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Aditi Khamar
Aditi Khamar
Rheumatoid arthritis
RA is a chronic, systemic disease. RA is a member of a
family autoimmune diseases with a high level of
rheumatoid factor which gives the condition its name. High
rheumatoid factor diseases include lupus erythematosis,
scleroderma, and sjorgren's syndrome.
RA is characterized by a pattern of swollen tender joints.
The joints most often include the small joints of the hands
and feet, wrists and knees.
Diagnosis
interviewing the patient to determine their history of
disease, testing the blood for rheumatoid factor and other
effects of the disease, physical examination to determine
the pattern of inflamed joints, and to look for lumps under
the skin (rheumatoid nodules), and imaging exams (x-ray,
CAT scan, and others).
As a systemic disease, RA may affect multiple organs
including the lungs, kidneys, even the tissue surounding the
heart. RA becomes active or flares up and then becomes
silent or goes into remission.
There is no cure for RA. Patients primarily take a variety of
anti-inflamatory drugs to ease the pain and inflamation of
RA. Aspirin is a time-tested non-steroidal anti-inflamatory
drug (NSAID). Newer NSAIDs including Ibuprofen and
Naproxophen are alternatives.
Steroids are very strong inflamation fighters. Prednisone is
a good choice to gain control of an especially bad flare.
There are other medications known as disease modifying
anti-rheumatic drugs or DMARDs. Gold, methotrexate, and
hydroxychloroquine slow the progress of the disease. These
medications carry their own serious side effects.
ORAL HEALTH
1)Part of the reason that RA patients have more serious
tooth decay and gum disease is that swollen, inflamed hand
and wrist joints make oral hygiene (brushing and flossing)
tedious and painful.
Electric toothbrushes provide larger, more comfortable
handles for patients who loose the ability to grasp the thin
handle of standard toothbrushes.
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returned to
normal.
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Reduced fertility
Smoking cessation
There are 5 crucial steps in advising people to stop
smoking:
Ask
Assess
Advise
Assist
Arrange
Ask
Ask the patient if he/she smokes. This information should
be recorded in the patients notes.
Smoking status should be kept up to date.
Assess
Assess the patients willingness to quit as well as recording
any previous quit attempts. This will help identify the best
means of quitting.
Advise
Advise smokers to quit. Most smokers are aware of the
dangers of smoking but may not appreciate the degree of
risk. There is good evidence that brief advice by dental
professionals is effective,
particularly for users of smokeless tobacco.
Dentists should stress to patients who have made
unsuccessful quit
attempts that it is common to make several attempts before
succeeding.
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CLASSIFICATION
Primary (essential) hypertension - 80-90% of
hypertensive patients are in this group, where no known
cause can be identified.
Secondary hypertension - 10-20% of patients are
hypertensive because of underlying disease:
renal - renal artery stenosis
endocrine - thyrotoxicosis
vascular - coarctation of the aorta
gynaecological - eclampsia and pre-eclampsia of pregnancy
COMPLICATIONS OF LONGSTANDING
HYPERTENSION
1. Cerebrovascular accident - thrombosis or aneurysm.
2. Cardiac - heart failure or myocardial infarction.
3. Renal failure.
4. Retinopathy - papilledema.
5. Headache - hypertensive encephalopathy.
MANAGEMENT OF ESSENTIAL HYPERTENSION
Non-drug measures - weight reduction, decreased salt
intake, stopping smoking, stress reduction, stopping oral
contraceptive drugs.
Medication - once commenced, drug therapy is continued
for life. The following broad categories of medication may
be used, sometimes in combinations depending on the
patient's response:
diuretics - for fluid overload, e.g. chlorothiazide
beta-blockers - to dampen the sympathetic input that
increases the activity of the heart, e.g. propranolol (Inderal)
vasodilators - to decrease peripheral vascular resistance,
e.g.hydralazine
centrally acting drugs which compete with neurotransmitter
chemicals of the sympathetic nervous system responsible
for increased
heart activity, thereby reducing sympathetic mediated
increased heart activity, e.g. methyldopa (Aldomet).
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Heparin
Clopidogrel
WARFARIN
1) Warfarin is a common oral anticoagulant prescribed for
patients with conditions like deep vein thrombosis, stroke,
pulmonary embolism, atrial fibrillation, prosthetic heart
valves.
2) So discontinuing warfarin for few days prior to dental
surgery in order to limit bleeding problems increases the
risk of thromboembolic events.
3) The possibility of post operative bleeding in patients
taking warfarin concerns the dentist. However, before
deciding if warfarin therapy should be interrupted , the risk
of post operative bleeding must be balanced against the risk
of thromboembolism.
4) The activity of warfarin is expressed using the INR(ratio
of PTtime of the patient to mean of Normal inr).
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Diabetic coma
hypoglycemia in a patient on insulin or
insulin secretogogues occurs when the
blood glucose level falls low enough to
cause symptoms and signs
adregenic symptoms
pale skin
sweating
shaking
palpitation
anxiety
neuroglycopenic symptoms
Conclusion
hunger
suboptimal intellectual function
confusion
coma
seizure
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dental history
management
-reassure the patient
-assess vital signs ,blood pressure,
pulse and respiratory rate
-defer dental treatment
-call 000
-or organise transport to medical
facilities
if patient is semi conscious will able to
drink then give a glucose drink
unconscious patient give 1mg glucagon
im or give 50ml of 50% glucose iv or
give 100ml of 20%glucose iv
there r some precaution we should take
in managing diabetic patients for
surgery
1. Perform the surgery soon after meal
time
2. Try to manage patient in short apt
3. A morning apt should be better
4. Patient should maintain oral
hypoglycemic drugs and carbohydrate
intake as usual
5. Ensure emergency glucose and drugs
to hand
6. Prescribe antibiotic and analgesic for
prophylaxis to prevent infection
secondary to delayed healing
7. Premedication in anxious patient
with benzodiazepines
8. Use gradual position changes to
avoid postural hypotension
medical considerations
take a thorough medical history for all
patients
obtain information concerning the
type of diabetes ,the severity and
control of the diabetes and presence of
cardiovascular or neurological
complications.
Refer any patient with the cardinal
symptoms of diabetes or finding that
suggest diabetes to physician for
diagnosis and treatment.-- headache,dry
mouth ,repeated skin infection,blurred
vision,paresthesia,progressive
periodontal disease
food intake and apt scheduling
1. Verify that the patient has taken
medication
2. Verify that the patient has had
adequate intake of food
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2.
3.
Contents
1 Types
o
3 Treatment
4 References
Types
Severe hypoglycemia
People with type 1 diabetes mellitus who must take insulin
in full replacement doses are most vulnerable to episodes of
hypoglycemia. It is usually mild enough to reverse by
eating or drinking carbohydrates, but blood glucose
occasionally can fall fast enough and low enough to
produce unconsciousness before hypoglycemia can be
recognized and reversed. Hypoglycemia can be severe
enough to cause unconsciousness during sleep.
Predisposing factors can include eating less than usual or
prolonged exercise earlier in the day. Some people with
diabetes can lose their ability to recognize the symptoms of
early hypoglycemia.
Unconsciousness due to hypoglycemia can occur within 20
minutes to an hour after early symptoms and is not usually
preceded by other illness or symptoms. Twitching or
convulsions may occur. A person unconscious from
hypoglycemia is usually pale, has a rapid heart beat, and is
soaked in sweat: all signs of the adrenaline response to
hypoglycemia. The individual is not usually dehydrated and
breathing is normal or shallow. Their blood sugar level,
measured by a glucose meter or laboratory measurement at
the time of discovery, is usually low but not always
severely, and in some cases may have already risen from
the nadir that triggered the unconsciousness.
Unconsciousness due to hypoglycemia is treated by raising
the blood glucose with intravenous glucose or injected
glucagon.
Advanced diabetic ketoacidosis
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Treatment
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Antigen or antibody
When found
HBs(surface)antigen or australian
antigen
Antibody to HBs(surface)antigen
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HBc(core)antigen
Hbe(envelope) antigen
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a)
b)
1.
2.
3.
4.
5.
6.
SECOND OPTION :
1.
2.
3.
4.
2.
THIRD OPTION :
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1.
2.
2.
3.
4.
3.
5.
6.
WHEN TO TREAT :
1.
2.
3.
4.
1.
2.
3.
4.
a)
TREATMENT :
b)
1.
5.
2.
3.
4.
6.
7.
d)
6.
Every pregnant patient should be scheduled for
periodic dental visits, the importance of which in the
prevention of serious periodontal disturbances should be
stressed
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CLINICAL FEATURES
1)pain, which arises mainly from soft tissue as bone is
insensitive.
2)bone exposed because overlying muco periosteum is
dependent on blood supply from bone
more in prominent areas like tori or posterior lingual aspect
of the mandible.
3)draining sinus at to=imes.
4)Extensive soft tissue infection possible
5)mobility of teeth
6)exposed bone
Radiograph might be completely normal
As medullary space of marrow is affected.
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General recommendations.
As with all dental patients, routine dental examinations are
recommended.
1)A comprehensive oral evaluation should be carried out of
all patients about to begin therapy with oral
bisphosphonates
2)The dentist should inform the patient taking oral
bisphosphonates that
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Common
or notable HIV-related oral conditions include 1)xerostomia
2) candidiasis
3) oral hairy leukoplakia
4) periodontal diseases such as linear gingival erythema
and necrotizing ulcerative periodontitis,
5) Kaposis sarcoma,
6)human papilloma virus-associated warts, and 7)ulcerative
conditions including herpes simplex
virus lesions, recurrent aphthous ulcers, and neutropenic
ulcers.
Xerostomia
Xerostomia is a major contributing factor in dental decay in
HIV-infected individuals.
experience moderate to severe xerostomia in association
with the effects of medications (eg, didanosine) or the
proliferation of CD8+ cells in the major salivary glands.
