BDS3 Human Disease Summarised PDF

ALL DISEASES HAEMATOLOGY........................................................................................................................................ 2 LIVER.......................................................................................................................................

ALL DISEASES HAEMATOLOGY........................................................................................................................................ 2 LIVER...................................................................................................................................................... 10 HAEMOSTASIS AND BLEEDING DISORDERS............................................................................................. 12 WARFARIN AND ASPIRIN........................................................................................................................ 13 GASTROENTEROLOGY............................................................................................................................. 15 RHEUMATOLOGY.................................................................................................................................... 20 COMMON SWELLINGS – HEAD AND NECK............................................................................................... 25 ALLERGY................................................................................................................................................. 26 PSYCHOSOCIAL....................................................................................................................................... 29 ALCOHOLISM AND DRUGS...................................................................................................................... 32 CHEMOTHERAPY..................................................................................................................................... 33 IMMUNOSUPPRESSION.......................................................................................................................... 35 INFECTIOUS DISEASES............................................................................................................................. 37 ENDOCRINOLOGY................................................................................................................................... 38 ADRENO-CORTICAL HYPER/HYPO FUNCTION.......................................................................................... 40 KIDNEY DISEASE...................................................................................................................................... 42 HEART - CARDIOVASCULAR DISEASES..................................................................................................... 45 INFECTIVE ENDOCARDITIS AND RHEUMATIC FEVER................................................................................ 53 RESPIRATORY.......................................................................................................................................... 54 DERMATOLOGY...................................................................................................................................... 61 NEUROLOGY........................................................................................................................................... 62 ORAL SURGERY COMPLICATIONS............................................................................................................ 69 DRUGS.................................................................................................................................................... 70 HAEMATOLOGY ANAEMIA DEFINITION CLASSIFICATION CAUSES SIGNS + SYMPTOMS Anaemia is the reduction in the oxygen-carrying capacity of the blood and is defined by a low value for haemoglobin (M:130-170g/L, F: 120-155g/L) Based on red-cell mean corpuscle volume (MCV) of RBCs: Microcytic (MCV 100fl): Lack of haemoglobin due to larger RBCs Caused by disease or drug therapy that cause the following mechanisms which result in anaemia: 1. Reduced red-cell production - Defects in haemoglobin function - Decreased production e.g. deficiency state or bone marrow aplasia 2. Increased red-cell destruction (haemolysis → congenital e.g. sickle cell, acquired e.g. malaria/drugs) 3. Loss of red cells from circulation (blood loss through bleeding) 4. Dilutional effect from increased plasma volume (e.g. pregnancy) Varied and depend on speed of onset. *Acute blood loss = injury/haemorrhage/ruptured ectopic pregnancy etc - Collapse - Breathlessness - Tachycardia - Poor volume pulse - Reduced BP Peripheral vasoconstriction *Mild Anaemia: - Asymptomatic - Lethargy - Pallor DENTAL RELEVANCE *Severe Anaemia (Hb 90 Grade 2 = mild CRF = GFR 60-90 Grade 3 = Moderate CRF = GFR 30-60 Grade 3 – Severe CRF = GFR 15-30 Grade 4 = End stage Renal Failure = GFR 40 = NO GA - COPD = NO GA - Pregnant = NO GA - Diabetics = caution – use insulin on “sliding scale” - Asthmatic patient = GA fine as long as asthma is controlled - Systemic arthritis = GA fine - Sickle Cell anaemia = NO GA - Liver disease = avoid GA IV SEDATION: - Hypertension = Good to give anaesthesia (reduces BP) - COPD = NO IV SEDATION - Kidney disease = proceed with caution (esp stage 4) = enhanced sedative effect - Anaemia = proceed with caution - Sickle cell anaemia = IV fine, but with o2 supplementation and preferably in hospital - Liver disease = avoid sedation → if must use, decrease dose and give slower - Diabetes = IV sedation fine, but MUST check INR before - Asthma = sedation with care - Epilepsy = sedation fine, preferably hospital setting with O2 supplementation Midazolam: Anxiolytic Benzodiazepine family Administration route: IV but can be given buccal in dental practice Sedates patient Reversal: flumazenil Other anticoagulants: Dabigatran and Apixaban(omit AM dose if take AM, normal PM dose) Rivaroxaban (treat AM if PM dose- 4 hour post procedure. If AM dose take early AM or after tx) ANTIBIOTICS: Thrombocytopenia: Avoid → anticoagulant effects increased Pt on warfarin/aspirin: avoid Kidney disease: Decrease dose ANTIBIOTIC PROPHYLAXIS: - Pt undergoing radiotherapy/chemotherapy - Sickle cell anaemia pt undergoing surgery - Pts who have had organ transplant INR: ratio of prothrombin time:normal = 1 in health Tranexamic acid: Anti-fibrinolytic = prevents breakdown of fibrin clot by inhibiting activation of plasminogen COMMON DOSES FOR ORAL SURGERY: Paracetamol QDS 1g Ibuprofen 400mg QDS (600mg before surgery!) Amoxicillin 500mg TDS 5 days- gram +ve mainly Metronidazole 400mg TDS 5 days – gram –ve mainly Erythromycin 500mg QDS 5 days – best alternative to amox as gram +ve Allograft: the transfer of tissue or an organ between nonidentical members of the same species Autograft: transfer of tissue from one location of an individual's body to another location that is in need of healthy tissue; in other words, the recipient is also the donor Xenograft represents the most disparate of genetic relationships, because it is the transfer of tissue or organs between members of different species NERVES Trigeminal Muscles mastication Sensory anterior + dorsum of tongue (Lingual branch) Maxillary nerve → branches to greater palantine → innervates anterior or hard palate Muscles of facial expression Nerve to stapedius Taste of anterior 2/3 of tongue Posterior 1/3 of tongue for sensory and taste Tonsillar fossa Parynx Parasympathetic parotid gland Pharynx Larynx Soft palate Facial Glossopharyngeal Vagus Instruments: Elevator → (and/or) Luxator → Deliver with forceps FORCEPS Damage PDL, then sever it. Engage at CEJ of root to dilate boy socket coronally. Move tooth laterally to dilate socket. Tooth delivered buccally. Mandibular forceps = right angled Maxillary forceps = straight ANTERIOR (U+L) UPPER Upper Cowhorns = 2 buccal roots, 1 palatal root LOWER Lower Cowhorns = Engage the furcation (2 roots) *Good for broken down teeth ELEVATORS By pushing tooth distally: *Severs PDL *Widens socket coronally Rotation of instrument lifts tooth out of socket LUXATORS BAYONET Forceps Couplands 1,2 and 3 *Used mesially *Larger handle than blade = lever advantage Warwick James Straight, left, right *90° blade to shank Positioned between root and bone Useful for… *Retained roots *Elevation and mobilisation of upper 8s Cryers Left, right Useful for… *Retained roots *Elevation and mobilisation of upper 8s Used in long axis of the tooth Sharp blade disrupts/severs PDL Wedged in = widens coronal aspect of socket For extraction of U8s (ones with curved tip can be used for upper posterior roots) POSITIONING LOWER LEFT LOWER RIGHT UPPER LEFT Infront RHS Chin down Chair lower Hand under chin to support mandible - thumb lingually, finger buccally either side of tooth Behind RHS Chin down Chair lower Hand under chin to support mandible - thumb lingually, finger buccally either side of tooth Infront RHS Chin Up Chair higher Hand supporting palate – thumb buccally, finger palatally Infront On RHS Chin up Chair higher Hand supporting palate – thumb buccally, finger palatally Patient upright Patient flatter UPPER RIGHT ANTERIOR POSTERIOR EXTRACTIONS Type of infiltration LL6 UR3 Buccal and palatal Nerves anaesitised ID, lingual and long buccal Anterior superior alveolar nerve, greater palantine and infraorbital Pulp of UL7 = Posterior superior alveolar nerve Pulp of LL6 = Inferior alveolar nerve Palatal gingivae of UL1 = Nasopalatine Buccal gingivae of LR6 = long buccal Structures to avoid during extraction: Lower 8s → avoid lingual nerve (Other complications = dry socket, fracture of mandible, ID damage) Upper 6 → avoid antrum When cannulating ante-cubetal fossa – avoid branchial artery Elevating L7 → avoid fracture/dislocation of TMJ LL6 → avoid mental nerve ORS IV Sedation = Midazolam GA sedative (inhalation) = Nitrous oxide Reason why there are sutures in soft palate/maxillary tuberosity = OAC Nasopalatine = anaesthetises gingiva (3-3) Greater palatine = anaesthetises