Dental Relevance Lectures PDF

[Dental Relevance -- Exam III ] **[Lecture: Blood ]** 1. **List common blood disorders in dental practice.** - Hemophilia -- genetic disorder that impairs blood clotting. - Thrombocytopenia -- low platelet counts leading to abnormal bleeding. - Anticoagulant therapy -- meds like warf...

[Dental Relevance -- Exam III ] **[Lecture: Blood ]** 1. **List common blood disorders in dental practice.** - Hemophilia -- genetic disorder that impairs blood clotting. - Thrombocytopenia -- low platelet counts leading to abnormal bleeding. - Anticoagulant therapy -- meds like warfarin & heparin - Leukemia -- blood cancer - Sickle cell anemia -- genetic disorder affecting RBCs. 2. **Define Anemia. and list and define the RBC indexes and explain how to classify anemia based on these indexes.** - Definition: Anemia is a condition characterized by a deficiency in the number or quality of red blood cells (RBCs) or hemoglobin. - Causes of anemia include blood loss, increase in destruction of RBCs (hemolysis) and decrease in production of RBCs. - RBC indexes: - **Mean Corpuscular Volume (MCV):** Measures the average size of RBCs. - **Mean Corpuscular Hemoglobin (MCH):** Measures the average mass of hemoglobin per RBC. - **Mean Corpuscular Hemoglobin Concentration (MCHC):** The average concentration of hemoglobin in each individual RBC. Density of Hb in each RBC. - **Red Blood Cell Distribution Width (RDW):** Variation in RBC size. - How is anemia quantified in practice? - **Red Blood Cell Count:** number of oxygen carrying cells in a volume of blood. - **Hemoglobin Level:** Hb \[ \] = Hb amount (g)/volume of whole blood (dL) - **Hematocrit level (HCT):** volume percent of RBC in blood - Classification of Anemia: based on MCV. - Microcytic (MCV \95): Vit b12 deficiency, folate deficiency, hypothyroidism - Normocytic 3. **List suggestive findings of anemia, particularly from a dentistry point of view.** - Generalized stomatitis (burning sensation and sore in the oral cavity) - Pale oral mucosa -- like gingiva. - Angular cheilitis - Atrophic changes in the oral mucosa - Atrophy of filiform papillae of tongue. 4. **Explain why dentists should be concerned about patients with anemia.** It affects your management of the patient. Dentists are sometimes the first people to see patients with symptoms and signs of anemia, so we need to make sure to take appropriate history. 5. **Explain the capacity to tolerate care in anemic patients or those with bleeding disorders.** Patients with any of the following conditions are considered unstable and routine treatment should be deferred until their health status improves. - Short of breath - Hb levels below 11 g/dL - Abnormal heart rate - Oxygen saturation less than 91% 6. **Define platelets and describe their origin.** **Definition:** Platelets are small blood components crucial for clot formation (also called thrombocytes) **Origin:** Platelets are derived from megakaryocytes in the bone marrow​. 7. **Define Coagulation, Hemostasis, and Thrombosis.** **Coagulation:** Process of blood clot formation to stop bleeding. **Hemostasis:** process by which body seals ruptured blood vessel and prevents further blood loss by first forming a hemostatic plug (platelet plug) and then stabilizing the plug by clot formation. **Thrombosis:** Formation of blood clot within a blood vessel - **Triad proposes three classic factors for thrombosis.** - Endothelial injury - Stasis (abnormal blood flow) - Hypercoagulability 8. **List and describe the different steps involved in hemostasis.** I. **Vascular injury** II. **Primary Hemostasis (forms the hemostatic plug or platelet plug)** a. Vasoconstriction b. Platelet plug formation **→ 3 key players include VWF, platelets and collagen.** i. Platelet adhesion → subendothelial is exposed and platelets can attach via exposure of collagen and VWF. ii. Platelet activation & secretion iii. Platelet aggregation III. **Secondary Hemostasis (blood clot stabilization via fibrin formation)** c. Coagulation (Fibrin clot formation) and Fibrinolysis iv. Coagulation cascade starts working. v. There is the intrinsic pathway and extrinsic pathway leading to common pathway. 1. Intrinsic: 12,11,9, 8 (9 uses help of 8 to activate 10) 2. Extrinsic: 7+3 = 10 3. Common pathway: 10,5,2,1 (10 uses help of 5 to activate 2) vi. Most coagulation factors are produced in the liver; thus, anything that affects the liver will affect hemostasis (i.e. liver disease) 9. **Briefly classify coagulation and bleeding disorders.