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

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

 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

 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  Uneven hips, arms or leg lengths  Diminished lung capacity  Pressure on heart

 Atrophy of skeletal, striated muscles  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

 Characteristics Swelling of affected muscles, destruction of striated bands, cytoplasm & fatty deposits replace muscle Muscular weakness and pain  Oral characteristics Mastication problems Speech problems Mouth breathing – HALITOSIS Drooling, excessive salivation Increased perio, caries

 Males (transmitted by female carriers)  Present at birth – apparent 2-5yrs of age  Weakness of hips, lordosis, waddling gait, balance issues, muscle wasting  Arrhythmias and cardiomyopathy common  Cardiomyopathy makes it harder for your heart to pump & deliver blood to the rest of your body  Rarely live past 30  Fully disabled by puberty, confined to wheelchair

 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

 Affects hips, shoulders, pelvis  Progression varies: rapid vs slow  Manifests in late childhood/early adolescence  Cardiomyopathy common  May become wheeelchair bound

Tx Considerations Protect airway Powered oral hygiene devises may be contraindicated Wheelchair transfer Premed if heart conditions present Consult with MD

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

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

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

 S&S  Joint pain & swelling  Fingers, hands, knees affected 1 st  Stiffness: morning, after periods of inactivity  Weakness, fatigue, loss of appetite, loss of weight, anemia, low-grade fever  Subcutaneous nodules in elbows, wrists, fingers  TMD common  Difficulty chewing

Medical treatment 1. Pain relief 2. PT & OT 3. Nutritional counseling 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

Relationship to periodontal disease  RA & perio are both chronic inflammatory diseases  Pathogenesis of both is similar  Extent & severity of perio disease with RA under research

 Under 16yrs of age  Differs from adult RA  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 that continues for yrs  Tx: meds, activity to maintain function

 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  85% cases >70yrs  Progression of disease leads to pain, deformity, limited movement  TMJ usually not involved

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

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

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

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

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

 Chronic autoimmune disorder  Affects connective tissue – over production of collagen  Hardening, thickening, shrinking of ct Immobility & rigidity of skin Limits opening of mouth  Death = renal, cardiac failure, pulmonary insufficiency, intestinal malabsorption  Etiology  Collagen synthesis irregularities, immunologic disorders, microvascular abnormalities

1 st symptom Episodic vasoconstriction of hands Discoloration of fingers when cold

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

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

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