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BDS3 Special Care Dentistry > neurology > Flashcards

neurology Flashcards

1
Q

NON VERBAL SIGNS OF PAIN

A
  • Trouble sleeping
  • Tugging at lip
  • Unable to ear
  • Agitated
  • Sleep disturbance
  • Changes in behaviour
  • Changes in diet - off, avoid hot/cold/hard
  • Hands on face/mouth - unusual for them
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2
Q

how to take a history and perfom examinatin if challenging? e.g. alzeheimers

A

Ask other health care professionals, then relatives

  • GDPs, care home, family
  • GP summary

If in wheelchair - see in chair - more comfortable. Supported

  • Hoist with sling to transfer immobile pt into chair

Plastic mirrors- less likely to break

Bite props

  • Mouth props - rest their jaw open
  • Finger guards - thimbles - bite on plastic not fully closed
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3
Q

what is this and cause

A

Angular cheilitis

  • Fold of skin
  • Poorly fitting denture
  • Moist
  • Staph aureus
  • Candida albicans
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4
Q

treatment options for angular cheilitis

A

Cream can help

  • Antifungals
    • miconazole (gel - only local, 4x a day)
    • Fluconazole (systemic - interactions - not recommend)
  • Fucidin - staph aureus anti bac gel

refit and reline denture

  • OVD reduced - need propped open again

Barrier creams - Vaseline to prevent getting damp

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5
Q

recommended antifungal for angular cheilitis

A

miconazole

gel - only local, 4x a day

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6
Q

fluconazole

A

systemic antifungal

not recommened for angular cheilitis or denture stomatitis

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7
Q

2 signs of v concerning ulcer

A
  • Raised rolled border
  • Feel it - if firm - concern
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8
Q

4 causes of ulcer

A
  • Chemical
  • Physical Trauma
  • Nutritional deficiency - iron, vita B12, folate, FBC
  • stress
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9
Q

how to treat ulcer

A

get rid of cause

e.g.

  • trauma - smooth RR, fix denture fit
  • hard to swallow iron tablets or aspirin as dry mouth - replace medication
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10
Q

how to measure ulcer during examination

A

BPE probe

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11
Q

mucosal sign of dry mouth

A

glazed glassy appearance on mucosa

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12
Q

clincal tests for dry mouth

A

Look for

  • Pools of saliva - curl tongue up
  • Mirror against mucosa - sticks - concern
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13
Q

treatments for dry mouth

A

saliva stimulators

saliva replacements

advice

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14
Q

saliva replacement options

A
  • oral balance,
  • salivix,
  • Glodosane – acidic only use if edentulous – not recommended

smooth onto mucosa to make more comfortable

  • Can be good whilst doing restorative work to make comfortable on extractions

Some have pork or cow mucins - be aware

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15
Q

advice for xerostomia mangement

A

regular drinks of plain tap water

cutting down on caffeine

chew sugar free gum

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16
Q

possible causes of dry mouth

A
  • Polypharmacy -compound it
  • Drug side effect

Contact GP

Can be really uncomfortable

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17
Q

what is this

A

Erythematous Palate

Denture stomatitis

  • Swollen, sore
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18
Q

common cause of denture stomatitis

A

candida albicans

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19
Q

remedies for denture stomatitis

A
  • Clean dentures - soak
  • Remove at night
  • Better fit - realign temporarily
  • Antifungal - topical
    • miconazole, on fitting surface of denture
    • tee tree oil is a natural antifungal

Candida can get into resin - so constant reinfects need new denture

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20
Q

howt to clean denture

A

Soap - best

  • Denture cleaning tablet
    • Effervescent tablet - between meals not good only

Warm water - not too hot

Brush

Clean over a bowl of water - so doesn’t smash

21
Q

overnight storage of denture

A

out of mouth

Steep in fresh water after cleaning with soap and toothbrush

or

  • Baby bottle cleaner - Milton - 20-30mins and not need to rinse

Chlorohexidine - if pure acrylic not metal

22
Q

toothbrushing advice for carer

A

Enhanced F toothpaste (high risk caries)

  • 2800ppmF duraphat (more common)
  • 5000ppmF

Swallowing sensory issues

  • SLS free toothpaste
    • E.g. Kingfisher - Still has F

Think oral extractions positions

  • Lower behind
  • Rest in front

2 brush - 1 to retract and 1 to brush

23
Q

criteria for MRONJ

A
  • Exposed bone for 8 weeks +
  • Never had radiation therapy to jaw (osteoradionecrosis)

Refer once the pt showing signs of MRONJ

24
Q

normal time for extractions to be healed

A

6 weeks post extractions

80-90% normally healed

25
Q

MRONJ

A

medication related osteonecrosis of jaw

  • Death of bone when take tooth out
    • Uncommon but risk

Infection risk

26
Q

5 key principles of AWI act

A
  1. Benefit
  2. Minimum necessary intervention
  3. Take account of the wishes of the adult
  4. Consultation with relevant others
  5. Encourage the adult to exercise ‘residual capacity’
27
Q

what to check if someone says they are POA or WG?

