Neurological Diseases and Seizure Disorders
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Questions and Answers

Which of the following is a common sensory deficit associated with cerebrovascular disease?

  • Unilateral facial paralysis
  • Weakness (correct)
  • Altered mental status
  • Nausea

What is the initial imaging technique recommended for diagnosing cerebrovascular disease?

  • MRI
  • CT scan (correct)
  • Ultrasound
  • X-ray

Which medication should be reported for its potential interaction with Warfarin that can increase INR?

  • Acetaminophen
  • Aspirin
  • Ibuprofen
  • Metronidazole (correct)

What is the recommended therapeutic range for INR in patients taking Warfarin?

<p>2-3 (C)</p> Signup and view all the answers

What factor should be considered when providing dental care to a stroke patient?

<p>Timing of recent dental procedures (C)</p> Signup and view all the answers

Which treatment is recommended for chronic management of cerebrovascular disease?

<p>Daily aspirin and anti-platelets (A)</p> Signup and view all the answers

What dental consideration should be given to a patient experiencing seizures?

<p>Effective pain control (A)</p> Signup and view all the answers

Which of the following could indicate a neurological deficit after a stroke?

<p>Dysphagia (D)</p> Signup and view all the answers

What is the best method to prevent anti-epileptic medication-induced gingival hyperplasia?

<p>Meticulous oral hygiene (B)</p> Signup and view all the answers

Among the following, which type of prosthetic restoration is considered safer for individuals with epilepsy?

<p>Fixed prosthetics (A)</p> Signup and view all the answers

In patients with xerostomia, which recommendation helps stimulate saliva production?

<p>Chew xylitol mints or gum (B)</p> Signup and view all the answers

What position should a tube-fed patient be placed in during a dental procedure to minimize aspiration risk?

<p>Upright position (A)</p> Signup and view all the answers

What is a transient ischemic attack (TIA)?

<p>A temporary focal neurologic deficit that lasts less than 24 hours (C)</p> Signup and view all the answers

What is the leading cause of death related to cerebrovascular disease worldwide?

<p>Stroke (B)</p> Signup and view all the answers

What is a common oral condition that can arise in tube-fed patients?

<p>Low caries rate (D)</p> Signup and view all the answers

Which of the following is a recommended oral hygiene practice before bedtime for patients with dry mouth?

<p>Brushing with a fluoride-containing dentifrice (D)</p> Signup and view all the answers

What should be monitored for patients on anti-epileptic medications?

<p>Gingival hyperplasia (A)</p> Signup and view all the answers

What is the incidence of stroke in Saudi Arabia per 100,000 people?

<p>43.8 (B)</p> Signup and view all the answers

What is a potential consequence of medication for epilepsy that affects the oral cavity?

<p>Medication-induced B-12 deficiency (D)</p> Signup and view all the answers

Which oral health complication is most associated with epilepsy patients?

<p>Increased risk of dental caries (C)</p> Signup and view all the answers

What condition may result from trauma associated with seizures, potentially requiring intervention?

<p>TMJ disc dislocation (D)</p> Signup and view all the answers

What oral health issue is commonly seen in patients taking antiepileptic drugs?

<p>Gingival hyperplasia (C)</p> Signup and view all the answers

What is the prevalence rate of seizure disorders in the general population?

<p>1% (C)</p> Signup and view all the answers

Which of the following is true regarding the risk of oral trauma in epilepsy patients?

<p>Oral trauma is a possible outcome of seizure activity. (A)</p> Signup and view all the answers

What is an important factor to assess in the medical history of a patient with epilepsy?

<p>Frequency of seizures and potential triggers (D)</p> Signup and view all the answers

What is a common symptom of generalized seizures known as 'myoclonic'?

<p>Involuntary jerking of limbs (B)</p> Signup and view all the answers

What neurological condition is associated with an increased risk of dental trauma due to seizures?

