dh201 clinicial sciences iii lisa mayo, rdh, bsdh “you must learn a new way to think before you...
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MUSCULO-SKELETAL
DISORDERSDH201 CLINICIAL SCIENCES III
Lisa Mayo, RDH, BSDH
“You must learn a new way to THINK before you can master
a new way to BE.”Marianne Williamson
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SUBJECTS FOR TODAY1. Scoliosis2. Muscular Dystrophy3. Arthritis4. Scleroderma
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SCOLIOSIS
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SCOLIOSIS
Curving of spine as a ‘C’ or ‘S’ shape more than 10◦ Wedging & rotation of the vertebrae
Secondary scoliosisResult of a neuromuscular conditions (ex: spina
bifida, CP) May see radiopacity in center of a pano Best results = tx’d when young
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SCIOLIOSIS
People having reached skeletal maturity are less likely to have a worsening case
S&SUneven musculature on one side of the
spineA rib prominence or a prominent shoulder
blade, caused by rotation of the ribcage Uneven hips, arms or leg lengthsDiminished lung capacityPressure on heart
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MUSCULAR DYSTROPHY
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MUSCULAR DYSTROPHY (MD)
Atrophy of skeletal, striated muscles Types
1. Duchenne type2. Limb-girdle dystrophy3. Facioscapulohumeral dystrophy
4. Becker: Similar to Duchenne type, but more benign with a later onset (5–15yrs)
5. Emery–Dreifuss: 5–30yrs, severe cardiomyopathy and risk for sudden death
6. Oculopharyngeal & myotonic dystrophies: Rare, 20–50yrs, slowly progressive, extensive involvement of orofacial muscles
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MUSCULAR DYSTROPHY (MD) Characteristics
Swelling of affected muscles, destruction of striated bands, cytoplasm & fatty deposits replace muscle
Muscular weakness and pain
Oral characteristics Mastication problems Speech problems Mouth breathing – HALITOSIS Drooling, excessive salivation Increased perio, caries
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DUCHENNE MUSCULAR DYSTROPHY
Males (transmitted by female carriers) Present at birth – apparent 2-5yrs of age Weakness of hips, lordosis, waddling gait,
balance issues, muscle wasting Arrhythmias and cardiomyopathy common
Cardiomyopathy makes it harder for your heart to pump & deliver blood to the rest of your body
Rarely live past 30 Fully disabled by puberty, confined to
wheelchair
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FACIOSCAPULOHUMERAL MD Males:Females equal 6-20yrs (average age 13yrs) Oral side effects
Facial, eye muscle issuesGaping of lips - similar to mouth breathersMalocclusion, TMD
Systemic side effectsCardiac involvement rareScapulae prominent, shoulder muscles weak
= difficulty raising arms Progression slower than Duchenne &
progression may arrest
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LIMB-GIRDLE DYSTROPHY Affects hips, shoulders, pelvis Progression varies: rapid vs slow Manifests in late childhood/early
adolescence Cardiomyopathy common May become wheeelchair bound
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MUSCULAR DYSTROPHY (MD)Tx Considerations
Protect airway Powered oral hygiene devises may be
contraindicated Wheelchair transfer Premed if heart conditions present Consult with MD
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ARTHRITIS
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ARTHRITIS
Inflammation in a joint Most common causes of chronic illness in
USA Acute & chronic forms Contributing factors
Infectious agents, traumatic disorders, endocrine abnormalities, tumors, allergy and drug reactions, inherited
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ARTHRITIS FORM1. Rheumatoid arthritis2. Juvenile RA3. Degenerative joint
disease/Osteoarthritis
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RHEUMATOID ARTHRITIS
Chronic, immunologic systemic disease in which inflammation of the joints occurs in exacerbations & remissions
Etiology: Unknown Onset 20-40yrs More women than men
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RHEUMATOID ARTHRITIS
S&S Joint pain & swellingFingers, hands, knees affected 1st Stiffness: morning, after periods of
inactivityWeakness, fatigue, loss of appetite, loss of
weight, anemia, low-grade feverSubcutaneous nodules in elbows, wrists,
fingersTMD commonDifficulty chewing
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RHEUMATOID ARTHRITIS
Medical treatment1. Pain relief2. PT & OT3. Nutritional counseling4. Meds
NSAIDsTrexall(Methotrexate): autoimmune diseases
& cancerGold compounds(Ridaura)Imuran(azathioprine): immunosuppressiveCyclosporin: immunosuppressiveHumera: TNF (tumor necrosis factor)-blocker
(TNF-α causes joint swelling & inflammation)5. Joint replacement surgery
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RHEUMATOID ARTHRITIS
Relationship to periodontal diseaseRA & perio are both chronic inflammatory
diseasesPathogenesis of both is similarExtent & severity of perio disease with RA
under research
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JUVENILE RA Under 16yrs of age Differs from adult RA Onset more acute, prolonged fever,
enlargement of the spleen & lymph nodes Inflammation of many joints (esp knees,
wrists, spine) TMD, limited opening Progression: complete remissions or ↑
disability that continues for yrs Tx: meds, activity to maintain function
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OSTEOARTHRITISDEGENERATIVE JOINT DISEASE
Affects weight-bearing joints Inflammation is not the joint problem like
RA Predisposing factors
Repeated trauma (athletes)ObesityAge-related change in tissuesMechanical/loading stressGenetics
85% cases >70yrs Progression of disease leads to pain,
deformity, limited movement TMJ usually not involved
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ARTHRITIS & DH CARE Joint pain and impaired motor function Joint replacement and antibiotic
premedication Oral self care if hands involved
Offer home care aids that accommodate issues
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NB QUESTIONA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:
a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus
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NB ANSWERA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:
a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus
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NB QUESTIONWhich of the following devises would you recommend for an arthritis patient?
a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush
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NB ANSWERWhich of the following devises would you recommend for an arthritis patient?
a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush
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SCLERODERMA
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SCLERODERMA Chronic autoimmune disorder
Affects connective tissue – over production of collagen
Hardening, thickening, shrinking of ct Immobility & rigidity of skin Limits opening of mouth
Death = renal, cardiac failure, pulmonary insufficiency, intestinal malabsorption
Etiology Collagen synthesis irregularities, immunologic
disorders, microvascular abnormalities
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RAYNAUD’S PHENOMENON
1st symptomEpisodic vasoconstriction of handsDiscoloration of fingers when cold
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SCLERODERMA
Oral CharacteristicsXerostomiaWidened PDLThin, rigid lipsDifficulty in opening and closing mouthThin, pale, tender, rigid mucosa &
gingiva↑ mobilityDifficult masticationTongue may be immobileSpeech difficult
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NB QUESTIONWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?
a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis
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NB ANSWERWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?
a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis