Dental Precautions in Muscular and Bony Diseases PDF

DENTAL PRECAUTIONS IN MUSCULAR AND BONY DISEASES Doç. Dr. KADER AYDIN OSTEOGENESİS İMPERFECTA DENTİNOGENESİS İMPERFECTA, SOFT DENTİN BROWN/ PUPLE COLORED TEETH AVOID PRESSURE DURING DENTAL SURGERY CLEİDOCRANİAL DYSOSTOSİS MULTİPL SÜRNÜMERARY TEETH MULTİPL IMPACTED TEETH PE...

DENTAL PRECAUTIONS IN MUSCULAR AND BONY DISEASES Doç. Dr. KADER AYDIN OSTEOGENESİS İMPERFECTA DENTİNOGENESİS İMPERFECTA, SOFT DENTİN BROWN/ PUPLE COLORED TEETH AVOID PRESSURE DURING DENTAL SURGERY CLEİDOCRANİAL DYSOSTOSİS MULTİPL SÜRNÜMERARY TEETH MULTİPL IMPACTED TEETH PERSİSTANT/ DEPRİMED PRIMARY TEETH CROWN/ ROOT MALFORMATIONS DENTİGEROUS CYSTS OSTEOPETROSİS INCREASE OF DENSITY OF THE SKULL BONES WIDENED FACE SUPERIORLY LOCATED NOSE TIP TRİGEMİNAL/ FACİAL NEUROPATHY OSTEOMYELIS DUE TO TOOTH EXTRACTIONS/ BONY FRACTURES MARPHAN SYDROME Heart and Blood Vessels (cardiovascular system) Bones and Joints (Skeletal system) Eyes (Ocular system) Heart and Blood Vessels (Cardiovascular system) Enlarged or bulging aorta, the main blood vessel that carries blood from the heart (aortic dilation or aneurysm) Separation of the layers of the aorta that can cause it to tear (aortic dissection) “Floppy” mitral valve (mitral valve prolapse – MVP) Bones and Joints (Skeletal system) Long arms and legs Tall and thin body type Curvature of the spine (scoliosis or kyphosis) Chest sinks in (pectus excavatum) or sticks out/pigeon breast (pectus carinatum) Long, thin fingers Flexible joints Flat feet Teeth that are too crowded  Eyes (Ocular system) Severe nearsightedness (myopia) Dislocated lens of the eye Detached retina Early glaucoma Early cataracts Other Body Systems Stretch marks on the skin, not explained by pregnancy or weight gain Sudden collapse of the lung (spontaneous pneumothorax) Swelling of the sac around the spinal column (dural ectasia). This is found with CT or MRI scans of the back EHLERS DANLOS PULP STONES PURPURA ECCHIMOSIS SMALL TEETH RICKETTS/ OSTEOMALASI DELAY IN ERUPTION INCREASED RADIOLUCENCY HEMORRAGIC DIATHESES D RESISTANT RICKETS: ENLARGED PULP CHAMBERS FAILURE OF DENTINAL CALCIFICATION FIBROUS DYSPLASIA PAGET SYMMETRICAL BUMPS PULP CALCIFICATIONS ROOT RESORBTION LOSS OF LAMINA DURA HYPERSEMENTOSIS POSTOP HEMORRAGIA EXPANSION OF THE ALVEOLAR BONES MUSCULAR DISTROPHY DYSPHAGIA GOOD SUCTION CANT WHISTLE EXPANSION OF THE ALVEOLAR BONES MALOCCLUSION AVOID GENERAL ANESTHESIA MYOTONIC DISEASES OPEN MOUTH DYSPHAGIA SJOGRENS DISEASE RHEUMATIC DISEASES IN DENTISTRY  SJÖGREN SYNDROME SCLERODERMA BEHÇET’S DISEASE RHEUMATOİD ARTHRİTİS JÜVENİLE İDİYOPATHIC ARTHRİTIS (JUVENİLE RHEUMATOİD ARTHRİTİS , FAMILIAL MEDITTERENEAN FEVER(FMF), SYSTEMİC LUPUS ERİTEMATOSİS, DERMATOMYOSITIS, HENOCH-SCHÖNLEİN PURPURA, POLYARTERİTİS NODOSA, KAWASAKİ DISEASE SJÖGREN SYNDROME It is an autoimmune disease that causes dry eyes and dry mouth. Sjögren can occur in two forms: primary and secondary. Primary Sjögren Syndrome occurs on its own and is not related to other diseases. Secondary Sjögren's Syndrome occurs with some types of inflammatory rheumatic diseases such as Rheumatoid arthritis, Lupus, and Polymyositis. Although it is relatively rare in people under 20, it can affect people of all ages and races. 90% of the patients are women. The tendency for Sjogren's Syndrome increases when someone in the family has the disease.  FINDINGS Dry Mouth: Patients with Sjogren's Syndrome produce less saliva than normal. This makes it difficult to chew, swallow, and speak. This can also reduce the sense of taste. Dry Eyes: Eyes feel dry, gritty. There may be burning and redness in the eyes. While sleeping, excess mucus (burr) may accumulate around the eye corners. Your eyes may be more sensitive to sunlight. If not treated well, Sjogren's Syndrome can lead to blind spots in the eyes and corneal ulcers (wound on the outer part of the eyeball). Rarely, this can lead to vision loss.  