<p>Seizure disorders (C)</p> Signup and view all the answers

Flashcards

Medication Updates

Regularly asking patients (or caregivers) about changes in their medication use.

Gingival Hyperplasia

Abnormal gum growth, sometimes caused by anti-epileptic drugs.

Oral Hygiene (Epilepsy)

Thorough gum & tooth cleaning is key to preventing excessive gum growth in seizure disorders.

Powered Toothbrushes (Seizures)

Use cautiously; some adults with seizures may find them too irritating.

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Prosthetic Restorations (Seizures)

Dental work should withstand seizure activity, preventing choking risks.

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Fixed vs. Removable Prosthetic

Fixed prosthetics are preferred due to the risk of choking with removable ones.

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Tube-fed Patients (Oral Health)

Tube-fed patients may have low cavities but increased calculus, GERD, sensitivity, and risk of choking.

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Xerostomia Management

Strategies to manage dry mouth include teaching proper oral hygiene, using fluoride, and stimulating saliva.

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Cerebrovascular Disease

Diseases affecting the cerebral blood vessels, impairing circulation.

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Stroke (CVA)

Sudden impairment in cerebral circulation, lasting more than 24 hours.

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Stroke Risk Factors

Factors that increase a person's chance of having a stroke.

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Stroke Symptoms

Sudden neurological impairments like weakness, visual problems, or speech difficulty.

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Stroke Diagnosis

Using brain imaging (CT and MRI) to locate stroke.

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Stroke Treatment (Acute)

Immediate treatment for a stroke, possibly including a clot-busting medication (tPA).

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Stroke Treatment (Chronic)

Ongoing treatment to prevent future strokes, often using aspirin.

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Stroke and Dental Care

Dental providers should assess a stroke patient's risk before any procedures, considering the stroke's timing and procedure type.

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Warfarin and INR

Patients on blood thinners (Warfarin) must report their INR (International Normalized Ratio) which is typically between 2-3.

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Oral Manifestations of Stroke

Stroke can cause oral problems like face paralysis, decreased sensation, and swallowing difficulties.

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What is epilepsy?

A brain disorder characterized by excessive neuronal discharge, causing seizures, unusual body movements, and loss or changes in consciousness.

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How common is epilepsy?

Approximately 1% of the general population has epilepsy.

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Two types of seizures

Partial seizures affect only part of the brain, while generalized seizures affect the entire cortex.

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Simple vs. Complex partial seizures

Simple partial seizures cause subtle symptoms with awareness intact, while complex seizures involve impairment of awareness and variable presentations.

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Types of generalized seizures

Absence seizures involve impaired consciousness with staring and eye blinking, while atonic seizures cause sudden loss of muscle tone and collapse. Myoclonic seizures involve jerking and impaired consciousness, while tonic-clonic seizures include loss of consciousness, jerking, stiffening, amnesia, and cyanosis.

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Diagnosing seizures

A neurologist will conduct a detailed neurological history and examination, and may utilize MRI, CT, and EEG for diagnosis.

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Epilepsy treatment

Antiepileptic drugs (AEDs) are the primary treatment for epilepsy, aiming to control seizure activity with minimal side effects.

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Oral health concerns in epilepsy

Patients with epilepsy may experience dental caries, oral trauma, glossitis, TMJ issues, tooth avulsion, and medication-induced gum problems.

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Important medical history

It's crucial to obtain a thorough medical history from patients with epilepsy, including seizure triggers, frequency, and level of control.

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Oral health considerations for epilepsy

Patients with epilepsy require careful oral health management, including preventive measures against caries and trauma, and attention to medication-induced side effects.

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Study Notes

Neurological Diseases

  • Neurological diseases affect the neuromuscular system, with a lifetime prevalence rate of 3% to 5%.
  • Every oral healthcare provider will encounter patients with these conditions.
  • Neurological conditions can impact oral health and dental management decisions.