Changes in the quantity and
quality of saliva, including diminished antimicrobial
properties, lead to rapidly advancing dental decay and
periodontal disease
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Candidiasis
The 3 common presentations of oral
candidiasis are angular cheilitis, erythematous
candidiasis, and pseudomembranous
candidiasis.
Angular cheilitis presents as erythema
or fissuring of the corners of
the mouth. Treatment involves
the use of a topical antifungal cream
Erythematous candidiasis
presents as a red, flat, subtle lesion on the dorsal surface of
the tongue or on the hard or soft
palates. It may present as a kissing lesionif a lesion is
present on the tongue, the palate should be
examined for a matching lesion
patients complaining of oral burning
Pseudomembranous candidiasis (or
thrush) appears as creamy, white, curdlike
plaques on the buccal mucosa,
tongue, and other oral mucosal surfaces.
The plaques can be wiped away,
typically leaving a red or bleeding
underlying surface.
Topical treatments for mild to moderate
cases of both erythematous and
pseudomembranous candidiasis
include clotrimazole troches, nystatin
oral suspension, and nystatin pastilles
treatment must be continued for at
least 2 weeks in order to reduce organism
colony-forming units to levels low
enough to prevent recurrence.
Topical agents (mild to moderate oral candidiasis)
Clotrimazole troches
Nystatin oral suspension
Nystatin pastilles
Systemic agents
Fluconazole
Itraconazole oral suspension
Voriconazole
Oral Hairy Leukoplakia
Oral hairy leukoplakia, which is caused by Epstein-Barr
virus, presents as a white, corrugated lesion
on the lateral borders of the tongue; the lesion cannot be
wiped away
patients presenting with it while on antiretroviral therapy
may be experiencing failure of their current regimen.
Periodontal Disease
Linear gingival erythema
Linear gingival erythema, or red band gingivitis, presents
as a red band along the gingival margin
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Kaposis Sarcoma
Kaposis sarcoma is the most frequent HIV-associated oral
malignancy, Kaposis sarcoma-associated herpesvirus
(KSHV) is the etiologic agent.
Kaposis sarcoma can be macular, nodular, or raised and
ulcerated, with color ranging from red to purple
early lesions tend to be flat, red, and asymptomatic, with
the color becoming darker as the lesion
ages.
Treatment ranges from localized injections of
chemotherapeutic agents, such as vinblastine sulfate, to
surgical removal. Oral hygiene must be
stressed. Systemic chemotherapy may be the treatment of
choice.
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1.
2.
3.
2.
Pregnant women
a. Contact patients physician to verify
physical status, present management plan,
ask for suggestions regarding patients
treatment and to obtain history of previous
pregnancies
b. Maintain optimum oral hygiene, including
prophylaxis, throughout pregnancy
c. Avoid elective dental care during 1st
trimester & of 3rd trimester
d. 2nd trimester is the best time for elective
treatment
e. Avoid radiographs during 1st trimester;
thereafter take only those necessary for
treatment, always using lead apron
f. Avoid administration of drugs known to be
harmful to fetus
g. In advanced stages of pregnancy (3rd
trimester), avoid placing patient in supine
position for prolonged periods of time
3.
Trimester wise
1st..spontaneous miscarriages occur
avoid elective treatment
Plaque control,
Oral hygiene
Sc, pol, Cur
Avoid elective treatment, only urgent
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More acidic
*esophageal relux-acid exposure
1)most gestational women must increase their caloric
intake during pregnancy. Frequently, this intake is in the
form of multiple, small meals, or increased carbohydratebased food, which exposes the patients teeth to higher acid
levels and caries risk
2)If dental caries is a source of pain or acute infection
dentist should provide invasive care no matter what the
patients phase of pregnancy.
3) Dental decay also presents an additional source of
bacterial load on the patient.
4)Oral-maxillofacial abscesses may release various
exotoxins, cytolytic enzymes, as well as grampositive and
gram-negative bacteria.
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Local Anesthetics
Antifungals
Antibiotics
Ulcer healing
NSAIDS
Opiods
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etidocaine
Bupivicaine, mepivicaine
Procaine
nystatin, chlorhexidine
Clotrimazole
ketoconazole
fluconazole
the penicillin family, the
erythromycins
azithromycin,
clindamycin,
metronidazole
cephalosporins
tetracycline, minocycline,
and doxycycline
Omeprazole
esmoprazole
lansoprazole
Pantoprazole
Misoprostol
teratogenic
Even ibuprofen,
ketoprofen, and naproxen
Acetaminophen
B
C (with codeine,hydroxyl
codeine or oxycodone)
Naproxen
Oxycodone
B
B
meperidine,
hydrocodone,
propoxyphene, and
codeine
Anxiolytic
Triazolam,
Diazepam
Controversial
the risk of oral cleft
developments during the
first trimester and the risk
of neonatal toxicity and
withdrawal symptoms
during the third trimester
Controversial
NO
Antacids
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Aluminium and mg
hydroxide
Simethecone
calcium carbonate
B
C
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