Neurological Impact on Oral Health
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What condition presented as a possible cause of epilepsy in older age groups is directly associated with degenerative changes in the brain?

  • Cerebro-vascular incident
  • Alzheimer’s disease (correct)
  • Developmental lesions
  • Idiopathic causes
  • Which phase is characterized by muscle stiffening during a grand mal seizure?

  • Aura
  • Recovery phase
  • Tonic phase (correct)
  • Clonic phase
  • Which of the following is a recommended safety aid for patients with epilepsy?

  • Increased physical activity
  • Protective headgear (correct)
  • Regular dental check-ups
  • Compliance with medication schedules
  • Which medication is commonly associated with inducing gingival enlargement in epilepsy patients?

    <p>Phenytoin</p> Signup and view all the answers

    What is an important dietary consideration for managing epilepsy in children?

    <p>Ketogenic diet</p> Signup and view all the answers

    Which of the following correctly describes epilepsy?

    <p>A recurrent dysfunction of brain neurophysiology accompanied by abnormal brain actions.</p> Signup and view all the answers

    What is a primary feature of a seizure?

    <p>A transient occurrence of signs due to abnormal neuronal activity.</p> Signup and view all the answers

    Which neurological disorder is characterized as a degenerative disease?

    <p>Parkinson’s disease</p> Signup and view all the answers

    Which statement accurately reflects the oral health implications for patients with neurological diseases?

    <p>Patients with neurological disorders may experience complications in oral health care.</p> Signup and view all the answers

    Which of the following is NOT listed as a common neurological disorder relevant to dental practice?

    <p>Alzheimer’s disease</p> Signup and view all the answers

    How many people worldwide are estimated to be affected by epilepsy?

    <p>About 50 million</p> Signup and view all the answers

    What is a potential vascular cause of neurological disease mentioned?

    <p>Arteriosclerosis</p> Signup and view all the answers

    Which of the following is an example of an infectious neurological disease?

    <p>Herpes simplex encephalopathy</p> Signup and view all the answers

    What is the male to female ratio of Parkinson's Disease prevalence?

    <p>1.46</p> Signup and view all the answers

    Which of the following is NOT considered a risk factor for Parkinson's Disease?

    <p>Smoking</p> Signup and view all the answers

    Which motor feature is characterized by a lack of physical movement?

    <p>Akinesia</p> Signup and view all the answers

    Which of the following treatments is considered a type of medical management for Parkinson's Disease?

    <p>Deep brain stimulation</p> Signup and view all the answers

    What are the non-motor features associated with Parkinson's Disease?

    <p>Visual hallucination and weight loss</p> Signup and view all the answers

    Deep brain stimulation for Parkinson's Disease primarily targets which areas of the brain?

    <p>Subthalamus nucleus and Globus Pallidus interna</p> Signup and view all the answers

    Which of the following symptoms is a common sensory disturbance in Parkinson's Disease?

    <p>Chronic pain</p> Signup and view all the answers

    Which of the following medications is NOT typically used in the management of Parkinson's Disease?

    <p>Antidepressants</p> Signup and view all the answers

    What should be prioritized during a dental procedure for a patient with epilepsy experiencing a seizure?

    <p>Ensure the patient does not harm/injure themselves</p> Signup and view all the answers

    Which of the following is a common oral health issue associated with epilepsy?

    <p>Phenytoin-induced gingival enlargement</p> Signup and view all the answers

    What is a common demographic characteristic of multiple sclerosis?

    <p>More common among those of Northern European ancestry</p> Signup and view all the answers

    Which of the following is NOT a clinical feature of multiple sclerosis?

    <p>Increased appetite</p> Signup and view all the answers

    Which treatment is NOT typically used to modify the disease course in multiple sclerosis?

    <p>Ibuprofen</p> Signup and view all the answers

    In cases of severe dental trauma in epileptic patients, what type of dental appliance is preferred?

    <p>Fixed appliances</p> Signup and view all the answers

    Which of the following medications is typically used for status epilepticus?

    <p>Buccal or intranasal midazolam</p> Signup and view all the answers

    What is a common type of neurological disease relevant to dental practice?