Seizure Disorders

  • Epilepsy is a brain disorder due to excessive neuronal discharge.
  • Seizures can involve unusual body movements, loss or altered consciousness.
  • Transient episodes of motor, sensory, or psychic dysfunction may occur, sometimes with convulsive movements.
  • Epilepsy prevalence is around 1% in the general population.
  • 75% of cases have no known cause.
  • Higher frequency in males.

Seizure Disorder - Clinical Features

  • Seizures are classified as partial or generalized.
  • Partial seizures affect only a part of the brain; can be subtle and awareness remains intact.
  • Complex partial seizures involve awareness impairment.
  • Generalized seizures affect the entire cortex, ranging from absence (impaired consciousness, staring, and eye blinking), to atonic (abrupt muscle tone loss and collapse), myoclonic (sudden jerking of arms and legs), and tonic-clonic (loss of consciousness, repetitive jerking, and sustained stiffening).

Seizure Disorder - Diagnosis

  • Neurological history and physical examination, MRI, CT, and electroencephalography (EEG) are essential for diagnosing seizure disorders.

Seizure Disorder - Management

  • Pharmacological therapy (antiepileptic drugs) is crucial for epilepsy treatment with minimal side effects.
  • The goal is choosing the most effective drug for a specific seizure type.

Seizure Disorder - Oral Health Considerations

  • Patients with epilepsy are at increased risk for dental caries, oral trauma, lacerations (including bite injuries to the tongue), and ulcerations/glossitis from B-12 deficiency, induced by medications.
  • Trauma-induced TMJ disc dislocation and tooth avulsions are also possible.
  • Medication-induced gingival hyperplasia, and delayed healing may occur.
  • Seizure triggers and control are key factors for proper patient care.
  • Dental patients with epilepsy should have meticulous oral hygiene and appropriate management in severity cases, potentially with surgical reduction.
  • Powered toothbrushes may be too stimulating for some patients.
  • Fixed prosthetics are preferred over removable ones, avoiding choking concerns.
  • Mouth guards may be beneficial.
  • Patients on tube feed have low caries, rapid calculus buildup, GERD, high sensitivity, and risk of aspiration in dental chair.
  • Low water intake, high suction, and suitable patient positioning are essential.
  • For xerostomia, manage oral hygiene (brushing, flossing, and nutrition), use fluoride-containing dentifrice before bed, a neutral 1.1% fluoride gel, and avoid rinsing after brushing and eating/drinking before bed.
  • Consider stimulating saliva production and caries resistance using xylitol mints, lozenges, or gum.

Cerebrovascular Disease

  • Cerebrovascular disease damages cerebral blood vessels, leading to impaired cerebral circulation.
  • Stroke (CVA) is a sudden impairment of cerebral circulation lasting over 24 hours. This event can lead to death or focal neurological deficits.
  • Transient Ischemic Attacks (TIAs) are reversible, acute focal neurological deficits (mini-strokes) within 24 hours.
  • Stroke is the second leading cause of death and the third leading cause of disability globally.
  • Incidence in Saudi Arabia is 43.8 per 100,000.

Cerebrovascular Disease - Clinical Features

  • Stroke symptoms include sensory and motor deficits, weakness, visual problems, sudden headaches, altered mental status, dizziness, nausea, seizures, impaired speech or hearing, memory, reasoning, and concentration deficits.

Cerebrovascular Disease - Diagnosis & Management

  • Brain imaging (CT scan followed by MRI), risk factor stratification (diabetes and hyperlipidemia), and acute treatment options (thrombolysis with intravenous tissue plasminogen activator (t-PA)) are essential.
  • Chronic treatment often involves daily aspirin and other antiplatelet medications.

