Dental & Oral Disorders: Management, Prevention, Treatment - PDF Slides

II. MANAGEMENT OF PATIENTS WITH INGESTIVE DISORDER SLIDESMANIA.COM SLIDESMANIA.COM  DENTAL DISORDER 1. DENTAL PLAQUE  Soft mass of proliferating bacteria with s...

II. MANAGEMENT OF PATIENTS WITH INGESTIVE DISORDER SLIDESMANIA.COM SLIDESMANIA.COM  DENTAL DISORDER 1. DENTAL PLAQUE  Soft mass of proliferating bacteria with scattering of leukocytes, macrophages and epithelial in a sticky polysaccharide protein matrix that adhere to the teeth.  Transparent, colorless in appearance. Carbohydrates contribute to plaque SLIDESMANIA.COM  formation. SLIDESMANIA.COM  2. DENTAL CARRIES/ TOOTH DECAY  Erosive process that can cause progressive demineralization and destruction of the outer enamel of the tooth.  Acid production, bacteria and carbohydrates results to dental caries. SLIDESMANIA.COM SLIDESMANIA.COM   Management: (Prevention and Treatment) Regular brushing/ flossing Diet: Low simple carbohydrates Fluoridation-addition of about one part per million of fluorides to the public water supply as a protection against tooth decay. Regular visit to the dentist (usually biannual or as prescribed) Cleaning, treatment of caries Filling Extraction SLIDESMANIA.COM Root canal treatment (pulpectomy) SLIDESMANIA.COM  3. PERIODONTAL DISEASES  Gingivitis - inflammation of the gums with gum bleeding, reddening, swelling, ulceration.  Periodontitis/ pyorrhea - inflammation extends from the gums into the alveolar bone and periodontal attachment destroy supporting structures of the teeth teeth loosen and fall SLIDESMANIA.COM out.   Management Good oral hygiene Lessen frequency of meals Minimize snacks Relieve pain 4. Malocclusion. Is a mal- alignment of teeth. This requires orthodontic treatment. 5. Impact third molar. This requires surgical removal of the SLIDESMANIA.COM third moral.  ORAL DISORDER 1. STOMATITIS  Causes: mechanical, chemical trauma a. Aphthous stomatitis (canker sores). Recurrent small ulcerated lesions of the soft tissues of the mouth (lips, tongue, inside the cheek)  Causes: Stress, trauma, vitamin, deficiency, food or drug allergies, SLIDESMANIA.COM endocrine imbalances, viral infections.   Signs and symptoms: o Well- circumscribed erythematous macule that undergoes necrosis pseudomembranous ulcer with erythematous borders. (painful, contagious, heals within 1-2 weeks)  Collaborative Management o Steroids o Avoid tomatoes, chocolates, eggs, shellfish, milk products, nuts, citrus fruits. These are irritating to the SLIDESMANIA.COM lesions.  b. Herpes Simplex (HSV)  Type I - fever blister (Herpes Labialis) “Cold sore”  Viral infection that causes blisters in the mouth and in the lips and tongue; appears coated.  It is contagious.  Lasts about a week  Collaborative Management: o Analgesics o Antimicrobial o Local Anesthetics o Mouthwash SLIDESMANIA.COM o Acyclovir (Zovirax)  C. Vincent’s Angina (Necrotizing Ulcerative Gingivitis, Trench mouth)  Acute bacterial infection of the gingival tissues.  Causes: fusiform bacteria, spirochetes, poor oral hygiene, nutritional deficiency, lack of rest/ sleep, local tissue damage, systematic infections, blood dyscracias, diabetes mellitus.  Signs and symptoms: ulcers covered with pseudomembranes, elevated WBC, foul taste, pain, chocking sensation, fever, thick secretions, anorexia, SLIDESMANIA.COM lymphadenopathy. SLIDESMANIA.COM  2. ORAL CANDIDIASIS  Also called oral thrush.  It is caused by Candida albicans.  Risk factors: immunosuppression, pronged antibiotics therapy.  Signs and symptoms: white patches on the tongue, palate, buccal mucosa (“milk curds”).  Interprofessional Collaborative Management for oral SLIDESMANIA.COM Candidiasis.   Assess for pain, tenderness, bleeding in oral cavity, fever  Assess for history of infections, use of antibiotics, treatments with radiation or chemotherapy  Analgesic as prescribed (ASA, acetaminophen)  Topical agents/swishes  Liquid/ pureed diet  Avoid spicy foods, citrus juices, hot liquids. To prevent irritation of lesions.  Good oral hygiene. Warm water, half-strength hydrogen peroxide. Avoid astringent mouthwash. SLIDESMANIA.COM (It’s alcohol content is irritating. )  3. TUMORS OF THE ORAL CAVITY a. Benign tumors - fibromas, lipomas, neurofibromas, hemangiomas b. Premalignant Tumors 1. Leukoplakia Buccalis  Precancerous, yellow - white or gray - white lesions.  Due to chronic irritation of the mucosa (physical thermal, chemical) e.g., smoking, spicy foods 2. Erythroplakia  Red-velvety-appearing patch, often indicative of early squamous cell carcinoma. SLIDESMANIA.COM  c. Malignant Tumors 1. Squamous cell carcinoma  This arises from tiny flat squamous cell of the mucous membrane.  