    <p>Epilepsy</p> Signup and view all the answers

    Which of the following is a potential emotional disturbance experienced by individuals with multiple sclerosis?

    <p>Mood swings</p> Signup and view all the answers

    What is the primary demographic for the diagnosis of multiple sclerosis?

    <p>Individuals aged 20-50</p> Signup and view all the answers

    What is the relationship between amalgam restorations and multiple sclerosis (MS)?

    <p>Amalgam restorations have no proven impact on MS.</p> Signup and view all the answers

    Which of the following is NOT an orofacial feature associated with multiple sclerosis?

    <p>Chronic sinusitis</p> Signup and view all the answers

    How can mobility issues in MS patients affect their access to dental care?

    <p>By limiting their movement and attendance at clinics.</p> Signup and view all the answers

    Which statement regarding communication in MS patients is true?

    <p>Communication may be compromised due to vision or dysarthria.</p> Signup and view all the answers

    What considerations should be made for oral hygiene methods in MS patients?

    <p>Oral hygiene methods may need to be adjusted due to motor defects.</p> Signup and view all the answers

    What is a notable concern regarding the medications used by MS patients and oral health?

    <p>They often lead to drug-induced oral dryness.</p> Signup and view all the answers

    What type of anesthesia is considered safe for use in MS patients undergoing dental procedures?

    <p>Inhalation or intravenous sedation</p> Signup and view all the answers

    Which of the following statements is true for the mood of MS patients regarding consent?

    <p>Mood issues can compromise their ability to give consent.</p> Signup and view all the answers

    What oral health risk is significantly increased due to Parkinson's disease?

    <p>Periodontal disease</p> Signup and view all the answers

    Which of the following mobility aids can help improve access for patients with Parkinson's disease?

    <p>Elevated dental chairs</p> Signup and view all the answers

    What effect does Parkinson's disease potentially have on communication?

    <p>Slowness of talking</p> Signup and view all the answers

    Which condition is NOT typically associated with oral manifestations in Parkinson’s disease?

    <p>Hypertension</p> Signup and view all the answers

    What is one effective management approach for drooling in Parkinson's disease patients?

    <p>Botulinum toxin A/B injections</p> Signup and view all the answers

    Which characteristic of Parkinson's disease may impair a patient's ability to give consent for dental procedures?

    <p>Dementia</p> Signup and view all the answers

    What is a common oral feature drug-induced oral dryness seen in Parkinson’s disease?

    <p>Halitosis</p> Signup and view all the answers

    Which of these is NOT a recommended modification in oral hygiene methods for individuals with Parkinson's disease?

    <p>Use of traditional toothbrushes</p> Signup and view all the answers

    During which time is it generally best to schedule dental appointments for Parkinson's disease patients?

    <p>Early morning</p> Signup and view all the answers

    What is one of the primary concerns regarding the use of general anesthesia in Parkinson's disease patients?

    <p>Increased risk of pneumonia</p> Signup and view all the answers

    Study Notes

    Neurological Disease Overview

    • Neurological diseases impact oral health and dental care greatly
    • Common neurological disorders include epilepsy, multiple sclerosis, and Parkinson's disease

    Intended Learning Objectives

    • Identify oral diseases arising from common neurological conditions
    • Understand the effects of neurological disorders on delivering oral healthcare

    Neurological Disease Causes

    • Neurological tissues (gray or white matter), meninges, and blood supply are all affected

    • Causes of neurological disease are either genetic or acquired

    • Genetic examples: Huntington's chorea, Tuberous sclerosis, many others

    • Acquired examples:

      • Degenerative: Parkinson's disease, dementia
      • Vascular: Arteriosclerosis (stroke)
      • Neoplastic: primary or secondary
      • Infective: encephalopathies (e.g., herpes, measles, mumps)
      • Inflammatory: multiple sclerosis
    • Many diseases may also have seizures as a feature

    Epilepsy and Seizures

    • Epilepsy: Paroxysmal dysfunction of brain neurophysiology (EEG). Accompanied by paroxysmal dysfunction in brain action (cognitive, behavioral, sensory, and experiential). Presents a tendency to recur
    • Seizure: Transient occurrence of signs and/or symptoms due to abnormal, excessive, or synchronous neuronal activity in the brain