Swollen Salivary Glands: Dental Caries: Fungal Infection In The Mouth: Dry Nose, Throat and Lungs: causes the throat to have a dry and tickling feeling. It can cause dry cough, hoarseness, decreased sense of smell and nosebleeds. Dryness can also lead to pneumonia, bronchitis and ear problems. Dryness of the Vagina: Fatigue: A common symptom of Sjögren's Syndrome. It may occur due to the disease itself or as a result of the physical and emotional stress of having a chronic disease. Other Problems: Inflamed and painful joints, muscle weakness, dry skin, rashes, constipation, numbness due to inflammation in the nerves, tingling and swollen lymph nodes  SCLERODERMA It means "hard skin" in Greek. With thickening and hardening of the skin; It is a chronic disease with scar tissue formation. It can cause damage to internal organs such as the lungs, heart and blood vessels, esophagus, stomach, and kidneys. Scleroderma can show a very different course from mild skin involvement to life-threatening organ involvement. Therefore, complaints also differ from patient to patient.  There are two types of scleroderma, localized and systemic. Localized scleroderma only affects the skin and usually does not cause as much damage as its systemic form. In its systemic form, in addition to skin changes, it can cause damage to blood vessels, internal organs such as the lungs, heart and kidneys. **** restriction in mouth opening  BEHÇET’S DISEASE There are recurrent round or oval ulcers with smooth edges, white base, red rim and called 'aphthae' in the mouth. Aphthae can usually be seen in the lips and cheeks, on the edge, base and dorsum of the tongue, on the soft palate, tonsils or pharynx. They recur with varying frequency and usually heal within 1-2 weeks without leaving a scar. Intraoral aphthae are also frequently seen (5-15%) in people who have no other complaints, and there is no clinical difference between these simple aphthae and Behçet's disease. Rheumatoid arthritis It is a chronic, inflammatory, multisystem, autoimmune disorder. It often shows polyarticular involvement. The symptoms that distinguish rheumatoid arthritis from other forms of arthritis are the swelling and inflammation of the soft tissue of many joints at the same time (polyarthritis).  Joints are affected bilaterally. The pain is reduced with the use of the affected joints and stiffness is usually felt in all affected joints for more than 1 hour in the morning. As the pathology progresses, inflammatory activity causes erosion and destruction of the joint surface, which damages the joint surface range of motion and causes deformity. The fingers often turn towards the little finger (ulnar deviation) and thus take on unnatural shapes.  Classical deformities seen in rheumatoid arthritis are Boutonniere deformity and swan neck deformity. Apart from these, different deformities can be seen. Dermatologically, nodules are formed under the skin (subcutaneous), usually on extensor surfaces such as elbows. Anemia occurs due to gastrointestinal bleeding as a side effect of drugs used in the treatment of the disease, especially NSAIDs (non-steroidal anti-inflammatory drugs) used for analgesia. Splenomegaly (enlarged spleen) can be seen with leukopenia (Felty's syndrome) and lymphatic infiltration can affect salivary and lacrimal glands (Sjögren's syndrome). In addition, the lungs may be affected as a stage of the development of the main disease or due to therapy.  