Most common type of oral cancer.  Predisposing factors are as follows: o Chronic irritation of the mucous lining of the mouth and oral cavity, e.g., alcohol, tabacco o Poor oral hygiene o Jagged tooth SLIDESMANIA.COM o Improperly - fitted dentures  o Hot, spicy foods, drinks o Malnutrition o Syphilis - due to leukoplakia o Liver cirrhosis - due to alcohol o Positive family history  Occurs on the lips, buccal mucosa, Tongue, floor of the mouth and Tonsils  Collaborative Management o Surgery o Chemotherapy o Radiation therapy SLIDESMANIA.COM  Surgery o Hemiglossectomy (partial removal of the tongue) o Glossectomy (total removal of the tongue) o Radical Neck Dissection o Mandibulectomy o Commando Operation- (COMbined MAndibulectomy and Neck Dissection Operation) o Tracheostomy o NGT feeling; gastrostomy feeding; SLIDESMANIA.COM TPN SLIDESMANIA.COM  SALIVARY GLAND DISORDERS 1. PAROTITIS  Due to prolonged NPO, diuretic therapy, AtSO4 administration ,oral bacteria multiply and invade the parotid/ salivary glands.  It occurs among postop clients, it is called “surgical parotitis.”  Collaborative Management:  Frequent oral hygiene SLIDESMANIA.COM  inadequate hygiene  Sugarless hard gums  2. SIALOLITHIASIS  Stones or calculi in the salivary glands.  This is due to inactive glands, metabolic conditions, precipitation of salts.  Signs: swelling, pain  Treatment: local excision 3. TUMORS: BENIGN AND SLIDESMANIA.COM MALIGNANT CARCINOMA  LIP DISORDERS 1. ACTINIC CHEILITIS  Whitish keratosis  May lead to cancer.  This is associated with too much sun exposure.  Prevention and treatment is to use lip gloss during hot weather. 2. CONTACT DERMATITIS  This is due to allergy to cosmetics, SLIDESMANIA.COM toothpaste, powder and anything that comes in contact with the lips.   This is characterized by itching and erythema of the lips.  Prevention is to identify and avoid the cause. 3. LIP CANCER  Usually squamous call cancer.  Higher incidence in men.  Risk factors to lip cancer are as follows:  Excessive sun exposure  Tobacco smoking  Alcohol SLIDESMANIA.COM  Constant irritation.  DISORDER OF THE ESOPHAGUS 1. DYSPHAGIA  Difficulty in swallowing 2. ODYNOPHAGIA  Painful swallowing, which is usually severe and long lasting.  It is accompanied by diffuse esophageal spasm.  Triggered by cold beverage, carbonated beverage, or solid SLIDESMANIA.COM food.  3. REGURGITATION  Ejection of small amount of chyme or gastric juice from the mouth and antecedent nausea.  This is due to incompetent LES/ cardiac sphincter of the stomach. 4. HEARTBURNS/PYROSIS/ INDIGESTION/ DYSPEPSIA  Painful sensation of warmth and burning in the lower retrosternal midline area. SLIDESMANIA.COM  Triggered by gastroesophageal reflux.  5. ACHALASIA  Impaired motility of the lower 2/3 of the esophagus.  LES fails to relax with swallowing.  Treatment  Bougienage – esophageal dilatation (flower part and sphincter) with pneumatic/ hydrostatic balloon into the cardiac sphincter, under fluoroscopy.  Esophagomyotomy, 6. ESOPHAGITIS  This is due to bacteria, trauma, or SLIDESMANIA.COM irritation from food or tobacco. SLIDESMANIA.COM  7. GASTROESOPHAGAEL REFLUX DISEASE (GERD/ REFLUX ESOPHAGITIS)  Backward flow of gastric contents into the esophagus.  This is due to inappropriate relaxations of the LES. Risk factors:  Nicotine  High - fat foods  Xanthine - derivatives (Theophylline, Caffeine)  Ganglionic stimulants (symphatomimetics) SLIDESMANIA.COM  Beta adrenergic agents (norepinephrine)   Elevated estrogen/ progesterone levels  Signs and Symptoms:  Heartburns. Odynophagia (painful swallowing), Dysphagia, water brash, acid regurgitation  Interprofessional Collaborative Management for the Patients with GERD  Antacids (1 to 3 hours after meals)  Histamine Blockers  Bethanechol Reglan (metoclopramide) SLIDESMANIA.COM    Small frequent feedings  Fluids with meals  Eat slowly and chew food thoroughly.  Avoid very hot or cold foods, spices, fats, alcohol, coffee, chocolates, citrus juices, eating and drinking 3 hours before retiring at night.  Elevate head of bed 6-8 inches.  Weight reduction  Avoid tobacco, salicytates, SLIDESMANIA.COM phenylbutazone.  