    Epilepsy and Seizures: Basic Background

    • Affects 50 million globally, with possible prevalence of 1% in some populations
    • Causes vary by age group
      • Young age group: Idiopathic, Developmental lesion, Tumor, Head injury
      • Older age group: Cerebro-vascular, Tumor, Head injury, Alzheimer's disease, Medications, Metabolic disturbance (alcohol/drug)

    Epilepsy- the basic clinical features

    • Highly variable but for simplicity in oral health care, epilepsy can be categorized as absence or "grand mal" episodes, often with an aura prior.
    • Aura: variable features (see below)
    • Tonic phase
    • Clonic phase
    • Recovery

    Epilepsy - What is Aura?

    • Aura is a single symptom as part of an epilepsy episode
    • Common symptoms include déjà vu, jamais vu, smells, sounds, tastes, visual changes, racing thoughts
    • Acting quickly is crucial in recognizing and treating auras, as well as obtaining medical attention

    Epilepsy: Management

    • Medical: Anti-epileptic drugs (AEDs) like phenytoin, valproate. Ketogenic diet (children).
    • Surgical: Deep brain stimulators, Vagus nerve stimulation, Neurosurgery

    Implications of Epilepsy on oral health care

    • Access to care: risk assessment, risk of seizure and trauma from care procedures
    • Communication: typically not an issue
    • Consent: unlikely to be an issue unless a seizure occurs
    • Education: risk of phenytoin-induced gingivitis, risk of dental pain inducing seizures
    • Surgical: no significant concerns with LA/inhalation or IV sedation. GA is not contraindicated
    • Oral trauma can lead to replacement with fixed appliances rather than removable ones, to avoid airway complications
    • Spread: No risks from spread.
    • Seizures: ensure patient safety by limiting movement, removing sharp objects, consider administering midazolam if status epilepticus is likely. Avoid using fingers to clear the mouth

    Multiple Sclerosis: Basic Epidemiology

    • Affects around 2.5 million people globally
    • More frequent in non-equatorial countries, Northern Europeans, and Caucasians than Hispanics or African Americans, and rare in Asians
    • Typically diagnosed between 20 and 50 years of age, occasionally in young children or older adults
    • Affects both genders

    Multiple Sclerosis: Basic Pathology

    • Demyelination (usually in the CNS)
    • Dissemination in time and space: evidence of scarring (plaques) in at least two separate areas of the CNS. Evidence that the plaques occurred at different points in time.
    • There is no other explanation for these changes

    Multiple Sclerosis: Basic Clinical Features

    • Cerebral hemispheres: mood, memory, and cognitive disturbances
    • Brain stem: double vision, slurred speech, sensory and motor disturbances
    • Cervical spinal cord: Various sensory and motor disturbances (including long tract involvement).
    • Lumbosacral spinal cord: paraplegia, incontinence, sexual dysfunction, optic nerve damage
    • Other features: fatigue, various vision problems, bladder/bowel dysfunction, numbness/tingling, muscle spasms, stiffness, weakness, tremor, mobility problems, pain (trigeminal neuralgia) cognitive problems (memory, processing), emotional fluctuations, speech/swallowing problems, heat sensitivity, sexual problems

    Multiple Sclerosis: 4 Types

    • Relapsing-remitting MS (RRMS): 85%
    • Primary progressive MS (PPMS): 15%
    • Secondary progressive MS (SPMS): 65%
    • Progressive relapsing MS (PRMS): 5%

    Multiple Sclerosis: Therapies

    • Disease modification therapies: Azathioprine, Methotrexate, Mitoxantrone, Monthly administration of methylprednisolone, IVIgG, Cladribine, Cytoxan, Bone Marrow Transplantation, Others (treatment has greatly changed with availability of biological agents)

    Multiple Sclerosis: Treatment Plan Team

    • Neurologist, Dentist, Speech/language therapist, Neuropsychologist, Psychotherapist, Urologist, Social worker, and Nurse

