1. Trauma
2. Neoplasms
3. Viral or bacterial infections
4. Progressive degenerative disorders
5. Vascular accidents
6. Compression from an arthritic spur
7. Congenital anomalies or deformities
Though there are many causes for dysfunction of the spinal cord, some major causes are __?
partial or complete paralysis
Spinal cord injuries can lead to __?
1. � from car accidents,
2. other causes are:
a. falls,
b. diving accidents
c. violence (gunshot, stabbing)
When do spinal cord injuries occur?
1 total or partial loss of sensory, motor, and autonomic function occurs below the level of the injury
The initial spinal cord injury causes what?
1. fracture
2. dislocation of one or more vertebrae.
3. Compression, stretching, bending or severing spinal cord
The types of spinal cord injuries are:
1. no twisting is critical,
2. when transferring patient should take at 4 people
At the time of the accident severe damage can be done if the patient is improperly immobilized. What precautions should be taken if spinal cord injury is suspected?
immediately after injury, causes a complete loss of flexibility....may last hours to 3 months
What is spinal shock?
1. Complete lesion: no sensation or motor function below level of the lesion
2. Incomplete lesion: partial transection or injury of the spinal cord leaves some sensation.....may return from hours to 1 year
3. Impairment of bladder and bowel movement/sexua
Sensorimotor effects:
of a spinal cord injury are __?
no sensation or motor function below level of the lesion
A complete lesion causes __?
partial transection or injury of the spinal cord leaves some sensation.....may return from hours to 1 year
An incomplete lesion causes __?
1. Respiratory function
2. Tendency for pressure sores
3. Spasticity
4. Body temperature
5. Vulnerability to infection
6. Automonic dysreflexia is a life threatening emergency condition in which the BP increases. May occur with T6 or above. BP may rise 30
What are some of the secondary complications that may occur with a spinal cord injury?
former male athlete
The typical spinal cord injury patient is:
1. psychiatric therapy
2. physical and occupational therapy may be required
What personal factors may be needed for a patient with a spinal cord injury?
during hospital stay
Emergency dental care may be needed when?
delayed until patient is stable
Non-emergency dental care of a spinal cord injury patient should be __?
1. Emergency dental care may be needed during hospital stay
2. non-emergency delayed until patient is stable
3. Dental Care: wheelchair transfer
4. 4-handed dental hygiene
5. Disease control
6. Mouth-held implements
Some of the aspects of treating a spinal cord injury patient are __?
When a place in the spinal column fails to close, the result is an open defect in the spinal canal
spina bifida =
protrusion or outpouching of the spinal cord and its covering (meninges) through an opening in the bony spinal column
Myelomeningocele =
protrusion of the meninges through a defect in the skull or spinal column
Meningocele =
congenital cleft in the bony encasement of spinal cord
Spina bifida =
1. Bony deformities
2. Loss of sensation
3. Bladder and bowel paralysis
4. Hydorcephalus: enlarged head
Some Physical characteristics of a spinal cord injury (Myelomeningocele) patient are __?
enlarged head
Hydorcephalus =
1. Neurosurgery
2. Orthopedic surgery
Medical treatment options for spinal cord victims are __?
1. General management
2. Need for premed
3. Latex allergy: common in spina bifida patients
4. Gingival care
Dental hygiene care of the spinal cord injury patient includes:
1. thrombosis,
2. intracerebral embolism,
3. ischemia,
4. cerebral hemorrage,
5. predisposing factors
The Etiologic factors that lead to Cerebrovascular Accident (Stroke) are usually brought on by:
1. Transient ischemic attack,
2. Acute symptoms of a stroke,
3. Residual or chronic attack
The Signs and symptoms of a Cerebrovascular Accident (Stroke) are:
1. Surgical,
2. physical and occupational therapy,
3. drugs
Medical Treatment for stroke victims consists of:
6 months
Dental hygiene care should be completed when after a stroke?
1. Timing: 6 months after stroke
2. Appointment procedure: may take multiple appts
3. Disease control: attempt complete care, daily fl2 may be needed, modified handles on TB's.
4. Disease risk detection: Panoramic radiographs are evaluated for evidence of
The dental hygiene care specifics for stroke patients includes __?
genetic myopathies characterized by progressive severe weakness and loss of use of groups of muscles
Muscular dystrophies are __?
male
Duchenne Muscular Dystropy (Pseudohypertrophic) primarily affects the __?
female
Duchenne Muscular Dystropy (Pseudohypertrophic) is transmitted by __ carriers.