gingiva (4-8) If pt is nervous + tooth badly broken down = Sedation because may turn into surgical procedure Dry socket RF = females (esp. OCP), smoker, mandibular, excessive rinsing, single/difficult/traumatic extraction 1-3% incidence) Resorbable = vicryl rapide Non resorbable = silk, ethilon, prolene Lower 6 = more likely to fracture mandible Upper 8 = fracture of maxillary tuberosity Lower 8 = risk of paraesthesia Oral-antrum communication (OAC) → OAF → chronic sinusitis OAC → oral-antral regime OAF → excision of fistula → 3 sided MPF → raise MPF → score periosteum to allow advancement of flap → suture buccal flap to palatal mucosa → wound edge → closure of fistula with resorbable sutures (this is a buccal advancement flap) Local Anaesthetic Intra-papillary infiltration → children + palate % Lidocaine or Articaine x 10 = y y x 2.2?ml cartridge = mg Lidocaine/articaine per cartridge Uppers = buccal infiltration for all buccal gingiva vs SAN = upper teeth Mental nerve = chin, lip tongue, floor of mouth Greater palatine = 4 Lower: Inferior alveolar nerve = enters via mandibular foramen → 8-4 teeth Mental nerve = comes out between 4 and 5 → buccal gingiva, chin, lip 4-1, long buccal does mucosa 5-8 Mental nerve block (BI) = relying on anaesthesia from mental nerve to hit inferior alveolar nerve Incisive nerve (BI) = 1-3 teeth Common problem with ID block → hitting lingual nerve TONGUE ANTERIOR ⅔ tongue: Sensory = Lingual branch (V3) Trigeminal nerve, Taste = Facial Nerve (Chorda Tympani) Posterior ⅓ tongue: Sensory + Taste = Glossopharyngeal (CN9) All tongue: Extrinsic muscles (motor) = Hypoglossal (CN12) Hard palate = Greater palatine (branch V2) + mucosa Summary of stages of tooth socket healing Day 1 = Formation of initial, unstable blood clot *** Day 1-2: risk of dry socket Day 2 = Stabilisation and consolidation of the blood clot. Excessive fibrinolysis occurs resulting from plasminogen pathway activation!!! Plasminogen breaks down to plasmin → plasmin is an enzyme which breaks down fibrin in clot → fibrin degradation products. Tranexamic acid inhibits plasminogen breakdown. Day 4 = Granulation tissue formation (capillary vessels, fibroblast, collagen, connective tissue) Day 18 = Early replacement of organizing granulation tissue by woven bone Day 18-42 = Mixture of woven and lamellar bone where lamellar bone replaces woven bone By day 78 = remodelling of lamellar bone. Local haemostatic measures: 1. Flush saline (removes lose blood clots) 2. Oxidised cellulose (initiates clotting = Surgical/Curacel) 3. Suture across socket – prevents haemorrhage from mucosa by putting pressure on the mucosa against the bone and prevents loss of the oxidised cellulose dressing (horizontal mattress/cross mattress) 4. Pressure on gauze for 10-15 mins 5. +/- tranexamic acid on gauze = prevents formation of plasmin from plasminogen, prevents degradation of fibrin, DOACS Dabigatran + Apixaban (am + pm) – Omit am dose, extraction, normal pm dose should there be no signs of active bleeding Rivaroxaban (am)– delay morning dose till 4 hours after treatment, should there be no signs of active bleeding Edoxaban (pm) – no change INR 4 = refer back to haematology clinic for medication adjustment ORS Instruments: Forceps (disrupt PDL, dilate bony socket, PDL/engage at CEJ, delivered buccally): Standard forceps Lower cow horns = right angled + pointy blades + engages furcation + for badly broken down tooth + furcation (Mesial/Distal) Upper cow horns = straight + 1 blade (btwn 2 buccal roots) + other blade (engages palatal surface of palatal root) + badly broken down/fractured upper molars Bayonets = Upper 8’s, bend vertically Root Forceps Bone nibbler = BAYONETTES Elevators (handle, shaft, working blade) (severe PDL, dilate bony socket, 90 degree to long axis/horixontally, between root surface and alveolar crest (fulcrum), pdl space, rotational movement, buccally only, possible to mobilise adj teeth): Couplands = flat (sharp) (3/2/1 = smallest) Warwick James = curved, round tip (L/R/straight), thin Cryers = sharp triangles (L/R) *Howarth = spoon shaped Mitchells trimmer = cuts away at bone a. b. c. d. e. HOWARTHS ELEVATOR = SPATULA → Luxator (long axis of tooth, insert in PDL space between root and bone, sharp blade, disrupts PDL, gentle rotating - round tip) Upper 1,2,3,5 = 1 root, Upper 4 = 2 roots, Upper 6-7-8 = 3 roots Lowers = all 1 root except L6-7-8 = 2 roots Uppers = all 1 canl except, U4 = 2 canals, U6 = 4 canals, U7 = 3 canals Lowers = all 1 canals except L6-7 = 3 canals = simple interrupted suture (most common) = horizontal mattress suture/horizontal cross mattress suture (most common for local haemostatic measures Also have vertical mattress suture and continuous suture. Human disease INR: Prosthetic Heart 3.5. Deep Vein Thrombosis or PE 2.0-2.5 Rheumatoid Arthritis treatment = Steroids, Biologics (Anti-TNF, TNF-blockers), Immunosupressive therapy (HAM) Sjogrens is secondary to: RA, Progressive systemic sclerosis (MS), SLE Patients to avoid NSAIDS: - Pregnant - Warfarin - Alcoholics - Liver/Kidney disease - Asthmatics - Gastric ulcers - Caution with: respiratory disease patients are sensitive to NSAIDS and Hep C patients - Inflammatory Bowel disorders (crohns/UC) Can undergo GA: Well controlled asthmatics Can’t go under GA: COPD, Pregnant, MI under 6 months, Caution with diabetics as lose glucose control Allodynia – pain from normally non-painful stimulus Hyperalgesia – increased response to normally painful stimulus Dysaesthesia – unpleasant sensation spontaneous/evoked Paraesthesia – unpleasant abnormal sensation – spontaneous/evoked Hypoalgesia – diminished pain response to painful stimulus Anaesthesia – no pain from painful stimulus Neuralgia – nerve distribution pain Neuropathic – nerve pathology/damage pain Neuropathy – nerve function/damage/pathology pain Pregnancy drugs that can be taken: CAN TAKE: Amoxicillin, Penicillins, erythromycin and cephalosporins, paracetamol 1. Antibiotics to be avoided = streptomycin, the tetracycline family (in the 3rd trimester) and trimethoprim (which interferes with folate metabolism and so should be avoided in the 1st trimester) 2. If mother taking warfarin then metronidazole should be avoided too. Sodium valproate - epilepsy - increased bleeding risk Herpes simples - all the Es, erythema multiform, encephalitis, Carbamazepine - treatment - trigeminal neuralgia Miconazole - anti-fungal - denture stomatitis Causes of Jaundice Pre-hepatic: haemolytic anaemia, thalassemia Intra-hepatic: Alcohol related (cirrhosis), Hep A/B/C, liver disease Post-herpatic: gall stone/cancer/tumour/pregnancy ENDOCRINOLOGY: Hyperthyroidism High thyroxine Low TSH (anterior pituitary) and low TRH (hypothalamus) Hypothyroism: Low thyroxine High TSH (anterior pituitary) and high TRH (hypothalamus) Cushing: Too much cortisol Reduced ACTH (anterior pituitary) and reduced CRH (hypothamalus) Addisions Too little cortisol High ACTh (anterior pituitary) and high CRH (hypothalamus) Conns High mineralcorticoids produced by the zone glomerulosa Hyperparathryoidism: Low calcium levels High parathyroid hormone Increased PTH (parathyroid gland) CRP for ketones – should be under 5 ESR – between 1 and 10 Serum – not a great test Gates glidden 800 RPM (1-3) - speed Immune mononucleosis – enlarged lymph nodes – more likely arm pits EBV – associated with hodgkins lymphoma and burkitts lymphoma Pleomorphic adenoma – salivary gland neoplasm Lipoma – benign tumour made of fat tissue – back, shoulder,abdomen RADIOLOGY Beam too shallow = elongation Beam too steep = foreshortening Paralleling technique = image receptor parallel to teeth, x-ray beam at right angle to image receptor and dentition 1. Periapicals → uses holders - Detection of apical infection and other diseases - Assessment of periodontal status - Assessment of root shape and number before extraction - Before, during & after endodontic treatment - Pre/post op evaluation of implants - Assess trauma to teeth & alveolar bone - Before and after apical surgery 2. Bitewings = shown crowns of upper and lower premolars and molars, 1/3 of roots, interdental alveolar bone → uses holders and sometimes bitewing tabs (1 time use for children etc) - Detection of dental caries (interproximal caries, @ contact points between teeth) - Monitoring the progression of dental caries - Assessment of existing restorations – secondary caries and overhanging restorations - Assessment of periodontal status Bisected angle technique = X-ray beam aimed perpendicular (90°) to the line which bisects the angle between the long axis of the image receptor and long axis of the tooth → no holder, bite block + image receptor placed 90° to beam - Unreliable - Get cone cuts easily - Good for gaggers - Vertical angulation too large = image foreshortened - Vertical angulation too small = image elongated - Incorrect horizontal angulation = overlapping of crowns and roots - Comfortable - Positioning of image receptor is relatively simple - Can get distorted image - Horizontal and vertical angles have to be assessed for each patient - Buccal roots of maxillary roots are foreshortened - Periodontal bone levels poorly shown - Tooth crowns are distorted, preventing detection of approximal caries - Cone cut errors - Shadow of zygomatic buttress is superimposed over the roots of upper molars - May be forced to use round collimator = more radiation dose Not reproducible images Parallax Technique = apparent displacement of an object due to 2 different positions of the observer 1. Horizontal Parallax: Method: Take 2 radiographs of unerupted tooth. 1st radiograph = tube at standard angle. 2nd radiograph = tube at distal position → 2 final images will show the unerupted tooth in 2 different positions relative to another tooth (reference tooth) - Unerupted canines - Common in children - Clinical exam not easy to determine buccal-palatal position of unerupted canines → need X-ray - Gives LOW radiation dose 2. Vertical Parallax: X-ray tube shifts in vertical plane = DPT, upper standard occlusal