Fibrositis may occur suddenly or as a result of treatment (eg methotrexate use). Amyloidosis can be seen, which can cause muscular pseudohypertrophy (pseudohypertrophy). Cardiovascularly include pericarditis, valvulitis and fibrosis. Keratoconjunctivitis sicca (dry eyes), episcleritis and scleromalacia can also be seen in the ocular aspect. Apart from these, vascular disorders can be considered as autoimmune. Neurologically, mononuritis multiplex and atlantoaxial subluxation may be symptoms.  Imaging In RA Hand- wrists graphies, Feet- ankle graphies are useful in the diagnosis and follow-up of joint damage. In the early period, soft tissue swelling and periarticular osteoporosis can be found around the joint. In time, small defects (marginal erosions) in the joint corners, cysts, narrowing of the joint space, subluxations and ankylosis may develop. Magnetic Resonance and ultrasonography are valuable in early diagnosis and follow-up. OSTEOARTRITIS ASPIRIN/ CORTICOSTEROIDS HEMORRAGIC DIATHESES ARTIFICIAL JOINTS: AB PROPHYLAXIS GOUT ORAL ULCERATIONS ANKYLOSING SPONDILITIS 10 % TMJ INVOLVEMENT Systemic lupus erythematosus (SLE) SLE is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.  DERMATOMYOSITIS Dermatomyositis (DM) is a long-term inflammatory disorder which affects skin and the muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin. The cause is unknown. Theories include that it is an autoimmune disease or a result of a viral infection. It is a type of inflammatory myopathy. Diagnosis is typically based on some combination of symptoms, blood tests, electromyography, and muscle biopsies. Medications in the corticosteroids family are typically used with other agents such as methotrexate or azathioprine recommended if steroids are not working well. Intravenous immunoglobulin may also improve  Henoch–Schönlein purpura (HSP also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain. With kidney involvement, there may be a loss of small amounts of blood and protein in the urine (hematuria and proteinuria), but this usually goes unnoticed; in a small proportion of cases, the kidney involvement proceeds to chronic kidney disease. HSP is often preceded by an infection, such as a throat infection.  Purpura, arthritis, and abdominal pain are known as the "classic triad" of Henoch–Schönlein purpura. 40 % have evidence of kidney involvement, mainly in the form of hematuria (blood in the urine), but only a quarter will have this in sufficient quantities to be noticeable without laboratory tests. Problems in other organs, such as the central nervous system (brain and spinal cord) and lungs may occur, but is much less common than in the skin, bowel and kidneys.  The diagnosis is based on the combination of the symptoms, as very few other diseases cause the same symptoms together. Blood tests may show elevated creatinine and urea levels (in kidney involvement), raised IgA levels (in about 50%), and raised C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) results; none are specific for Henoch–Schönlein purpura. The platelet count may be raised, and distinguishes it from diseases where low platelets are the cause of the purpura, such as idiopathic thrombocytopenic purpura and thrombotic thrombocytopenic purpura. Biopsy of the skin may be performed to distinguish the purpura from other diseases that cause it, such as vasculitis due to cryoglobulinemia; on microscopy the appearances are of a hypersensitivity vasculitis, and immunofluorescence demonstrates IgA and C3 (a protein of the complement system) in the blood vessel wall Venereal dıseases and dentıstry  SYPHİLİS Etiology: Agent; Treponema Pallidum1 from the spirochete group. The spiral or corkscrew-like spirochetes could not be cultured. The spirochete, which is not resistant to the external