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DH201 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.

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Presentation on theme: "DH201 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."— Presentation transcript:

1 DH201 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

2 1. Scoliosis 2. Muscular Dystrophy 3. Arthritis 4. Scleroderma

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5  Curving of spine as a ‘C’ or ‘S’ shape more than 10 ◦  Wedging & rotation of the vertebrae  Secondary scoliosis  Result of a neuromuscular conditions (ex: spina bifida, CP)  May see radiopacity in center of a pano  Best results = tx’d when young

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8  People having reached skeletal maturity are less likely to have a worsening case  S&S  Uneven musculature on one side of the spine  A rib prominence or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis  Uneven hips, arms or leg lengths  Slow nerve action (in some cases)  Diminished lung capacity  Pressure on heart  Restricted physical activities

9  Observation  Physical therapy  Chiropractic  Occupational therapy  Casting  Bracing  Surgery

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13  Atrophy of the skeletal, striated muscles  200,000 people in USA  Over 50% between 4-15yrs of age  Etiology unknown  Types 1. Duchenne type 2. Limb-girdle dystrophy 3. 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

14  Characteristics Swelling of affected muscles, destruction of striated bands, cytoplasm and fatty deposits replace muscle Muscular weakness and/or pain Mobility problems/walking problems Lack of stability in a chair  Oral characteristics Mastication problems Speech problems Mouth breathing – oral malodor Drooling, excessive salivation Increased susceptibility to periodontal disease and caries

15  Primarily limited to males, transmitted by female carriers  Present at birth – apparent 2-5yrs of age  Muscles enlarged, weakness of hips, lordosis w/ abdominal protuberance, waddling gait, balance issues, muscle wasting (thighs, shoulders, trunk)  Arrhythmias and cardiomyopathy common  Cardiomyopathy makes it harder for your heart to pump and deliver blood to the rest of your body  Could lead to heart failure  Rarely live past 30  Fully disabled by puberty, confined to wheelchair

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17  Males:Females equal  6-20yrs (average age 13yrs)  Oral side effects  Facial, eye muscle issues  Gaping of lips - similar to mouth breathers  Malocclusion, TMD  Systemic side effects  Cardiac involvement rare  Scapulae prominent, shoulder muscles weak = difficulty raising arms  Progression slower than Duchenne & progression may arrest  Most patient live normal life and become incapacitated later in life

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19  Affects hips, shoulders, pelvis  Progression varies: some rapid, some decades before affected  Manifests in late childhood/early adolescence  Cardiomyopathy common  May become wheelchair bound

20  Tx Considerations Protect the airway Powered oral hygiene devises may not be best idea Wheelchair transfer Premed if heart conditions present Consult with MD

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22  Inflammation in a joint  Most common causes of chronic illness in USA  Acute or chronic forms  Contributing factors  Infectious agents, traumatic disorders, endocrine abnormalities, tumors, allergy and drug reactions, inherited

23 1. Rheumatoid arthritis 2. Juvenile RA 3. Degenerative joint disease/Osteoarthritis

24  Chronic, immunologic systemic disease in which inflammation of the joints occurs in exacerbations & remissions  Etiology: Unknown  Onset 20-40yrs  More women than men  Rare in tropical countries

25  S&S  Joint pain and swelling  Polyarthritis with migratory pain, swelling, tenderness, and warmth in symmetric joints  Fingers, hands, and knees are usually affected first  Stiffness: morning, after periods of inactivity  Weakness, fatigue, loss of appetite and weight, anemia, low-grade fever  Subcutaneous nodules in elbows, wrists, fingers  TMD common  Difficulty chewing

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29 Medical treatment 1. Pain relief 2. Physical & occupational therapy 3. Overall health maintenance w/ adequate nutrition 4. Meds NSAIDs Trexall(Methotrexate): autoimmune diseases & cancer Gold compounds(Ridaura) Imuran(azathioprine): immunosuppressive Cyclosporin: immunosuppressive Humera: TNF (tumor necrosis factor)-blocker (TNF- α causes joint swelling & inflammation) 5. Joint replacement surgery

30 Relationship to periodontal disease  RA & perio are both chronic inflammatory diseases  Pathogenesis of both is very similar  Etiology differs  Extent & severity of perio disease & RA have a relation (unclear rsrch)

31  Under 16yrs of age  Differs from the disease in adult  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 or mild arthritic symptoms that continue for yrs  Tx: meds, activity to maintain function

32  Affects weight-bearing joints  Inflammation is not the joint problem like RA  Predisposing factors  Repeated trauma (athletes)  Obesity  Age-related change in tissues  Mechanical/loading stress  Genetics  50-70yrs (85% people >70yrs)  Progression of disease leads to pain, deformity, limited movement  Hips, knees, vertebrae most affected  TMJ usually not involved  Stiffness greatest in AM

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34  Joint pain and impaired motor function  Joint replacement and antibiotic premedication  Oral self care if hands involved  Offer home care aids that accommodate issues

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36 A chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines: a. Progressive systemic sclerosis b. Rheumatoid arthritis c. Tubular sclerosis d. Lupus erythematosus

37 A chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines: a. Progressive systemic sclerosis b. Rheumatoid arthritis c. Tubular sclerosis d. Lupus erythematosus

38 Which of the following devises would you recommend for an arthritis patient? a. Flossing instruction b. Oral irrigator c. Manual toothbrush d. Electric toothbrush

39 Which of the following devises would you recommend for an arthritis patient? a. Flossing instruction b. Oral irrigator c. Manual toothbrush d. Electric toothbrush

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41  Chronic autoimmune disorder  Affects connective tissue – over production of collagen  Hardening, thickening, shrinking of ct Immobility & rigidity of skin Limits opening of mouth  Etiology  Collagen synthesis irregularities, immunologic disorders, microvascular abnormalities  No Hereditary links  Raynaud’s phenomenon: first symptoms  Episodic vasoconstriction of hands  Discoloration of fingers when cold

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43  30-50yrs of age but can affect any age grp including infants  May develop over months or yrs  More women than men  Localized to skin or can affect organs  Death = renal, cardiac failure, pulmonary insufficiency, intestinal malabsorption

44 Oral Characteristics  Xerostomia  Widened PDL  Thin, rigid lips  Difficulty in opening and closing mouth  Thin, pale, tender, rigid mucosa & gingiva  ↑ mobility  Difficult mastication  Tongue may be immobile  Speech difficult

45 Which of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen? a. Scleroderma b. Systemic lupus c. Multiple sclerosis d. Rheumatoid arthritis

46 Which of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen? a. Scleroderma b. Systemic lupus c. Multiple sclerosis d. Rheumatoid arthritis


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