Cerebrovascular Disease - Oral Health Considerations

  • Assess patients'stroke risk before dental procedures.
  • Timing and the complexity of the procedure are important for avoiding complications.
  • Patients on Warfarin must report their INR, as therapeutic levels range from 2-3.
  • Metronidazole and tetracycline can increase Warfarin's INR.
  • Effective pain control during procedures reduces stress and risk factors.
  • Local anesthesia with a minimal vasoconstrictor (epinephrine 1:100,000 or 1:200,000, and less than or equal to 0.04mg) is important to reduce risks.
  • Oral manifestations can include unilateral facial paralysis, loss of oral sensory stimulus, flaccid tongue, dysphagia, neglected oral self-care on one side, increased caries, periodontal disease, and halitosis.
  • Rigorous preventive measures such as 3-month recall appointments and topical fluoride application are recommended.

Parkinson Disease

  • Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder.
  • PD results from the degeneration of dopaminergic cells in the substantia nigra, reducing dopamine in the basal ganglia. Prevalence in Saudi Arabia is estimated at 27 per 100,000.

Parkinson Disease - Clinical Manifestations

  • Resting tremor, stiffness or rigidity of limbs/trunk, slowness of movement (bradykinesia), postural instability or balance impairment, and coordination problems.
  • Also includes dementia, behavioral/psychiatric symptoms(depression, anxiety, apathy, and irritability), autonomic dysfunction (orthostatic hypotension, constipation and urinary problems), and abnormal sweating.

Parkinson Disease - Diagnosis & Management

  • Clinical diagnosis.
  • Genetic testing for hereditary patterns.
  • Treatment focuses on symptom management, not cure. Dopamine replacement therapy using levodopa (combined with carbidopa) remains the initial gold standard.
  • Various medications are used for different symptoms.

Parkinson Disease - Oral Health Considerations

  • Patients often require treatment in a relatively upright position.
  • Dysphagia and impaired gag reflex increase aspiration risk.
  • High-speed fluid evacuation is vital to reduce aspiration risk..
  • Levodopa and dopamine agonists can cause orthostatic and potentially severe hypertension.
  • Monitoring blood pressure and advising slow, staged standing are recommended.

Myasthenia Gravis

  • Myasthenia gravis (MG) is a chronic neuromuscular disease caused by autoimmune destruction of the skeletal neuromuscular junction, characterized by episodic weakness of skeletal muscles.
  • Weakness worsens with activity and improves with rest.
  • Anti-acetylcholine receptor (AChR) antibodies are the most common.
  • Prevalence rates are between 15-20 cases per 100,000 in Western countries

Myasthenia Gravis - Clinical Features

  • Diplopia (double vision) and ptosis (drooping eyelids), oropharyngeal, facial, masticatory muscle weakness; dysphagia (difficulty swallowing), asymmetry, and dysarthria(difficulty speaking) are key features.
  • Disease course often varies, with a generally progressive pattern.

Myasthenia Gravis - Diagnosis & Management

  • Clinical examination and medical history are highly suggestive.
  • Tensilon (edrophonium) challenge for rapid Ach increase, and serum anti-AChR antibodies are diagnostics.
  • Treatment involves plasma exchange and high-dose intravenous immunoglobulin, along with symptomatic treatment.

Myasthenia Gravis - Oral Health Considerations

  • High aspiration risk due to potential difficulties with prolonged opening and swallowing.
  • Using adequate suction, rubber dams, and avoiding bilateral mandibular anesthesia can mitigate aspiration risks.
  • Respiratory crisis may arise from the disease or excessive medication.
  • Patients may be best treated in hospital environments to allow possible intubation.
  • Avoid drugs affecting neuromuscular junctions (narcotics, tranquilizers, barbiturates).
  • Caution with drugs affecting neuromuscular function, like antibiotics (tetracycline, streptomycin, sulfonamides, and clindamycin), and some anesthetics (those metabolized by plasma cholinesterase).

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Neurological Diseases PDF

Description

This quiz covers crucial information about neurological diseases, focusing on their implications for oral healthcare providers. It also delves into seizure disorders, including clinical features and prevalence rates. Test your knowledge on how these conditions influence dental management.

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