environment, soap, detergent and antiseptics, dies within 1-2 minutes in a dry environment, but can survive for a few hours in humid environments. The safest method in the diagnosis of the disease is to observe the spirochete. Since spirochetes are found in deep layers of the skin, they can be detected in serum obtained by irritating the skin. The prepared preparation is examined under the dark field microscope. Thus, bright and mobile spirochetes can be seen in the dark environment. If there is no skin symptom, spirochetes are sought in serum obtained by puncture from enlarged lymph nodes (Hoffmann method). VDRL testing  Transmission: Treponema Pallidum is abundant in all skin manifestations of 1st and 2nd cycle syphilis. Eroded lesions play an important role in contamination. The most infectious lesions are condilomata lata and papule erosiva. The agent can be isolated from the patients' blood, lymph, saliva, urine, ejaculate, milk and CSF during these periods. Cases in which skin symptoms are not observed (Latent syphilis) are quite risky in terms of contagiousness due to the lack of attention. Contagiousness is reduced in 3rd cycle syphilis, but the blood of the sick person is still infected.  Acquired syphilis is most commonly transmitted by sexual intercourse. In addition, contamination with blood transfusions or infected body fluids may occur. In order for spirochete to enter the organism, the integrity of the skin or mucosa must be compromised (wound, ulcer, abrasion, etc.) Congenital syphilis occurs if the spirochetes are passed from mother to fetus via placental route. If the mother is infected towards the end of her pregnancy and the baby receives the spirochete in the birth canal, acquired syphilis will develop.  Course: Syphilitic Chancre (Chancre) occurs at the entrance area approximately 3 weeks (10-90 days) after the introduction of the Spirochet and this period is defined as the 1st Incubation Period. The 6-week period that starts after the chancre comes out and lasts until the 2nd Period is called the 2nd Incubation Period. Serological reactions become positive about 2 weeks after chancre is removed. The first one is defined as the Seronegative 1st Period, and the next 4-week period is referred to as the Seropositive 1st Period. In acquired syphilis, the first cycle lasts 9 weeks in total, while the second cycle starting with general lymphadenopathy lasts for an average of 4 years. The 3rd period, in which internal organ damage is seen together with skin symptoms, lasts an average of 6-7 years and the disease continues as neurosyphilis. There is no clear boundary between episodes of the disease; When the patient has chancre, symptoms of the 2nd cycle may occur (18-32% of the cases).  The course of congenital syphilis without chancre is similar to the 2nd (Syphilis Congenita Precox) and 3rd (Syphilis Congenita Tarda) cycles of acquired syphilis. Generally, as a result of contamination with blood transfusion, without the signs of the 1st cycle, the condition that occurs with the symptoms of the 2nd cycle is called Syphilis d'Amblee. Classification: It is divided into two groups as Acquired and Congenital according to the form of transmission. Both groups are divided into periods characterized by various lesions. A-Acquired Syphilis B-Congenital Syphilis  1st cycle syphilis (primary syphilis) syphilis congenita precox (early congenital syphilis) 2nd Cycle Syphilis (Secondary Syphilis) Syphilis Congenita Tarda (Late Congenital Syphilis) 3rd Period Syphilis (Tertiary Syphilis) Neurosyphilis The 1st and 2nd stages of acquired syphilis are defined as Early Syphilis, 3rd period and neurosyphilis as Late Syphilis. The disease usually shows no clinical symptoms in the second half of the second cycle syphilis, except sometimes serological test positivity, and this picture is defined as Latent Syphilis and plays an important role in the spread of the disease.  