** - Coagulation is normal process in the body and is a balance between clot formation and bleeding. However, tilt in this balance results in hemorrhagic (bleeding) or thrombotic (clot formation) disorders. Coagulation disorders can be classified into: - Bleeding disorders - Acquired (Congenital) - Hereditary - Thrombotic disorders or thrombophilia - Acquired (Congenital) - Hereditary Bleeding disorders arise from issues with coagulation factors, platelets, blood vessels or fibrinolysis. Can be classified into: - Coagulation factor disorder \*\* - Congenital - **Hemophilia A and B** - Hemophilia is an inherited bleeding disorder caused by deficiency of clotting factors → leads to impaired blood clotting and prolonged bleeding. - Hemophilia A: deficiency of factor VIII (8) - Hemophilia B: deficiency of factor IX (also called Christmas disease) - Clinical manifestations: easy bruising, spontaneous bleeding, prolonged bleeding, hemarthrosis (bleeding into joints) and muscle bleeds. - **VW Disease** - Most common inherited bleeding disorder caused by deficiency or dysfunction of VWF (VWF helps platelets adhere to damaged blood vessels and protects factor VIII) - Different types: mild, moderate, and severe. - Symptoms: easy bruising, nosebleeds, prolonged bleeding and menorrhagia (heavy menstrual bleeding). - Acquired - Liver disease - Vitamin K deficiency - DIC - Warfarin use - Platelet disorder - **Thrombocytopenia** → quantitative disorder; lack of number of platelets. - Defined as platelet count less than 50x10\^9L (below 150,000/mm2) - Occurs due to mechanisms that affect platelet production (bone marrow), increased destruction, increased consumption, and mixed etiology. - Vascular disorder - Fibrinolysis disorder 10. **List some oral findings in patients with bleeding disorders.** - Petechia or ecchymosis in skin - Petechia \< 3mm - Purpura 3-10mm - Ecchymosis 10mm\< - Spontaneous gingival bleeding - Brown deposits on the surface of teeth - Dental caries and signs of periodontal diseases. - Warning signs for bleeding disorders \*\* Remember evidence of petechiae, ecchymoses, hematomas or excessive gingival bleeding should direct the practitioner's attention toward a possible underlying bleeding disorder and require advising patient to visit their physician. \*\* 11. **List a few coagulation disorders of clinical significance in dental practice that are provided in the lecture.** - Hemophilia A and B - VW disease 12. **List the coagulation and hemostasis tests essential before an invasive dental procedure and explain their significance.** I. Complete blood count (CBC) a. RBC, platelet, WBC → gives quantity. II. Bleeding time → measures the quality or function of platelets in blood. III. Partial thromboplastin time (PTT) → integrity of the intrinsic and common pathways b. Think play table tennis inside IV. Prothrombin time (PT) → integrity of the extrinsic and common pathway c. Think play tennis outside. V. Thrombin time (TT) → function and level of fibrinogen in the blood. VI. Internationalized normal ratio (INR) → clot formation time. VII. Liver Biochemistry → function of the liver. **[Lecture: Neurophysiology ]** 1. **List some neurological disorders of clinical significance in dental practice.** - Cerebrovascular accidents (stroke) - Epilepsy - Alzheimer - Parkinson's - Multiple Sclerosis - Cerebrospinal Fluid (CSF) shunts - Abnormalities related to CN. 2. **List some potential complications for patients with neurologic diseases in a dental clinic.** - CVA - Altered consciousness. - Adverse bleeding - Myocardial infraction (heart) - Infective endocarditis. 3. **Define stroke and list some symptoms, oral manifestations, and complications of patients with stroke.** Stroke: sudden obstruction or rupture of the blood supply into the brain → artery is completely blocked. - Ischemic stroke: clot blocks blood flow - Hemorrhagic stroke: bleeding occurs inside or around brain tissue. - TIA (transient ischemic attacks): artery temporarily blocked → less than 24 hours; "mini stroke." Symptoms of stroke → depend on what part of the brain it affects. - Sensory, motor, autonomic or complex functions - Slurred speech - Weak muscles - Difficulty swallowing - Loss or difficulty in speech - Unilateral paralysis - Loss of sensory stimuli - Flaccid tongue - Etc. Who is at risk for stroke? - Men - Increasing age - Smoking - Obesity - Heavy alcohol 4. **Explain how taking an appropriate history is important in managing a dental patient with CVA (Cerebrovascular Accident).** 1/3 of people who have stroke are at risk to experience a recurrent stroke within 1 month of the initial event and this risk is elevated for at least 6 months. - Must take history! 5. **Explain the association between periodontal diseases and carotid artery plaques.** Calcified atherosclerotic plaques are visible on panoramic X-rays in the arteries of older adults and patients w diabetes. Carotid calcifications on panoramic X-rays are powerful markers of future vascular events → prompt cardiovascular evaluation and risk management. - Patients with periodontitis are at risk of stroke especially ischemic events → research shows high association (but exact cause and effect is still unclear) - Severe periodontal bone loss is linked to carotid artery plaques and stroke risk. 6. **Define multiple sclerosis.