Med- Sjogren’s, Cancer, Xerostomia – Flashcards
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There is primary and secondary sjogrens syndrome. Of the secondary sjorens pts what are some systemic diseases/conditions you can also have?
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- *Systemic Lupus Erthromatosis 75%* - *Scleroderma 15%* - *Rheumatoid Arthritis 25-35%* - Primary Biliary Cirrhosis - Diabetes (bolded was mentioned in 2 lectures)
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What is sarcoidosis?
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granulomatous changes
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What is cystic fibrosis?
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Eosinophilic material in acini
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What is HIV CD 8+ ?
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ambiguity with medications causing salivary hypofunction
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GVHD
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Graft versus-host disease
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Radiation and chemotherapy causes what
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Indice cellular DNA damage
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How does medicine mess up salivation?
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Oral mucosa --> afferent --> salivary nuclei in medulla --> efferent --> acetylcholine --> salivary gland cells --> saliva hypo function
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What kind of meds most likely cause xerostomia?
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anti depressants, anti-cholinergenics, anti histamines, diuretics, etc
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About how many americans use medicines?
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2/3 of americans use medicines 49% prescription drugs 30% use nonprescription medicine
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____ of older adults take at least one prescription medication. ____ take three or more prescription medications. National trend in psychiatric medication increasing. 1 to 2 in average.
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82 % of older adults take at least one prescription medication. 53 % take three or more prescription medications. National trend in psychiatric medication increasing. 1 to 2 in average.
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What is sjogrens syndrome?
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A chronic, autoimmune inflammatory disorder of exocrine glands, characterized by diminished lacrimal and salivary gland secretion in association with autoantibody production or a CT disorder
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What is the ratio of men to women for sjorgrens? How many ppl in the USA affected?
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- 9:1 ratio of women:men (perimenopausal or postmenopausal most common) - 1-4 million individuals affected in the USA
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What tests are required to "diagnose" sjoren's? European-American Criteria
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1. Either lip biopsy OR positive sjogrens specific antibody (*Ro or La*) 2. Also need 3 of the following: Positive Eye Test, low salivary function, perception of dry eye, perception of dry mouth (For the positive eye test- Schirmer, rose bengal, lisamine green) (Low salivary function- unstimulated salivary flow below 0.1ml/min in a 15 minute collection, positive scintigraphy)
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What #'s are indicated for low salivary function?
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Low salivary function- unstimulated salivary flow below 0.1ml/min in a 15 minute collection, positive scintigraphy
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What tests are required to "diagnose" sjoren's? ACR Criteria
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1. Positive sjorens specific antibody (Ro or La) 2. Positive Lip Biopsy 3. Positive eye test (rose bengal or lisamine green)
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Salivary gland biopsies for sjogrens syndrome
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1 or more foci of 50 lymphocytic concentration in 4 mm2 area for positive lip biopsy!!
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Signs and symptoms or Sjoren's
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- Asymptomic or complain of dry mouth - Hoarse voice - May experience trouble eating/chewing/speaking/swallowing/loss of sensation - Frequent sip water while eating try food - Awakening at night with oral dryness - Difficulty in wearing oral prostheses - Sore and painful mouth - Pain in the ear due to blocked parotid lands - Ocular dryness
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Autoimmune disease often experience a ____ year delay between their first symptom and diagnosis
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6-7 year delay
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Of an estimated 1 million patients with newly diagnosed cancer in the United States each year, 400,000 may develop _______ oral complications
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ACUTE or CHRONIC
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Radiation increase what in the body?
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ROS (reactive oxygen species)
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How does the oncologist, Nurse, Dentist, PCP and Pt play a role in the cancer tx? (Coordinative care)
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Radiation Therapist/Oncologist determines urgency of treatment and modalities used Nurses coordinate care Dentist/Oral Medicine assess patient before treatment to remove sources of infection and follow during and after treatment. Teach oral care. Primary Care assesses medical status of patient. Patient has to be able to understand and follow instructions
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For bone marrow transplant was is the normal platelet count? WBC?
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Platelets- 50-80,000 WBC- Treat w as low as 1000 antibiotic coverage
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What would you fix prior to bone marrow transplant?
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- Sharp restorations - Overhnags - Improper dental restoration - Orthodontic appliance
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How long before bone marrow transplant should you assess the pt?
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1 month prior to transplant is when they come in --> we want to evaluate them so we can take care of them before they go in
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For bone marrow transplant what are some indications for extractions?
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- Dental carious lesions: non-restorable - Active periapical disease (not if chronic or well localized): symptomatic teeth - Moderate to advanced periodontal disease - Lack of opposing teeth - Compromised hygiene - Partial impaction/incomplete eruption - Bifurcation involvement
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After radiation tx what should you avoid? What if you HAVE TO what should you use?
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- Extraction - Periodontal surgery - If an invasive procedure is required, the use of hyperbaric oxygen therapy before and after surgery is advised
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What is the most prevalent side effect of pts receiving radiaition therapy for head and neck cancer?
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- Xerostomia (shocking..) - Increased fissuring, depapillation and dryness
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When you have salivary hypo function what type of saliva is affected first?
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- Serous portion of saliva affected first
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The less saliva, the more.... ?
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decay
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What is some tx of trismus?
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- Stretching exercises - Mechanical devices (therabite)
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How can you stimulate flow of saliva?
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- Xylitol - Salagen
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How can you treat candidiasis?
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- Nystatin (fix it STAT!) - Clotrimazole oral troches - Fluconazole (if evidence is salivary function) ....... Also? Pilocarpine: 5-7.5mg *titrate* to max dose Evoxac 30 mg *titrate* to max dose
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WHat are some synthetic saliva?
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- Caphosol and NeutraSal (Maybe think like Sol/Sal as Salt and that makes saliva)
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Dry mouth toothpaste?
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Biotene and MI Paste
