength in the muscles of mastication and a diminished biting force are characteristic of all forms.

• As a result speech may be nasal and hard to understand

• High incidence of open bite and overexpanded maxilla. 

• Higher incidence of perio and decay

dental and oral hygiene considerations for Muscular dystrophy

seatbelts

ct must remain smi upright

rubber dam

non foam toothpastes

wheelchair transfer

short appts

Parkinson's Disease is characterized by

muscular rigidity, tremor, bradykinesia (slowness of movement)

what is Parkinson's Disease

degeneration of the deep cerebellum

decreased production of dopamine

loss of controlled voluntary movments of the body

gradual dementia will occur

what is the cause of Parkinson's Disease

mostly unknown

cerebral vascular accident

carbon monoxide poisoning

cerebral trauma

what are manifestations of Parkinson's Disease

tremors

shakes

lack of muscular control

ridgid large joints

heat sensitivity

oral manifestations of Parkinson's Disease

drooling

spasms

difficulty swallowing

tremors

xerostomia

lack of facial expression

clinical considerations for people with Parkinson's Disease

short appts

appts are best when meds are effective (60-90 min after ingestion)

may need wheelchair transfer

rubber dam

place ct in 45 degrees