Surgery: o Nissen’s Fundoplication o Hill’s operation- The pylorus is examined carefully for any evidence of pyloric stenosis that might impede gastric emptying. o Belsey’s Repair (Mark IV)- The goal is to return the “high-pressure zone” SLIDESMANIA.COM of the cardia,  8. ESOPHAGEAL DIVERTICULUM  Outpouching of the mucosa of the esophagus  Types: a. Pulsion - weakness through muscle wall of the esophagus b. Traction - pulling outward of esophageal wall due to scarred/ enlarged peri-bronchial lymph node. SLIDESMANIA.COM   Signs and symptoms:  Dysphagia  Fullness in the neck  Regurgitation  Tracheal irritation  Coughing/ belching  Interprofessional Collaborative Management for Patients with Esophageal Diverticulum  Blenderized food.  Antacids as ordered  Small frequent feedings Backrest for several hours after eating SLIDESMANIA.COM    Avoid irritating foods  Surgery  Care of the client with Chest Tubes during the postop period SLIDESMANIA.COM  9. CANCER OF THE ESOPHAGUS  Lower 2/3 of the esophagus is most commonly affected. Predisposing factors:  Alcohol  Smoking  Spicy foods  Poor oral hygiene  Family history  Obesity  Drinking large volume of hot tea  Collaborative Management  Surgery: Esophagogastrectomy and Gastrostomy feedings. SLIDESMANIA.COM  III. MANAGEMENT OF PATIENTS WITH DIGESTIVE DISORDERS SLIDESMANIA.COM  HIATAL HERNIA (DIAPHRAGMATIC HERNIA)  The two types of hiatal hernia are sliding hiatal and paraesophageal/ rolling hiatal hernia.  Sliding hiatal hernia. Is protrusion of the esophagogastric junction into the thoracic cavity and back into the abdominal cavity in relation to position changes. (On recumbent position, the stomach slides up; on SLIDESMANIA.COM upright position, the stomach slides down).   The primary cause of sliding hiatal hernia is muscle weakness in the esophageal hiatus (the opening between the two domes of diaphragm where the esophagus enters the abdominal cavity).  This maybe due to aging process, congenital muscle weakness, obesity, trauma, surgery, or prolonged increases in intraabdominal pressure like SLIDESMANIA.COM heavy lifting and obesity.   Para-esophagael hernia or rolling hernia. Is protrusion of the fundus of the stomach and the greater curvature remains below the next to the esophagus. The gastric junction remains below the diaphragm. This type of hernia is due to anatomic defect. SLIDESMANIA.COM SLIDESMANIA.COM  The clinical manifestations of hiatal hernia are as follows. 1. Heartburns due to gastroesophageal reflux. 2. Dysphagia (Difficulty swallowing). The odynophagia (painful swallowing) are due to the compression of the esophagus. 3. Dyspnea due to compression of the lungs. 4. Abdominal pain due to compression of the protruding portion of the stomach. 5. Nausea and vomiting due to stimulation of sensitive structures in the stomach. SLIDESMANIA.COM  6. Gastric distention, belching, flatulence due to accumulation of gas in the stomach and abdomen. This is caused by impaired mobility. Interprofessional Collaborative management for patients with hiatal hernia are as follows: 1. Medications: a. Antacids to relieve heartburn b. Antiemetics to relieve nausea and vomiting. c. Histamine H2 receptors antagonists to suppress secretion of the gastric acid SLIDESMANIA.COM d. Proton pump inhibitors to suppress gastric acid secretion. SLIDESMANIA.COM  Note: The patients with hiatal hernia should avoid drugs that lower LES pressure. To prevent gastroesophageal reflux. The drugs to be avoided by the client are as follows: anticholinergics, Xanthine derivatives, calcium - channel blockers and diazepam. 2. Nursing Interventions for hiatal hernia  Relieve pain by administering antacids.  Modify diet. o High protein diet to enhance LES SLIDESMANIA.COM pressure and prevent esophageal reflux.  o Small frequent feedings to prevent gastric distention. o These, also prevent further protrusion of the stomach into the thoracic cavity. o Instruct the patient to eat slowly and chew food and beverages that decrease LES pressure like fatty foods, cola bevarages, coffee, tea, chocolates, alcohol. o The patients should assume upright position before and after eating for 1 to 2 hours. o This prevents protrusion of the stomach in the thoracic cavity and prevents reflux. o Instruct the patient to reduce body weight, if obese. SLIDESMANIA.COM o To reduce intraabdominal pressure.  o Advise the patient to promote lifestyle changes: – Elevate head of bed to 6 to 7 inches for sleep. – Avoid factor that increase abdominal pressure like use of constructive clothing, straining at stool, heavy lifting, bending, stooping, and vigorous coughing. If coughing cannot be avoided, follow through with open mouth. – Avoid cigarette smoking. Smoking causes rapid and significant drop in LES pressure. 3. Surgery o The surgical procedure for hiatal hernia is Nissen SLIDESMANIA.COM fundoplication or gastric wrap - around.