A
  • Ask for paper work from court process
    • Read through ensure dental decisions

get AWI from doctor

  • Regardless if POA there - she is not able so u or someone else
28
Q

what to do with RR not causing any symptoms

A

leave alone?

ask colleagues for second opinion and record asked and there response in notes

29
Q

3 difficulties often seen with neurological cases

A

cranial, oromandibular and speech difficulties

30
Q

common neurological presentations

A
  • Confusion
  • Coma
  • Memory loss
  • Attacks of altered consciousness
  • Gait disturbance or imbalance
  • Movement problems
  • Headache
  • Pain or paraesthesia
  • Visual loss or change
  • Sensory disturbance
  • Weakness
  • Dizziness
  • Problems with speech or swallowing
31
Q

common neurological disorders

A
  • Dementia
  • Multiple sclerosis MS
  • Head injury
  • Parkinson’s disease
  • Neurogenerative conditions (e.g. Huntingdon’s)
  • Peripheral neuropathies
  • Muscle diseases
  • Stroke
  • Migraine
  • Epilepsy
  • Meningitis and encephalitis
  • Spinal cord disease
  • Neuromuscular disease
  • CNS tumours
  • Sleep disorders
32
Q

ptosis

A

weakness of eyelids

33
Q

myaeshtenia gravis pathogenesis

A

autoimmune disorder - antibodies to acetylcholine receptor at post synaptic NMJ

associattion with other autoimmune disorders

may be associated with thymic hyperplasia or thymoma

affects young women in 20s and older men in 70s

34
Q

myaesthenia gravis investigation and symptoms

A

antibodies to AChR present in 85% of cases

single fibres EMG and reptitiive nerve stimulation also normal

fatiguable weakness of oclular, bulbar, neck, respiratory and/or limb muscles

  • bilateral ptosis
  • bilateral facial weakness
  • poor cough and neck flexion
  • milk fatiguable proximal limb weakness
  • slurred speech
  • double visison
  • difficulty swallowing
35
Q

myaesthenia gravis management

A

managed with pyridostigmine (anti-acetylchloine esterase) and immunosuppressive therapies (e.g steroid and IV immunoglobulin)

36
Q

what is unusual complication of endotracheal intubation

A

Right side of tongue not working so deviates to right

Atrophy of tongue muscle on that side

37
Q

muscle and nerve to stick tongue out

A

genioglossus

hypoglossal nerve CN12

38
Q

taste sensation of tongue

A

ant 2/3 CN7

Post 1/3 CN9

39
Q

motor of tongue

A

Motor CN12 (All intrinsic and extrinsic)

Bar palatoglossal CNX

40
Q

what condition

progressive dysarthria to anarthia over 9 months

progressive dysphagia over 6 months

emotional lability and change in personally noted by family members

A

motor neuron disease

slurred to no speech in 9 months

  • unable to move tongue
  • poor palatal movement
  • tongue is wasted

slowly progressive neurodegenerative disorder

  • bulbar – speech and swallowing
    • wasting and weakness of facial and mouth muscles
41
Q

motor neuron disease common presentation

A

Limb weakness in younger common

25% bulbar onset affecting speech

42
Q

bacterial meningitis effects

A

speech and motor difficulties after

e.g. jaw dystonia and dysphagia

  • Involuntary jaw opening and retro Collis (backwards head)
    • Restriction in neck movements

Chronic neurological effects of brain injury in youth – hypoxic (Cerebral palsy), bacterial meningitis

43
Q

parkinson’s disease effect on facial muscles

A

Jaw opening

  • not able to close,
  • tongue spasm or tremor
    • need to use hand to close mouth and struggles to swallow
    • need assistance push thumb under chin to trigger tongue to palate

Laboured and high pitch speech

  • Can overcome if concentrate

After commencing medication for Parkinson’s disease

Voice returned to normal pitch

44
Q

benefits of parkinson’s medications on facial muscles

A
  • Not choking
  • Less sensitive to tongue spasms
  • Voice changed
  • More alive and alert to life

When tired/stressed jaw still opens involuntary but feel more control over it

Take medication before food – half hour before so can get more control of life

Not just limbs

45
Q

hemifacial spasm

A

rare

fairly continuous right sided facial movements

twitch like - zygomatic, contiunus eye close, nasiolabial fold more ex on right and mouth turned up to right

  • Blood vessel Post brain
  • Cross brainstem touches nerve roots of CNVII on one side
  • Botox
    • Protection of nerve roots to prevent
      • Sheath over
46
Q

functional neurological disorder FND

A

variety of presentation

sometimes psychological origin - neurosymptoms.org

e,g, pic

not normal anatomical position

  • speech fine

not facial palsy characteristics - sudden movement to right onset, symptoms intermittent and distractable

abrupt onset

continued for a few weeks after onset

47
Q

dystonia

A

involuntary muscle activation

Prolonged prescription – drug induced side effect

Speech, breathing all affected

e.g.

head jerk to the left

left pull of head rather than primary positions

  • SCM overactive – turning head to left

Arms unaffected

Unable to straighten left fingers

48
Q

parkinson progression

A

slowly progressive neurodegenerative disorder

49
Q

parkinson treatment

A

deep brain stimulation surgery

  • electrodes deep into brain -subthalmic nucleus
  • attach to stimulator - like pace maker

programme stimulation by impulse stimulator

10-15% benefit

BDS3 Special Care Dentistry (21 decks)

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