22. Myasthenia gravis. Parkinson’s disease. Epiliepsy. Dental management of the patients.

Question 1

Myesthesia gravis definition

Answer 1

• Autoimmune disease
• Weakened response to acetylcholine
• Weakness and rapid fatigue of voluntary muscles

Question 2

Clinical features of Myesthenia gravis

Answer 2

• Weakness of masticatory muscles-hanging jaw
• Difficulties with speech, mastication and swallowing
• Paresis or atrophy of tongue
• Gingival overgrowth(ciclosporin)
• Candidosis(immunosuppressants)

Question 3

Dental treatment of Myesthenia Gravis

Answer 3

• Caried out shortly after medication early in day
• Mouth prop used
• Upright position more comfortable
• Rubber dam to prevent swallowing due to poor muscular control
• La used w/ caution-vasocontrictor used but reduced dose

Question 4

Parkinsons definition

Answer 4

• Common idopathic disease
• Loss of basal ganglia neurons

Question 5

Symtoms of Parkinsons

Answer 5

• Expressionless face
• Fatigue
• Impaired balance
• Tremors
• Drooling
• Poor muscular control for dentures
• Poor OH
• Postural hypotension

Question 6

Epilepsy definition

Answer 6

• Abnormal electrical activity in brain leading to motor activity and altered states of consciousness
• Seizures

Question 7

Main factors that result in seizures

Answer 7

• Severe stress
• Alcoholic drinks
• Hypoglycemia
• Pain

Question 8

Phases of Seizures

Answer 8

1. Aura
2. Convulsion phase
3. Post convulsion phase

Question 9

Aura

Answer 9

• Prodromal symptoms
• Tinnitus, yawning, dizziness
• Anxiety, characteristic smells
• Lasts a few seconds

Question 10

Convulsion phase

Answer 10

• Spasmodic movements of body
• Forcible jaw closing, rolling of eyes
• Froth from mouth
• Cease after deep breath

Question 11

Post convulsion phase

Answer 11

• Disturbances in conscious state, pallor and weakness
• 10-30 mins
• Risk of airway obstruction
• Patient feels exhausted w/ headache but no recall of seuzure

Question 12

Status epilepticus

Answer 12

• Repeated seizures longer than 30mins
• No recovery period
• Medical emergency-Not enough time for patient to breath and recover from seizures

Question 13

Dental management of seizures

Answer 13

• Reduction of stress (e.g., with appropriate anxiolytic medication)
• Administration of small amounts of local anaesthetic
• Short appointments, as painless as possible
  *Additional anticonvulsant drugs before the surgical procedure
• Consultation with the
  treating physician