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Oral Med GERD
| Question | Answer |
|---|---|
| What are 2 common GI Diseases? | GERD and PUD |
| Which is the most common GI disorder in the US? | GERD |
| What symptom do most pt's complain about with GERD? | Heartburn |
| What is causing GERD to happen? | Esophageal sphincter is not functioning properly, causing stomach acid to flow back up the esophagus |
| What can GERD cause? | irritation and ulcerations of the esophageal lining. |
| What is the effect of chronic GERD on the teeth? (3) | Decalcification of tooth structures Perimylolsis (acid erosion of enamel) Increased risk for malignancy due to metaplastic changes in the epithelium of the esophagus. |
| What is the LES? | Lower Esophageal Sphincter |
| Location of the lower esophageal sphincter? | At the base of the esophagus, top of the stomach. |
| What does a normally functioning LES look like? | Closed |
| What does a dysfunctional LES look like? | It has areas of erosion and bleeding, cannot close properly |
| Signs and symptoms of GERD? (6) | Burning in upper chest, burping, cramps, difficulty swallowing, dry cough, full stomach feeling,. |
| What can GERD feel like? | Heart attack |
| What treatment modifications and education should you make for someone that has GERD? (4) | Semi-supine position, have them avoid eating 4 hours before appt., recommend rinsing with a weak sodium bicarbonate solution after reflux and to avoid brushing 30-60mins after reflux. Stress use of Fluoride products. |
| How can a pt. manage their GERD? (3) | Taking acid secretion reduction meds, eating small meals, and avoiding eating 4 hrs before bed. |
| What is PUD? | Peptic Ulcer Disease |
| What is the cause of PUD? | Breaks in the stomach mucosa that cause a lesion larger than 3 mm within the esophagus, stomach or duodenum. |
| What causes the erosive lesions in PUD? (2) | H. Pylori and stomach acid |
| Who does GERD and PUD occur most often in? | Older adults |
| What is pain caused by with PUD? | The acid is able to get into the submucosal area. |
| What are 5 causative factors of PUD? | Smoking, heavy alcohol use, NSAIDs, stress, hereditary |
| Signs and symptoms of PUD? (3) | Burning, gnawing pain Can go on for hours Hurts most on empty stomach |
| How to manage PUD that is localized and uncomplicated? (1) | Take antisecretory PPIs |
| How to manage PUD that is more advanced? (2) | Combination therapy w/ antibiotics to eradicate the H. pylori bacteria in addition to taking PPIs |
| Dental manifestations of PUD? (3) | Median rhomboid glossitis caused by antibiotic tx Perymylolsis Candidiasis |
| 3 medication types that can be used to treat PUD? | Antibiotics that kill H. pylori Proton Pump Inhibitors (PPI) Antacids |
| What antibiotics kill H. pylori? | Amoxicillin, Clarithromycin, etc. |
| What do proton pump inhibitors do to help? | Reduce stomach acid |
| What is asthma? | A chronic, inflammatory, respiratory disease |
| What happens during an asthma attack? | Bronchial inflammation and muscle constriction |
| What else can borrow the airway? | Mucous secretion |
| What does asthma cause? | Reduced ability to expel air from the lungs |
| Asthma is a ___________ respiratory condition if caught early enough with medications. | Reversible |
| Cause of asthma? | Bronchiole lung tissue that is sensitive to stimuli |
| Trachea branches into the right and left _______. | Bronchi |
| At the end of the bronchi, what are there? | Alveoli |
| What happens to the alveoli during asthma? | They get inflamed with air because the person can't exhale all of the air that they are inhaling. |
| Asthmatics have a higher chance of being allergic to what drugs? | NSAIDS |
| What should you recommend instead to manage pain? | acetaminophen (Tylenol) |
| What are the 5 types of asthma? | 1.) Extrinsic (allergic) asthma ~ IgE mediated 2.) Intrinsic (non allergic) asthma 3.) Exercise induced asthma 4.) Drug-induced asthma 5.) Status Asthmaticus |
| What is the most common asthma type? | Extrinsic (allergic) asthma |
| What age group often has this type? | Children to young adults |
| What types of things can trigger extrinsic asthma? | Seasonal allergens, Dust, Mold, Animal dander, Tobacco smoke, Latex |
| How does intrinsic asthma differ? | It is stimulated from within the body |
| When does intrinsic asthma usually develop? | After age of 35 |
| What can intrinsic asthma be triggered by? | Emotional stress or infections in the lungs |
| How do IgE levels differ from extrinsic to intrinsic asthma? | Intrinsic has normal IgE levels, extrinsic has an increased amount. |