** Immune system mistakenly attacks the protective covering of nerve fibers (myelin), leading to inflammation, damage, and the formation of scar tissue. - Most common autoimmune disease of nervous system - Affects the fatty tissue (myelin) in the brain and CNS. - Leads to chronic and continuous demyelination of the corticospinal tract neurons in two or more regions of the brain and spinal cord. - Has phases of relapse and remission. - Optimal time for treatment is remission. 7. **Provide a brief explanation of the basis of pathophysiology in multiple sclerosis.** - Affects mostly the CNS and not PNS: - Optic nerve - Cerebral white matter - Cervical spinal cord 8. **List the basic symptoms of a patient with multiple sclerosis (MS).** Can impact different organs. - Nystagmus and double vision (diplopia) are the most common presenting manifestations. - Nystagmus = involuntary repetitive movements of the eye. - Abnormal face pain like trigeminal neuralgia - Numbness - Muscle weakness and fatigue - Dysarthria (scanned speech) Oral manifestations occur in 2-3% of MS patients and symptoms include: - Dysarthria -- slow irregular speech - Paresthesia -- tingling sensations - Numbness of oral facial structures - Trigeminal neuralgia -- intense facial pain - Most common presenting manifestation - 400 times more likely in MS patients than normal - Myokymia -- twitching of facial expression. 9. **Define epilepsy, seizure, and status epilepticus.** Seizure: abrupt and sudden episode of abnormal brain cell's electrical activity. - May be convulsive. - Classified as: partial (focal; only affects part of the brain), generalized (convulsive or nonconvulsive; affects whole brain) and unclassified. - Who is at risk? Sleep deprivation, alcohol intake and missing antiepileptic medication. - How to manage a patient w seizure: do not move them to floor, clear anything that can harm, maintain airway but DO no put anything in mouth, avoid restraining them, first take care of patient to ensure they do not self-harm and then call 911. Epilepsy: recurrent seizures; uncontrolled excessive and synchronous electrical activity in the brain. - Side effects include: - Due to the seizure, lip and cheek biting or tooth fracture. - Antiepileptic medications will cause xerostomia (dry mouth), gingivitis and gingival overgrowth. 10. **List different phases of a grand mal seizure.** Grand mal seizure is classified as a generalized, tonic-clonic seizure; affects entire brain and has tonic and clonic phases. a. **Aura phase** → abnormal sensations b. **Loss of consciousness** c. **Tonic phase** → body stiffens. && **Clonic phase** → twitching or jerking d. **Postictal phase** → recovery phase 11. **List some important complications of seizures, particularly oral complications.** Complication of seizures: trauma, aspiration pneumonia Complication of epilepsy: status epilepticus (seizures occur without recovery repeatedly) - Side effects include: - *Due to the seizure*, lip and cheek biting or tooth fracture. - *Antiepileptic medications* will cause xerostomia (dry mouth), gingivitis and gingival overgrowth. 12. **Define Parkinson\'s disease.** Progressive neurodegenerative disorder that affects movement causing tremors, stiffness, and impaired coordination because of dopamine-producing cell loss in the brain → movement disorder of the CNS. 13. **Explain the basis of pathophysiology in Parkinson\'s disease (PD).** Caused by death and depletion of dopaminergic neurons. Neurons play a key role in the nigrostriatal pathway which is responsible for the coordination of voluntary movements. 14. **List the basic symptoms of a patient with Parkinson\'s disease (PD).** TRAP -- tremor, rigidity akinesia and posture/balance. Masklike appearance, stare and excessive sweating, drooling w lots of saliva and gait with rapid, short shuffling steps and reduced arm swinging. 15. **List concerns in the management of a dental patient with Parkinson\'s disease (PD).** PD impairs patients' ability to perform oral hygiene tasks and affects their coordination during dental procedures. - Dentists play a role through observations made during routine dental examinations. Management involves two primary concerns: - Minimizing the adverse outcomes of muscle rigidity and tremor - Avoiding drug interactions \*\* can schedule shorter appointments and provide stress reducing measures\*\* 16. **List two cranial nerves that have an important role in oral health and explain why they are important.** Trigeminal nerve (CN V): sensory for face Facial nerve (CN VII): motor for face