Duchenne Muscular Dystropy (Pseudohypertrophic)
This disease is Present at birth...becomes evident between 2-5, but before 10. It is characterized by musculature, weakness of hips, lordosis, gait, progressive muscular wasting, intellectual impairment.
Pseudohypertrophic
Another name for Duchenne Muscular Dystropy is __?
Pseudohypertrophic Muscular Dystrophy
The Characteristics of this disease are: poor musculature, weakness of hips, lordosis, gait, progressive muscular wasting, intellectual impairment. By puberty most patient's with this disease are disabled and confined to a wheelchair. Most patients rarely
males and females equally
The occurance of Facioscapulohumeral Muscular Dystrophy occurs in __?
Facioscapulohumeral Muscular Dystrophy
The characteristics of this disease are: facial muscles involved, weak shoulder muscles, difficulty closing eyes. most live normal life span becoming incapacitated late in life
No specific known...preventive tx
The medical treatment for Facioscapulohumeral Muscular Dystrophy is:
Patient reception and seating
1. Assistance for the walking patient
2. Seating preparation
3. Seated patient
4. Assistance for patient while rising from chair
Patient instruction
1. Problems for oral cleanliness
2. Oral disease control
Dental hygiene care for patient's with Muscular Dystrophy includes:
Myasthenia Gravis
This can occur at any age but early peak is 20 and effects women twice as much as men...in adult life more men are affected.
1. Oral/facial problems: muscles of face, mastication, and tongue lead to swallowing difficulties, disturbed speech
2. Respiratory involvement: when muscles become involved with breathing respiratory problems occur
3. Precipitating factors
4. Types of cri
The Signs and symptoms of Myasthenia Gravis are:
1. Anticholinesterase agents
2. Therapy to induce remission (removal of thymus gland and drug therapy)
Medical treatment for patients with Myasthenia Gravis includes:
1. Good OH is critical
2. Appt factors (time and length, maintenance)
3. 4-handed dental hygiene
4. Patient instruction for dx control and biofilm control
Dental hygiene care focuses for patient's with Myasthenia Gravis includes:
between 20 and 40
Multiple Sclerosis happens to patient's at what age?
women
Multiple sclerosis occurs twice as often in ___.
Multiple Sclerosis
This disease is more prevalent in terperate climates.
1. Visual impairment, coordination, tremor, fatigue, weakness, diplopia, paresthesia of hands or feet
2. Course of Dx: replases and remissions
3. Physical symptoms
Some characteristics of Multiple Sclerosis are __?
1. Relapsing-remitting
2. Secondary progressive
3. Primary progressive
4. Progressive relapsing
The categories of multiple sclerosis are __?
acute episodes worsening with recovery and a stable course between relapses
Relapsing-remitting =
Gradual neurologic deterioration with or without superimposed acute relapses in a patient who previously had relapsing-remitting multiple sclerosis
Secondary progressive =
Gradual nearly continuous neurological deterioration from the onset of symptoms
Primary progressive =
Gradual neurologic deterioration from the onset of symptoms but with subsequent superimposed relapses (very uncommon)
Progressive relapsing =
Progressive relapsing
Which Multiple sclerosis condition is most uncommon?
1. Corticosteroids: antiinflammatory
2. Interferon Beta: reduce or prevent severity
3. Glatiramer Acetate: reduce or prevent relapse
4. Mitoxantrone: anticancer med
5. Natalizumab: infusion med
6. Pallitive Meds that treat:
a. Fatigue
b. tremors
c. nausea
Treatment for multiple sclerosis is:
1. Prevent relapses,
2. treat exacerbations,
3. relieve symptoms,
4. psychological support
Treatment for multiple sclerosis does what?
1. provide a warm, quiet comfortable environment
2. frequent short appts are better
Appt considerations for the multiple sclerosis patient consists of:
Cerebral Palsy
This is when injury to parts of the brain has occurred prenatally, natally, or postnatally?