1st cycle syphilis (primary syphilis) In order for the spirochet to enter the organism, the integrity of the skin must be impaired. The first symptom appears approximately 3 weeks after the introduction of the agent (1st incubation period). At the entrance of the spirochetes, a single, 3-5 mm in diameter, red-brown, slightly dandruff, painless and non-itchy papule appears at the entrance site. The lesion rapidly expands around and begins to ulcerate in the middle. Papule, round or oval, 1-2 cm in diameter, slightly raised from the skin, erode and watery, flesh-colored, smooth and mouthless as if pierced with a stapler; Within 6-7 days, it hardens as if a cardboard is inserted under it and is defined as Şankr Syphilitic. During this period, it feels like a button is palpated under the skin. In each encounter with the spirochet in the person at different times, new chancres appear at the entrance points. However, it is 10-11 after the chancre comes out. Even if it encounters spirochetes day after day, no new chancre emerges. This feature, which is valid throughout all stages of syphilis, is called Chancre Immunity.  Chancre; It is mostly located in the shaft of the penis and sulcus coronarius in males and in the labia in females. Perirectal localizations can be observed according to sexual intercourse preferences. In patients with gonorrhea, it may be located intraurethrally and the stiffness of the urethra is detected on palpation together with bloody-purulent discharge. An important point to be known is that chancre can show different localizations such as lip, tongue, perioral region, breast and finger. Chancre without secondary infection heals within 4-6 weeks without leaving scars. Regional lymphadenopathy occurs 8-10 days after chancre emerges. Enlarged lymph nodes are rubbery and painless, do not adhere to the surrounding tissues and do not soften and open out. One of the lymph nodes is larger than the others and is compared to the imame of the simile.  2nd cycle syphilis Symptoms and signs of 2nd cycle syphilis occur 6-8 weeks after chancre comes out. Patients may develop flu-like symptoms (headache, malaise, malaise, joint pain, and weakness). Mild splenomegaly is frequently observed. Anemia, leukocytosis, relative lymphopenia, and associated sedimentation rate can be detected. Generalized lymphadenopathy occurs with the beginning of the 2nd cycle and continues for weeks. Mouthless, mobile and rubbery lymph nodes do not stick to the environment and are not ulcerated and opened. It often shows a symmetrical distribution. The regions where lymphadenopathy develops are inguinal, axillar, cervical, epitroclear, femoral and supraclavicular regions, respectively. Although T. pallidum is found in all tissues and organs, the most prominent and characteristic symptoms of the second cycle are skin lesions. However, the diagnosis and treatment of syphilis is delayed due to the insufficient recognition of these symptoms and the imitation of many skin diseases. 1/4 of the patients may not have a history of chancre and some do not have the symptoms described below.  