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Chapter 17: Effects of Systemic Disease on Nutritional Status and Oral Health

Terms in this set (31)

Iron Deficiency Anemia
Etiology:
- Increased needs during growth periods such as infancy or pregnancy
- Excessive bleeding
- Inadequate intake

Oral Manifestations:
- Atrophic glossitis
- Aphthous ulcers
- Gingival and mucosal pallor
- Angular cheilosis
- Candidiasis
- May impair wound healing
Anorexia
A condition in which a person has a poor appetite for various reasons

May decrease because of pain, apathy, anorexia, drugs, inactivity, or other reasons
Smell
People with loss of _____________:
- Report eating less
- Use more spices
- Eat/drink fewer sweet
Taste
People with loss of ___________:
- May require greater amounts of sodium and sugar
- Inadequate food intake
- Weight loss
Vitamin C
Encourage ______________ to enhance absorption of Iron in patients with Iron Deficiency Anemia
Megaloblastic Anemia
Etiology:
- Increased Needs
- Inadequate intake of B12
- Malabsorption of B12

Oral Symptoms:
- Angular cheilosis
- Recurrent aphthous ulcers
- Erythematous mucositis
- Pale or yellowish oral mucosa
- Atrophic glossitis; beefy red color
Pernicious Anemia
Megaloblastic Anemia from vitamin B12 deficiency is also known as __________.
Megaloblastic Anemia
Etiology:
- Poor diet
- Medications that interfere with Folate absorption (phenytoin or methotrexate)

Oral Manifestations:
- Atrophic glossitis
- Ulcerations
- Glossodynia
- Angular Cheilitis
- Fungal Infections
Neutropenia
Etiology:
Results from dysfunctional bone marrow
- Cancer (ex: leukemia)
- Drugs (ex: chemotherapeutics or antibiotics)
- Radiation therapy
- Autoimmune disease (ex: RA, Lupus)
- Bacterial or viral infection
- Hematologic disease
- Nutritional deficiencies

Oral Manifestations:
- Mucositis
- Viral infections
- Fungal Infections (candidiasis)
GERD (Gastroesophageal Reflux Disease)
Lower esophageal sphincter allows gastric contents to backflow into the esophagus

Etiology:
- Hiatal hernia
- Obesity
- Pregnancy

Recommendations:
- Avoid trigger foods (ex: fatty foods)
- Eat small, frequent meals
- Keep patient in supine position
- Assist with tobacco cessation
- Weight loss as needed
Malabsorptive Conditions
Etiology:
- Crohn's disease
- Ulcerative colitis
- Cystic fibrosis
- Gluten- sensitive enteropathy (sprue or celiac)
- AIDS

Oral Manifestations:
- Swollen, bleeding, erythematous gingiva
- Diffuse pustular eruptions on buccal gingiva
- Oral ulcerations
- Swelling of the lips
- Cobblestone-like, raise hypertrophic lesions
- Taste alterations: metallic dysgeusia, reduced taste acuity
Stroke (Cerebrovascular Accident-CVA)
Results if occlusion or ischemia occurs in an artery supplying the brain, or if hemorrhaging in the brain occurs

Oral Manifestations:
- Dysphagia
- Facial muscle weakness
- Slurred speech
Hypertension
Dental Hygiene Considerations:
- Minimize stress for the appointment
- Monitor blood pressure
- Manage medication- induced xerostomia
- Recommend fruits and vegetables, low-fat/nonfat dairy products; to limit sodium, alcohol, caffeine; tobacco cessation; lose weight; reduce stress
Stroke (Cerebrovascular Accident-CVA)
Dental Hygiene Considerations:
- Monitor blood pressure
- Using water for rinsing or ultrasonic instrumentation may be contraindicated during dental care if dysphagia is present
- Neurological deficits may cause some to be unaware of the presence of food in the mouth, so the mouth should be checked for any pocketed foods after meals
Hyperlipidemia
Excess fat in the blood

Dental Hygiene Instructions:
- Recommend reducing total fat, saturated fat, dietary cholesterol
- Encourage noncariogenic, low fat snacks
- Long- term use of bile acid sequestrants to lower serum lipids may cause malabsorption of fat-soluble vitamins and folic acid
Biphosphonates
___________ used to treat osteoporosis and multiple myeloma increases risk of osteonecrosis.
Diabetes Mellitus
Symptoms:
- Fruity smelling breath
- Polydipsia
- Polyuria
- Polyphagia
- Unexplained weight loss

