Podcast
Questions and Answers
What condition presented as a possible cause of epilepsy in older age groups is directly associated with degenerative changes in the brain?
What condition presented as a possible cause of epilepsy in older age groups is directly associated with degenerative changes in the brain?
Which phase is characterized by muscle stiffening during a grand mal seizure?
Which phase is characterized by muscle stiffening during a grand mal seizure?
Which of the following is a recommended safety aid for patients with epilepsy?
Which of the following is a recommended safety aid for patients with epilepsy?
Which medication is commonly associated with inducing gingival enlargement in epilepsy patients?
Which medication is commonly associated with inducing gingival enlargement in epilepsy patients?
Signup and view all the answers
What is an important dietary consideration for managing epilepsy in children?
What is an important dietary consideration for managing epilepsy in children?
Signup and view all the answers
Which of the following correctly describes epilepsy?
Which of the following correctly describes epilepsy?
Signup and view all the answers
What is a primary feature of a seizure?
What is a primary feature of a seizure?
Signup and view all the answers
Which neurological disorder is characterized as a degenerative disease?
Which neurological disorder is characterized as a degenerative disease?
Signup and view all the answers
Which statement accurately reflects the oral health implications for patients with neurological diseases?
Which statement accurately reflects the oral health implications for patients with neurological diseases?
Signup and view all the answers
Which of the following is NOT listed as a common neurological disorder relevant to dental practice?
Which of the following is NOT listed as a common neurological disorder relevant to dental practice?
Signup and view all the answers
How many people worldwide are estimated to be affected by epilepsy?
How many people worldwide are estimated to be affected by epilepsy?
Signup and view all the answers
What is a potential vascular cause of neurological disease mentioned?
What is a potential vascular cause of neurological disease mentioned?
Signup and view all the answers
Which of the following is an example of an infectious neurological disease?
Which of the following is an example of an infectious neurological disease?
Signup and view all the answers
What is the male to female ratio of Parkinson's Disease prevalence?
What is the male to female ratio of Parkinson's Disease prevalence?
Signup and view all the answers
Which of the following is NOT considered a risk factor for Parkinson's Disease?
Which of the following is NOT considered a risk factor for Parkinson's Disease?
Signup and view all the answers
Which motor feature is characterized by a lack of physical movement?
Which motor feature is characterized by a lack of physical movement?
Signup and view all the answers
Which of the following treatments is considered a type of medical management for Parkinson's Disease?
Which of the following treatments is considered a type of medical management for Parkinson's Disease?
Signup and view all the answers
What are the non-motor features associated with Parkinson's Disease?
What are the non-motor features associated with Parkinson's Disease?
Signup and view all the answers
Deep brain stimulation for Parkinson's Disease primarily targets which areas of the brain?
Deep brain stimulation for Parkinson's Disease primarily targets which areas of the brain?
Signup and view all the answers
Which of the following symptoms is a common sensory disturbance in Parkinson's Disease?
Which of the following symptoms is a common sensory disturbance in Parkinson's Disease?
Signup and view all the answers
Which of the following medications is NOT typically used in the management of Parkinson's Disease?
Which of the following medications is NOT typically used in the management of Parkinson's Disease?
Signup and view all the answers
What should be prioritized during a dental procedure for a patient with epilepsy experiencing a seizure?
What should be prioritized during a dental procedure for a patient with epilepsy experiencing a seizure?
Signup and view all the answers
Which of the following is a common oral health issue associated with epilepsy?
Which of the following is a common oral health issue associated with epilepsy?
Signup and view all the answers
What is a common demographic characteristic of multiple sclerosis?
What is a common demographic characteristic of multiple sclerosis?
Signup and view all the answers
Which of the following is NOT a clinical feature of multiple sclerosis?
Which of the following is NOT a clinical feature of multiple sclerosis?
Signup and view all the answers
Which treatment is NOT typically used to modify the disease course in multiple sclerosis?