Skin symptoms seen in 80% of the cases and defined as Syphilid are generally non-itching. These lesions, which are prone to symmetrical localization in the early stages, heal in 4-10 weeks without leaving scars, with or without treatment. Oral Mucosal Lesions: The most common symptom is Angina Spesifica, which is the mucosal form of roseoli that occurs in the early period. The tonsil, soft palate, uvula and pharynx are erythematous and edematous. Larinx localizations cause hoarseness. When the lenticular papules are located in the mucosa, they take the Plaque Mucous step. The papules with a mascara appearance, covered with a white or grayish layer, may become eroded over time. Lesions located in the tongue cause deletion of the papillae. These lesions, which are painless, are highly contagious and tend to recur. SHALLOW PAPULAR LESIONS - OPALIN PLAK ULCEREOUS PAPULES- EROSIVE PLATE  3. Cycle Syphilis It is a condition in which damage to the internal organs and parenchyma begins with skin symptoms, which can be observed approximately 4 years after the onset of infection and in 16% of untreated cases. Most frequently affected organs in order of frequency; skin and mucosa, bone, cardiovascular system, nervous system and visceral organs. Lesions with asymmetric distribution and chronic course are highly infiltrating, usually destructive and heal with cicatrix.  1-Erythema Tersiaris: These are round or oval macules with diameters of 2-3 cm or larger, pink-red, with no clear borders and do not show dandruff, located in the body and extremities. 2-Gom Syphilitic: It is the most common symptom in the clinic and it is a granulomatous lesion of the 3rd period. Mostly gums, clavicula, sternum showing pretibial localization in lower extremity. They settle in areas such as the face and forehead where the skin is close to the bone. They may originate only from the skin, or from subcutaneous tissue (muscle, bone, periosteum and lymph nodes, etc.) and secondarily involve the skin during the opening phase. Syphilis gum; shows a course in the form of formation, softening, opening and recovery periods. After the gum has healed, new gums develop around the scatrix, showing a horseshoe or serpentine distribution. No new gum forms on the scatrix. This feature is characteristic and this condition is defined as "respect of syphilis scatrix". Since Goms causes damage to the organs and tissues they are localized; Different findings occur depending on the area where they live. The gums placed in the hard palate cause perforation, those placed in the nasal septum cause bone destruction and a saddle nose picture.  3-Tubercular Syphilid (Syphilid): These are tubercles that are dermally located, 1-2 cm in diameter, hard, without subjective symptoms and tend to be dandruff. The tubercles that are red-brown and tend to grouping are usually located on the face and extensor side of the extremities. When the lesions heal, whether ulcerated or not, they end in scarlet fever.  Early Congenital Syphilis (Syphilis Congenita Prekoks): It is a congenital syphilis picture that occurs in the first 2 years of life. Symptoms occur within the first 3 months in most cases. Babies with low birth weight or premature are prone to be irritable. In addition to the skin symptoms seen in the 2nd stage of acquired syphilis, the following findings help the diagnosis. Pemphigus Syphiliticus: It usually manifests itself with grouped vesicles and bullae, showing symmetrical distribution, on the palms- soles, on a red-brown infiltrated ground. Since bullet fluid contains dense spirochetes, they play an important role in contamination. Corysa Syphilitica (Syphilis Fever): It is a bloody-purulent discharge that is observed bilaterally in the nose and contains plenty of spirochetes. Flu, which lasts for about 6-8 weeks, causes damage to the mucosa, cartilage and bone. Septum perforation, saddle nose, or clover nose may develop. Parrot's Pseudoparalysis: It is a condition characterized by pain that increases with movement due to osteochondritis or epiphysitis of the long bones in infants. The baby does not move that limb as if it were paralyzed in order to avoid pain. If the baby shakes or moves, the baby cries due to the pain, this finding is called cradle sign.  