Oral Manifestations
- Poor healing
- More severe Periodontal disease
- Tissue necrosis from major trauma
- Candidiasis
Treat patient in the morning; ensure patient ate at usual time; took medications
What 3 things should you do to help prevent hypoglycemia?
Hypopituitarism
Etiology:
- Congenital
- Tumor
- Head Trauma
- Stroke
- Radiation
- Brain Infection

Oral Manifestations:
- Decreased skeletal growth results in disproportionate retardation of mandibular growth
- Delayed Eruption
- Malocclusion
Cushing's Syndrome
Symptoms:
- High blood pressure
- Pre-diabetes or diabetes
- Obesity
- Muscle weakness
- Bruise easily
- Acne
- Hirsutism
- Osteoporosis
- Depression

Oral Manifestations:
- Diabetes and osteoporosis may affect management of periodontal disease and associated bone loss
Hypothyroidism
Etiology:
- Inadequate consumption of iodine
- Inborn error of metabolism
- High intake of goitrogen
- Treatment of hyperthyroidism
- Thyroid gland disorder
- Deficient secretion of TSH

Oral Manifestations:
** In children:
- Short stature
- Intellectual disabilities
- Delayed eruption
- Severe malocclusion
- Risk for caries

- Macroglossia
Hyperparathyroidism
Hypersecretion of the parathyroid hormone (PTH), leading to alterations in calcium, phosphorus, and bone metabolism

Oral Manifestations:
- Increased osteoclastic bone resorption
- Brown tumors occur in the head and neck, especially the mandible
Renal Disease
Etiology:
- Primary glomerular disease
- Secondary glomerular disease (hypertension, diabetes, lupus)
- Vascular disease
- Tubulointerstitial disease

Oral Manifestations:
- Platelet abnormalities may cause gingival bleeding
- Gingival pallor
- Slow wound healing
- Bad taste (from urea)
- Malodor
- Stomatitis
- Hairy leukoplakia
Parkinson's Disease
Symptoms:
- Involuntary muscle tremors
- Bradykinesia (slowness of movement)
- Muscular weakness
- Rigidity
- Stooped posture
- Decreased fine motor coordination
- Orthostatic hypotension

Oral Manifestations:
- Abnormal chewing and swallowing pattern
- Holding food in mouth for extended periods
- Frequent drooling
- Tremor of mandible, lips, tongue
Epilepsy
A neuromuscular problem that does not result in any specific oral or feeding problems, but the phenytoin used to treat it can affect oral health as well as nutritional status
Phenytoin
_____________, a medication used to treat epilepsy, increases the need for vitamins D, K, and folate and can affect bone mass long term

Causes gingival hyperplasia which makes oral self-care challenging
Kaposi's Sarcoma
Highly malignant tumor of blood vessel origin that occurs on the skin and oral mucosa
- Red-purple macular lesions in the mouth may progress to raised, indurated lesions with central areas of necrosis and ulceration

Appears in many HIV-positive patients
Acute Leukemia
Generalized malignant disease characterized by distorted proliferation and development of white blood cells

Oral Manifestations:
- Gingiva may become severely inflamed with tissue hyperplasia, areas of ulcerations, necrosis, and spontaneous bleeding
- Delayed wound healing
- Increased susceptibility to infection
AIDS
Symptoms:
- With HAART, classing wasting is less evident, although wasting and anorexia may be present
- Opportunistic infections
- Multiple nutrient deficiencies
- Protein-energy malnutrition

Oral Manifestations:
- Oral candidiasis
- Oral hairy leukoplakia
- Herpetic ulcerations
- Kaposi's sarcoma
- May have more severe periodontitis
- Xerostomia
Anorexia Nervosa
Primary affects adolescent and young females who have an exaggerated, intense fear of becoming fat

- Weight loss equal to or exceeding 15% below expected or original body weight
- Amenorrhea
- Excessive desire for slimness with distorted body image
Bulimia
Eating disorder not necessarily associated with significant weight loss, may be sightly overweight
- Bingeing and purging

Oral Manifestations:
- Erosion of enamel (lingual maxillary anterior teeth)
- Palatal bruises
- Enlarged parotid glands
- Dentin hypersensitivity
- Perimolysis
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