Which treatment is NOT typically used to modify the disease course in multiple sclerosis?
Signup and view all the answers
In cases of severe dental trauma in epileptic patients, what type of dental appliance is preferred?
In cases of severe dental trauma in epileptic patients, what type of dental appliance is preferred?
Signup and view all the answers
Which of the following medications is typically used for status epilepticus?
Which of the following medications is typically used for status epilepticus?
Signup and view all the answers
What is a common type of neurological disease relevant to dental practice?
What is a common type of neurological disease relevant to dental practice?
Signup and view all the answers
Which of the following is a potential emotional disturbance experienced by individuals with multiple sclerosis?
Which of the following is a potential emotional disturbance experienced by individuals with multiple sclerosis?
Signup and view all the answers
What is the primary demographic for the diagnosis of multiple sclerosis?
What is the primary demographic for the diagnosis of multiple sclerosis?
Signup and view all the answers
What is the relationship between amalgam restorations and multiple sclerosis (MS)?
What is the relationship between amalgam restorations and multiple sclerosis (MS)?
Signup and view all the answers
Which of the following is NOT an orofacial feature associated with multiple sclerosis?
Which of the following is NOT an orofacial feature associated with multiple sclerosis?
Signup and view all the answers
How can mobility issues in MS patients affect their access to dental care?
How can mobility issues in MS patients affect their access to dental care?
Signup and view all the answers
Which statement regarding communication in MS patients is true?
Which statement regarding communication in MS patients is true?
Signup and view all the answers
What considerations should be made for oral hygiene methods in MS patients?
What considerations should be made for oral hygiene methods in MS patients?
Signup and view all the answers
What is a notable concern regarding the medications used by MS patients and oral health?
What is a notable concern regarding the medications used by MS patients and oral health?
Signup and view all the answers
What type of anesthesia is considered safe for use in MS patients undergoing dental procedures?
What type of anesthesia is considered safe for use in MS patients undergoing dental procedures?
Signup and view all the answers
Which of the following statements is true for the mood of MS patients regarding consent?
Which of the following statements is true for the mood of MS patients regarding consent?
Signup and view all the answers
What oral health risk is significantly increased due to Parkinson's disease?
What oral health risk is significantly increased due to Parkinson's disease?
Signup and view all the answers
Which of the following mobility aids can help improve access for patients with Parkinson's disease?
Which of the following mobility aids can help improve access for patients with Parkinson's disease?
Signup and view all the answers
What effect does Parkinson's disease potentially have on communication?
What effect does Parkinson's disease potentially have on communication?
Signup and view all the answers
Which condition is NOT typically associated with oral manifestations in Parkinson’s disease?
Which condition is NOT typically associated with oral manifestations in Parkinson’s disease?
Signup and view all the answers
What is one effective management approach for drooling in Parkinson's disease patients?
What is one effective management approach for drooling in Parkinson's disease patients?
Signup and view all the answers
Which characteristic of Parkinson's disease may impair a patient's ability to give consent for dental procedures?
Which characteristic of Parkinson's disease may impair a patient's ability to give consent for dental procedures?
Signup and view all the answers
What is a common oral feature drug-induced oral dryness seen in Parkinson’s disease?
What is a common oral feature drug-induced oral dryness seen in Parkinson’s disease?
Signup and view all the answers
Which of these is NOT a recommended modification in oral hygiene methods for individuals with Parkinson's disease?
Which of these is NOT a recommended modification in oral hygiene methods for individuals with Parkinson's disease?
Signup and view all the answers
During which time is it generally best to schedule dental appointments for Parkinson's disease patients?
During which time is it generally best to schedule dental appointments for Parkinson's disease patients?
Signup and view all the answers
What is one of the primary concerns regarding the use of general anesthesia in Parkinson's disease patients?
What is one of the primary concerns regarding the use of general anesthesia in Parkinson's disease patients?
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
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.