    Implications of Multiple Sclerosis on Oral Health Care

    • Access to care: No significant concerns with local or intravenous anesthetics. GA is not contraindicated
    • Communication: No significant issues, but can be compromised with disease progression
    • Consent: No significant issues, unless patient has compromised cognition
    • Education: Risk of oral dryness caused by many drugs
    • Surgical: No significant concerns LA/inhalation or IV sedation. GA is not contraindicated
    • Oral features: drug-induced dryness
    • Orofacial features: Trigeminal neuralgia, Trigeminal neuropathy (paraesthesia or anaesthesia), Facial nerve weakness (rare), Loss of mastication function (very rare)
    • Spread: No spread risks

    Parkinson's Disease: Basic Epidemiology

    • Worldwide, incidence is 1 in 3,000
    • Prevalence increases with age
    • Male to female ratio is 1.46
    • Becoming increasingly common

    Parkinson's Disease: Basic Pathology

    • Progressive neurodegenerative disease impacting dopaminergic neurons in the substantia nigra
    • Potential causes and protections suggested
    • Risk factors: Genetics, head trauma (boxing, Muay Thai), toxin exposure (pesticides, herbicides)
    • Protective factors: Smoking, caffeine consumption, black tea

    Parkinson's Disease: Basic Clinical Features: Motor

    • Motor features: Dyskinesia, Akinesia, Bradykinesia, Postural instability and gait disturbance
    • Other features: Dysphagia, speech changes, drooling, scoliosis, leg deformities

    Parkinson's Disease: Basic Clinical Features: Non-Motor

    • Autonomic dysfunctions: orthostatic hypotension, sweating, gastrointestinal disturbances, weight loss.
    • Sensory disturbances: visual hallucinations, anosmia (loss of smell), chronic pain
    • Neurological deficits: cognitive impairment, dementia, psychosis, hallucinations, affective disorders
    • Sleep disturbances: REM sleep behavioral disorders, vivid dreaming, insomnia, daytime hypersomnolence

    Parkinson's Disease: Medical Management

    • Medical: Levodopa and combinations (carbidopa), Dopamine agonists, MAO-B inhibitors, COMT inhibitors, and anticholinergics
    • Surgical: Deep brain stimulation (Subthalamus nucleus (STN), Globus Pallidus interna (GPi), Lesioning (thalamus, Globus Pallidus)

    Parkinson's Disease: Supportive Management

    • Physical therapy: general, treadmill training, dance, martial arts, cuing
    • Strength training: weight machines, resistance cycling
    • Occupational therapy: dysphagia support, utensil recommendations
    • Speech and language therapy: compensatory and rehabilitative approaches for dysarthria and dysphagia

    Implications of Parkinson's disease on oral health care

    • Access to care: Mobility impairment (wheelchairs, limited movement, balance issues. Difficulty attending appointments due to fatigue, mood changes). Additional clinical time.

    • Communication: Possible compromise due to dementia (with severe disease), mood swings, slow speech, reduced vocal volume.

    • Consent: Can be compromised by dementia

    • Education: Risk of oral dryness from medications, modification in oral hygiene methods due to motor defects

    • Surgical: Generally no significant concerns with LA/inhalation or IV sedation. GA is still an option

    • Oral features: Oral dryness, principally drug induced. -Orofacial features: Dyskinesias, drooling, and other possible features (see following slides).

    • Spread: No spread risks

    General Key Points on Neurological Diseases

    • Epilepsy has a low likelihood of seizure during oral health care delivery.
    • Multiple sclerosis is increasingly common and impacts access to care.
    • Parkinson's disease can significantly impede access to care.
    • Staff needs awareness of potential issues and adaptations in appointment timing, clinic layout, and communication style.

    Reading Material

    • Students should review relevant teaching from second and fourth years.
    • Special Care Dentistry (Scully, Diz Dios, Kumar, 2007) is a useful textbook.

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    Description

    This quiz explores how various neurological diseases like epilepsy, multiple sclerosis, and Parkinson's disease affect oral health and dental care. It aims to identify specific oral diseases that arise from these neurological conditions and understand their implications on healthcare delivery.

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