Neurological Disorders in Dentistry

Neurological Disorders

• Clinical Significance in Dentistry:
  • Cerebrovascular accidents (stroke)
  • Epilepsy
  • Alzheimer's
  • Parkinson's
  • Multiple Sclerosis
  • Cerebrospinal Fluid (CSF) shunts
  • Cranial nerve abnormalities
• Potential complications for patients with neurologic diseases in a dental clinic:
  • CVA (stroke)
  • Altered consciousness
  • Adverse bleeding
  • Myocardial infarction (heart attack)
  • Infective endocarditis

Stroke

• Definition: Sudden obstruction or rupture of the blood supply to the brain.

• Types:

  • Ischemic stroke: Clot blocks blood flow.
  • Hemorrhagic stroke: Bleeding occurs inside or around brain tissue.
  • TIA (transient ischemic attacks): Temporary blockage of an artery, lasting less than 24 hours; a “mini-stroke."

• Symptoms:

  • Sensory, motor, autonomic, or complex function impairments
  • Slurred speech
  • Weak muscles
  • Difficulty swallowing
  • Loss of speech
  • Unilateral paralysis
  • Loss of sensory stimuli
  • Flaccid tongue (weak and limp)

• Risk factors:

  • Men
  • Increasing age
  • Smoking
  • Obesity
  • Heavy alcohol use

Taking History

• Importance: A history is crucial because one in three people who have a stroke are at risk for another stroke within one month.
• History for patients who have already had a stroke:
  • The risk of a recurrent stroke is elevated for at least six months.

Periodontal Disease and Stroke

• Link: Calcified atherosclerotic plaques (hardening of arteries) are visible on panoramic X-rays. Carotid calcifications (in the neck) are linked to future vascular events.
• Association with Periodontitis: Patients with periodontitis are at increased risk of stroke, especially ischemic events.
• Bone Loss: Severe periodontal bone loss is linked to carotid artery plaques and stroke risk.

Multiple Sclerosis

• Definition: An autoimmune disease that affects the protective covering of nerve fibers (myelin). The immune system mistakenly attacks the myelin, causing inflammation, damage, and scar tissue formation.
• Location: Most commonly affects the central nervous system (CNS) and not the peripheral nervous system (PNS).
• CNS Areas affected:
  • Optic nerve
  • Cerebral white matter
  • Cervical spinal cord
• Stages: Marked by phases of relapse (symptoms worsen) and remission (symptoms improve).
• Treatment: Treatment is most effective during remission phases.

Parkinson's disease

• Definition: A progressive neurodegenerative disorder that affects movement, causing tremors, stiffness, and impaired coordination.
• Cause: Caused by the death and depletion of dopamine-producing cells in the brain.
• Dopamine and Movement: Dopamine (a neurotransmitter) plays a crucial role in the nigrostriatal pathway, which coordinates voluntary movements.
• Symptoms: TRAP:
  • Tremor
  • Rigidity
  • Akinesia (slowness of movement)
  • Posture/balance problems
• Other symptoms:
  • Masklike appearance
  • Excessive sweating
  • Drooling
  • Gait with rapid, short shuffling steps and reduced arm swinging.

Dental Management of Parkinson's Disease

• Challenges: Parkinson's disease impairs oral hygiene tasks and affects coordination during dental procedures.
• Key concerns:
  • Minimizing adverse outcomes: Muscle rigidity and tremors.
  • Avoiding drug interactions: Certain medications can interact with dental medications.
• Scheduling: Short appointments and stress-reducing measures can improve patient outcomes.

Cranial Nerves

• Trigeminal nerve (CN V):

  • Sensory for the face.

• Facial nerve (CN VII):

  • Motor nerve for the face.

Explore the clinical significance of various neurological disorders in the field of dentistry. This quiz covers conditions like stroke, epilepsy, Alzheimer's, and their potential complications, particularly in dental settings. Understand how these disorders can affect patient care and safety in dental clinics.