1. Spasticity
2. Athetosis: involuntary, unorganized muscular movement
3. Ataxia: loss of equilibrium
4. Rigidity: muscles may be rigid and stiff
5. Tremor: involuntary muscle quivering
6. Flaccidity: muscles are flabby and weak, drooling
7. Mixed: variou
The Types of characteristics common with cerebral palsy are:
1. Mental retardation
2. Learning disabilities
3. Seizures
4. Sensory disorders - seeing and hearing
Examples of conditions that occur in cerebral palsy patients that accompany motor activity issues are:
1. Surgical,
2. orthopedic,
3. speech,
4. physical/occupational therapy,
5. meds
Medical treatment for patients with cerebral palsy includes:
1. Disturbances of musculature,
2. malocclusion,
3. attrition,
4. fractured teeth,
5. caries,
6. perio infections
Oral characteristics for patients with cerebral palsy includes:
Bell's Palsy
Paralysis of the facial muscles innervated by the facial or seventh cranial nerve. Cause is unknown but some possibilities may include: bacterial/viral infections (herpes simplex, injury, trauma)
women
Bells Palsy affects __ who when young?
men
Bells Palsy affects __ who when over 50 years old?
1. Abrupt weakness or paralysis of facial muscles
2. one side of mouth and eye drooping.
3. Speech may be impaired
4. Most patients return to normal in about a month
Characteristics of Bell's Palsy are:
1. bacterial/viral infections (herpes simplex,
2. injury,
3. trauma
The cause of Bell's Palsy is unknown but some possiblities may include:
1. Palliative: eye protection with lubricating drops, massaging muscles, hot compresses
2. Drugs: steroids
3. Surgical
Medical treatments for Bell's Palsy include:
frequent
It is important for Bell's Palsy patients to have __ dental appts
Parkinson's Disease
This is a progressive disorder of the CNS?
middle-aged and older person, higher incidence with men
The occurance of parkinson's disease is most common in __?
Parkinson's disease
Tremor, rigidity, and a loss of motor function could all be symptoms of what condition?
Good general health
Treatment for parkinson's disease:
Rheumatoid Arthritis
This is a chronic, immunologic systemic dx in which inflammation of joints occurs in exacerbations and remissions.
20-40% more females than males
Who is most likely to get Rheumatoid Arthritis?
1. joint pain/
2. swelling/
3. morning stiffness,
4. weakness
Rheumatoid Arthritis has the following signs and symptoms:
NSAIDS
How is Rheumatoid Arthritis treated?
16
Juvenile Rheumatoid arthritis occurs in children under what age?
Degenerative joint disease:
This joint disease affects the weight bearing joints, is treated with moderate exercise and pain-relieving drugs, and occurs in patient's between 50 and 70 years old.
1. depression,
2. discouraged,
3. worried,
4. pessimistic
Some personal factors that may affect arthritis patients are:
Progressive systemic sclerosis
Scleroderma is also known as __?
Scleroderma
This is an autoimmune disease of the connective tissue that is 2-5x more common in females.
1. may be localized and involve only the skin 2. may be generalized and involve all organs
3. General manifestations: joints, polyarthritis, skin, face
4. Oral characteristics: lips, mucosa, teeth, radiographic findings, mastication, tongue
The characteristics of Scleroderma include:
Scleroderma (Progressive systemic sclerosis)
Medications that retard collagen deposition are typically used for which condition?
Good Oral Hygiene
The dental hygiene care plan for Scleroderma, arthritis , and Parkinsons Disease is __?
Kidney disease
This is a disease which involves impaired kidney function and may need a premed as it is considered a major health care problem.
Urinalysis and blood test
How is kidney disease diagnosed?
Peritoneal dialysis
Hemodialysis: if dental tx causes bleeding not performed
Treatment of end-stage renal disease involves:
1. Petechiae,
2. ammonia in saliva,
3. stomatitis,
4. erythema,
5. edema,
6. candidiasis,
7. demineralization of bone
Oral finding in patients with Kidney disease include:
1. lidocaine/xylocaine,
2. NSAID's,
3. acetaminophen,
4. penicillin,
5. clarithromycin
Which medications are contraindicated for patients with kidney disease?
Kidney disease
This condition requires the highest level of oral cleanliness.