| What causes exercise induced asthma? | Inhalation of cold air causes temperature change in the lungs, causing mucosal irritation and then airway hyperactivity. |
| What age group does exercise induced asthma mostly effect? | Children and young adults because they are more active. |
| Is drug-induced asthma caused by an allergy? | No. |
| What 3 types of drugs can cause drug-induced asthma? | Aspirin, NSAIDS, Beta-Blockers |
| Most severe clinical form of asthma? | Status asthmaticus |
| What is status asthmaticus? | A prolonged asthma attack that is unresponsive to treatment |
| Is this a medical emergency? | Yes. |
| Two medications that treat asthma? | Anti-inflammatory agents and bronchodilators |
| What are two types of inflammatory agents that can be used? | Systemic corticosteroid: Prednisone Inhaled corticosteroid: Beclomethasone |
| What are two types of broncholidors that can be used? | Beta-2 agonist: Albuterol, Salmeterol Methylxanthine : Theophylline |
| What drug is often in the rescue inhaler? | Albuterol, a Beta-2 agonist bronchodilator |
| Oral manifestations of asthma? (3) | Increased caries and gingivitis from xerostomia that is caused by the beta-2 agonist Increased acid erosion caused by the beta-2 agonist Oral candidiasis from frequent inhaler use |
| What are treatment modifications for someone with asthma? (3) | Remind patient to bring inhaler or meds Schedule late morning or late afternoon appointments Provide a reduced-stress environment |
| If asthmatic pt. has a sulfite allergy, what kind of anesthetic should be used? | One without a vasoconstrictor |
| What should you tell pt. to reduce risk of oral candidiasis when using their inhaler? | Rinse with water after using. |
| What should be recommended to prevent decay? | A fluoride regimen at home. |
| Drugs to avoid in asthmatic pt.? | Aspirin, NSAIDS, ACE meds, Narcotics and barbiturates, sulfites |
| 5 follow up questions to ask someone with asthma? | 1.) When was last asthma attack? 2.) How often does it occur? 3.) Do you have bronchodilator or rescue inhaler with you? 4.) What causes an attack? 5.) Medications? Type? |
| What does COPD stand for? | Chronic Obstructive Pulmonary Disease |
| What is COPD? | IRREVERSIBLE airway obstruction and destruction |
| 2 most common types of COPD? | Emphysema and Chronic Bronchitis |
| lower respiratory conditions are the ________ leading cause of death after heart disease | 2nd |
| Most causative factor of COPD? | Smoking |
| What causes emphysema? | Destruction of alveolar walls causes person to get air in but not all of it out. |
| Is COPD a childhood disease? | No. |
| True or false: the airway is obstructed during inhalation with COPD? | False, difficulty only happens with exhalation. |
| With emphysema, the lungs tend to stay inflated and air is trapped in lungs. What can this cause? | A barrel chest. |
| Why is emphysema called "pink puffer" | describes tissue color (no hypoxia) and the mechanism to expel the air. (Purses lips together to forcibly expel the air) |
| 2 symptoms or signs of emphysema? | Dry nonproductive cough and dyspnea (labored breathing) |
| What is chronic bronchitis caused by? | Excessive mucus production causing a cough with mucus for at least 3 months of the year for 2 or more years. |
| What kind of cough can be heard with chronic bronchitis? | A productive smoker's cough |
| True or False: Obstruction is only present during exhalation with chronic bronchitis? | False, obstruction is present during Bothe inhalation and exhalation. |
| Why is chronic bronchitis called the "blue bloater"? | Describes cyanotic tissue color of tissues (hypoxia), and frequently overweight nature of patient |
| What does acronym blue stand for? | B: Big and blue skin L: Long term chronic cough with sputum U: Unusual lung sounds E: Edema |
| What does acronym PINK stand for? | P: Pink skin and pursed lips I: Increased chest N: No chronic cough K: Keep tripoding |
| Is there a cure for COPD? | No |
| What can a person do to help their COPD stop progressing? | Quit the cigs |
| What 3 things can a person with COPD do to manage their condition? | Use a Bronchial dilator Low-flow oxygen therapy Vaccine for pneumonia and flu |
| Dental management for a person with COPD? (5) | Recommend Smoking Cessation program Semi-supine or upright chair position Avoid bilateral mandibular or palatal local anesthetic. |
| 5 other dental management considerations for COPD? | If severe, avoid rubber dam No Nitrous Oxide with severe COPD Low dose Valium (diazepam) if needed Watch for signs of candidiasis due to the possible use of inhalers Advise patient to rinse mouth after use |
| 5 follow-up questions to ask a person with COPD? | When diagnosed? Medications? Type? Ask about previous dental experiences Preferred position in dental chair Do you have an inhaler with you? |
