Myasthenia Gravis

Question 1

Describe myasthenia gravis

Answer 1

• Neuromuscular disease where antibodies bind to acetylcholine receptors
• This blocks acetylcholine from binding to the receptor, holistically blocking nerve impulses/ muscle contractions

Question 2

List the general signs and symptoms of myasthenia gravis (6)

Answer 2

• Weakness & fatigability of symmetrical voluntary muscles
• Eye movement weakness with diplopia & ptosis (drooping eyelids)
• Speech & swallowing difficulties
• Lack of facial expression
• Severe cases, total paralysis or serious breathing problems
• Respiratory failure leads to death

Question 3

List the oral signs and symptoms of myasthenia gravis (medications that causes oral symptoms) (3)

Answer 3

• Anticholinesterase: hypersalivation
• Cyclosporin: gingival enlargement
• Immunosuppressive drugs: vulnerability to infection

Question 4

Describe the overall dental management of myasthenia gravis (6)

Answer 4

• Short, frequent, early morning
• Stress reduction protocol
• Be prepared for possible respiratory emergency
• Assistant needed to suction & monitor
• Toothbrush modifications (power-assisted brush)
• Instructions to caregiver

Question 5

Describe the characteristics of a Myasthenia Gravis onset in a clinical scenario and its emergency management

Answer 5

Sudden inability to swallow, speak or maintain airway

Emergency procedures include:
• Suctioning
• Opening airway
• Obtaining medical assistance