Late Congenital Syphilis (Syphilis Congenita Tarda): It is a table that occurs after the age of 2-3 and the 3rd period symptoms of acquired syphilis are observed. Changes occur due to the destruction of Goms. In addition, interstitial keratitis, bilateral neural deafness and half-moon notching in the anterior incisors, mulberry-shaped molars (Hutchinson's teeth, Mullberry molar) can be seen, and this picture is defined as the Hutchinson Triad. The most important of the other symptoms are hydrarthrosis, periostitis Syphilitica or osteomyelitis Syphilitica. The bone due to the involvement of the tibia curves forward and this picture is defined as the scabbard tibia. gonorrea Neisseria GONORREA Usually FEMALES Strong / foul-smelling discharge Traveling joint pains MILD enanthems Ulceromembranous stomatitis Whole mouth is erythematous Aphthous lesion with multiple pseudomembranes and surrounding erythema Ulcers can occur all over the mucosa Reduction and thickening of saliva Heavy LAP High fever Culture is required for diagnosis  Condyloma acumınatum Hpv Broad-based papules Hyperkeratotic Urogenital carcinoma Parakeratosis / acanthosis / koilocytes Acquıred ımmune defıcıency syndrome aıds HIV DECREASE IN T4 CELLS  1. LAS OR ARC LAP AT LEAST 1 CM, AT LEAST 2 PLACES OUTSIDE THE INGUINAL ZONE, LASTING FOR AT LEAST 3 MONTHS HIV + LAP ın NECK AND scruff SPLENOMEGALIA SILENt, REPEATING FEVER, NIGHT SWEAT, LOSS OF WEIGHT, DIARea, MUCOCULAR LESIONS EXANTEM, ACNE, PYODERMIA, HSV, VERRUKA VULGARIS, CONDYLOMAS, FUNGI INFECTIONS 2. FINALIZED AIDS PERIOD IMMUNITY DISORDER FINDINGS, RESIDIVES HIV + BACTERIAL, VIRAL, PARASITARY INFECTIONS PNEUMOCYTIS CARINI PNEUMONIA, ASPERGILLUS, CANDIDA, COXAKIE INF, CYTOMEGALOVIRUS INF, MYCOBACTERY AND TOXOPLASMA INF MULTILOCULAR, NODULAR, PLAX NEOPLASIES (KAPOSY SARCOMA) LYMPHOMAS LEUKEMIA, CARCINOMAS FEVER, WEIGHT LOSS, WEAKNESS, FATIGUE, MUSCLE-JOINT-HEAD-THROAT PAIN, DIARREA, LAP ORAL FINDINGS OF HIV KNUG FAST PROGRESSING PERIODONTITIS DELAYED WOUND HEALING Rare oral INFECTIONS Kaposy sarcoma SCC NON-HODGKIN LYMPHOMA ORAL HISTOPLASMOSIS ORAL CANDIDIASIS HSV HERPES ZOSTER CYTOMEGALOVIRUS INF HAIRY LÖKOPLAKİA Thank you DENTAL INTERVENTIONS IN NEUROLOGICAL DISORDERS  EPİLEPSY MS PARKİNSON MYASTENİA GRAVIS CVD  EPİLEPSY TONIC-CLONIC CONTRACTIONS POSTICTAL CONFUSION BUMPERS TO PREVENT TONGUE BITE DURING A SEIZURE PREVENT SALIVA FROM REACHING THE RESPIRATORY http://t2.gstatic.com/images?q=tbn:ANd9GcRvqeQoOthgS88H7Mza2ndfsirqq4hjP35ecjx9GKWeqFRp8UUi TRACT CORNEA REFLEX – BABINSKI REFLEX + ANTİEPİLEPTICS KARBAMAZEPİN (TEGRETOL)- AGRANULATOSIS DİFENİLHİDANTOİN (EPDANTOİN)- GINGIVAL HYPERPLAZIA VALPROATE DENTAL PROBLEMS 1. CONVULSIONS 2. DRUG REACTIONS 3. GINGIVAL HYPERPLASIA 4. BLEEDING TENDENCY 5. PSYCHIATRIC REACTIONS MS DEMYELINATED PLAQUES (AMYLOID) of CNS MAY EFFECT DIFFERENT SITES NEURAL CONDUCTION IS DEPRESSED MEDICATION ACUTE – ACTH CHRONİC- METİLPREDNİSOLON DENTAL SIGNS PARESTHESIA, ANESTHESIA, TRİGEMİNAL NEURALGIA, TRISMUS PARKİNSON DECREASE IN DOPAMİN RELEASE TREMORS, RIGIDITY, BRADİKİNESIA CONFUSION, DEMENTIA ATAKSİC WALKING HYPERSALİVATION MYASTENIA GRAVIS ASCho İNHİBİTION CAUSES NEUROMUSCULAR BLOCKAGE THYMOMA YOUNG FEMALES, 50+ MALES WEAKNESS WEAKNESS IN CHEWING AND EYE MUSCLES DRY MOUTH, INCREASED CARIES PROHIBITED DRUGS; ESTER LA (PROCAINE), TETRACYCLINE, CLINDAMYCIN, LINCOMYCIN, ASPIRIN http://t3.gstatic.com/images?q=tbn:ANd9GcTHiYO1neuWYCcUe4zNA_nv1XIMsvDum3nMS8mXDsyLS2wPUhgExg CVD SUDDEN LOSS OF NEUROLOGICAL FUNCTION ATHEROMA IN CAROTID ARTERIES, CEREBRAL ARTERIES PARALYSIS HEMIPLEGIA/PARAPLEGIA/QUADRIPLEGIA USE OF ASPIRIN