| Eating disorders are caused by what? | The interaction of genetic, biological, behavioral, psychological, social and emotional factors |
| Dangerous ______ can be present, and can be obvious or ________. | Malnutrition, non detectable |
| Give the 3 eating disorders from most common to least: | B.E.D., Bulimia Nervosa and Anorexia Nervosa |
| Are eating disorders more prevalent in men or women? | Women |
| True or False: Prevalence of eating disorders has decreased? | False, increased for both genders |
| Why can dental pros play an important role in detecting ED? | 1st signs are usually oral. |
| What are the 4 oral signs of an ED? | enamel erosion dental caries salivary abnormalities ~ xerostomia dental sensitivity |
| When is a BED disorder diagnosed? | When behavior occurs on average at least 1 time per week for 3 months. |
| What is BED? | When person has overwhelming desire to consume large amounts of food within a short period of time |
| With BED, are binge eating episodes followed by purging? | No. |
| How can a person with BED look weight-wise? | Normal to oversized to obese |
| What does a person with Bulimia Nervosa do? | Recurrent episodes of binge eating , eating beyond feeling full then feel guilty, and then making themselves puke, use of laxatives or diuretics, strict dieting, vigorous exercise |
| What can bulimia nervosa cause orally? (3) | Caries and erosion, Increased risk of esophageal/laryngeal cancer, esphogitis (inflammation of esophagus) |
| What are the other 3 consequences of BN? | Malnutrition, Amenorrhea, osteoporosis, death |
| What is Russel's Sign? | Abrasion on the knuckles caused by repeated incisor/canine contact. |
| What are 3 things that mean someone has anorexia nervosa? | Refusal to maintain body weight at or above minimal normal weight for their specific age, sex and height. Intense fear of gaining weight or becoming fat. Has a distorted view of themselves; believing there is no problem or not under weight. |
| What are the medical consequences of AN? | Death (>10%) Severe dehydration, electrolyte imbalances, cardiac arrhythmias, suicide • Delayed puberty/ infertility/ • Osteoporosis • Amenorrhea |
| What disorder has higher rate of mortality? | AN |
| Suicide is the _____ leading cause of death in those with AN. | 2nd |
| 4 oral side effects of AN? | Enamel erosion, dental caries, salivary abnormalities, dentin hypersensitivity |
| What type of person behavior wise is likely to have AN? | Perfectionist, clean,energetic, overachievers, pleasers • OCD, depression • Malnourished |
| What type of person behavior wise is likely to have BN? | • Lack of Impulse Control • 30% are substance abusers • 40% have personality disorders • Depression, anxiety • May appear ‘normal’ |
| 6 less severe symptoms of AN? | Hair loss • Easy bruising • Dry skin • Feeling cold, especially hands and feet • Constipation • Dizziness, fatigue |
| 7 more severe symptoms of AN? | Cardiac arrhythmias • Electrolyte imbalances • Severe dehydration • Chronic cardiac dysfunction • Amenorrhea, infertility • Osteoporosis • DEATH |
| Where is erosion most common on the teeth of those with BN? | The palatal surfaces of the incisors, cuspids, and bicuspids. |
| What 5 things should you rule out before thinking that erosion has to do with BN? | Chronic alcoholism, Pregnancy, GERD, Chronic sucking of citrus or sugary hard candy, Specific Medical Conditions |
| What 3 things can you do in clinic for person with bN? | Custom fluoride trays Home fluoride treatments – neutral sodium 3-month recalls with fluoride varnish tx |
| What educational care should you give to someone with BN? (6) | Oral hygiene instruction Home fluoride routine Non-abrasive toothpaste Nutritional counseling Discuss consequences of eating disorders Strategies to decrease caries – xylitol products |
| What 6 dental treatments may a person with BN need? | Full mouth reconstruction after cessation of vomiting Crowns / Veneers Endodontics Grafting, crown lengthening Orthodontics Nightguard |
| How should you approach person with suspected ED? | Talk to the patient in a safe, non-threatening way (no blame or judgement) Reassure the patient you want to help her/him avoid serious consequences. Offer information and resources Refer the patient to their physician - Do not try to treat. |
| Medical tx considerations for someone with ED? | Refer for tx as soon as possible, pt. likely has other mental disorders too. |
| What types of tx can they get to help? (3) | Individual, group or family therapy. Nutritional counseling Cognitive behavioral therapy |
Created by:
Saylorlee5