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Flipped Classroom questions
Terms in this set (19)
when a person presents to the clinic with one of these conditions, how do we bring this up to the patient? How do we say "this looks like lupus" without setting them into a total panic?
We don't, because it is not our job to diagnose patients. The best thing you can do is gently tell the patient what you see without referring to a specific disease. Say something like: "You have a very dry white substance on the commissures of your mouth. How long has this been going on?". Start the convo that way and then advise them to have it checked out. We do not diagnose anything!
In patients with autoimmune disorders, do we tend to see increased incidence of gingivitis? Or are WBCs busy attacking body cells. I know we see an increased incidence of oral lesions and whatnot, but I was sure about inflammation of gingival tissue.
It depends on which autoimmune disease the patient has and if the patients ability to care for themselves or salivary flow is impacted. We cannot generalize gingivitis to autoimmune diseases though.
Would we refer the patient to their PCP if we saw oral signs of these diseases or would the dentist refer them directly to a specialist?
We would treat these patients to the best of our ability and gently urge them to go see the PCP
My question is should we be following up with the PCP of a patient with an autoimmune disorder regarding their health or leaving that as the patients responsibility? In terms of making sure we know exactly whats going on and making sure nothing is getting left out, if so how often would we be doing this?
Every practice will have a different protocol. I follow up when the patient returns, if the issue impedes you from conducting treatment that day it is best to take care of the phone calls yourself at the time they are in the chair . If the patient has yet to be diagnosed, this it out of our hands. This would come out at the time of the med hx. If you are aware your patient has a documented disease you need to inquire about it at every visit
Are people with Hashimoto's Disease more prone to cleft lip and/or palate?
No, but their children are!
What would be the best oral hygiene instructions for someone who has lesions from Pemphigus vulgaris and is in pain while trying to brush their teeth? Would flossing cause any trauma to the ulcerated tissues present?
Home care for those impacted by PV should be EXTREMELY GENTLE. A small manual TB would be best, even offering a pedo brush to aid in site specific cleaning would be wise. Advising the patient not to distend the cheek tissue is wise. An electric TB is NOT indicated here
What causes scleroderma- or is it of unknown etiology?
Unknown, as it is an autoimmune disease
Sjögren's syndrome. With this condition I understand that a patient will have an extremely dry mouth but is this something that is constant? Or is this something that progressively keeps getting worse or do these patients have some days where the saliva may secrete somewhat normally?
It is typically progressive in nature especially without treatment. This article is very interesting, check it out!
What are the possible/most known, trigger mechanisms of lupus erythematosus?
As we know, Lupus occurs when the body starts to attack itself and the reason is unknown. There are three major environmental triggers that include: sunlight, infections, and certain medications. Medication triggered lupus subsides when the patient stops taking the medication.
At what point does Hyperadrenalism progress to Cushing's syndrome? It seems like people with hyperadrenalism tend to have cushing-like symptoms but when does this progress to actual Cushing's syndrome?
The patient has to be exposed to high levels of cortisol for an extended period of time without treatment for the disease to take form. This will be different for each person, So I cannot really put a time frame on it.
Patients with Sjögren's syndrome would those patients be more at risk for periodontal disease since it has to do with their salivary glands? As long as they have good oral home care and frequent dental visits could they avoid the periodontal disease altogether with also using products like biotene rinses and xylitol gum??
Without saliva the patient will be lacking the natural cleansing process that can be seen in those with no salivary deficits. No cleansing is usually an indicator for increased caries. Caries are causes by bacteria and the lack of plaque removal. Perio is also caused by bacteria. So yes, a salivary substitute or aid will keep bacterial counts down. Avoiding perio disease is case to case, but yes it is possible.
Are curing lights safe to use in a patient with lupus erythematous, due to the photosensitivity patients experience?
Yes and no, long term exposure of the curing light to oral tissues other than enamel can be harsh. Newer style curing lights can cure resin based materials in 3 seconds. This may be the best option for this patient pool.
A patient with a goiter comes in to our office do we have to take extra precautions while treating them?
Not necessarily, but we would want to refer them back to their GP
In the case of a terminal autoimmune disorder such as AIDS or the more recently identified as an auto immune, Alzheimer's, what is the next move when care is near impossible? When the Alz patient is in a debilitating state. Do we push for dental care for the sake of preventing further pain. Or do we weigh the options as best we can and discern whether to let the oral cavity be as the person declines?
In most cases this is , sadly, left to the family to decide. Most of the live-in facilities will offer dental care to patients are frequently as possible. Dentists are not typically on staff, but these facilities may offer a rotating schedule of dentists that will come in to treat the patients, adjust dentures etc.
How is rheumatoid arthritis associated with Sjogren's syndrome?
Sjogren's syndrome involves the salivary and lacrimal glands. Rheumatoid arthritis is an inflammatory disease that affects the joints.
Sjogren's and RA are linked by their inflammatory qualities. Sjogren's is an inflammation of the exocrine glands. RA is characterized by inflammation of the joints. Autoimmune diseases are sadly an anomaly and have not been given a true reason as of yet. It is thought, not confirmed, that something in the environment stimulates the body to react negatively.
Does a patient need 2-3 month intervals FOR LIFE if they have one of these infections just like perio maintenance?
Perio main is for life as long as the person keeps showing signs of disease, remission, disease, remission patterns. A perio main can be changed to a more frequent adult prophy if the patient exemplifies absolutely perfect oral health for an extended period of time. If a patient presents with one of the diseases we discussed, they likely will not achieve a remission state and should be kept on the more frequent recall to aid in achieving a higher level of overall health; which we know is greatly impacted by oral bacteria.
Are these Autoimmune Diseases similar to AIDS in that they both attack the body's immune system? Is the big difference just that AIDS is acquired and the ones in the PowerPoint happen because of both a genetic predisposition and an environmental trigger?
In AIDS, because of the HIV factor, the body is too compromised and too weakened to defend itself against infection, and this type of infection is highly contagious. Autoimmune diseases are an attack of the body against itself therefore the immune system needs to be suppressed, these diseases are not infectious. Autoimmune disease treatment protocol typically include attempts to weaken the person's immune system so it stops attacking itself.
What about addison's? It sounds like medical emergencies that arise from addison's can mimic hypoglycemia. If a patient is not diagnosed with addison's or diabetes, how do we know how to treat them? If a patient is diagnosed with addison's, what do we do in a medical emergency?
If the patient is showing signs of an adrenal emergency call 911 immediately and have the med hx on hand to report out to Emergency responders . In the meantime, if the office has injectable hydrocortisone it should be administered by the Doctor only roughly 100 mg
Hashimoto's disease is the most common cause of hyperthyroidism in developed countries. Exophthalmos is a sign of Hashimoto's disease.
We now know that exophthalmos is a sign of graves disease and is indicated by bulging of the eye balls
So, in your notes, for scleroderma and lupus patients, you said that Raynaud Phenomenon may occur. What is that, and would our treatment as dental hygienist change if they were experiencing that?
This is what Reynaud's looks like. The arteries block the flow of blood to the body's extremities. The tissues blanch and turn white. Autoimmune diseases can cause this, as can atherosclerosis of the arteries.
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