Musculoskeletal disorders dentally related questions

Question 1

What is osteoarthritis? and what joints are affected?

Answer 1

Inflammation causing joint pain, wearing cartilage that covers and cushions joint
Affecting distal inter-proximal pharyngeal joints

Question 2

What radiographic changes are seen in osteoarthritis?

Answer 2

Scerlosis - whitening
Subchondral bone cysts
Joint space narrowing
Osteophytes - benign outgrowths of bone

Question 3

How is osteoarthritis managed?

Answer 3

Analgesics, NSAID, coxibs with omeprazole, steroid/hyaluronan injections
Quad exercises, <25 BMI, aids/supports
Surgical replacement of knee/hip

Question 4

What is the ARA criteria for rheumatoid arthritis?

Answer 4

Symmetrical arthritis (every joint except distal inter-pharyngeal joints)
Hand joints 
At least 3 area 
Morning stiffness >60 minutes 
Rheumatoid nodules
Xray changes

Question 5

What does rheumatoid arthritis look like on a radiograph?

Answer 5

Early: Thin black bone, peri-articular erosions
Late: Joint space narrowing, subluxation/dislocation, ankylosis

Question 6

What extra-articular manifestations are there of rheumatoid arthritis?

Answer 6

Lymphadenopathy
Lung = pleurisy, effusion, fibrosis 
Heart = pericarditis
Muscle atrophy
Vasculitis 
Osteoporosis of the bone

Question 7

What drugs can be offered for rheumatoid arthritis management?

Answer 7

DMARDs –> disease modifying anti-rheumatic drugs, slowing progression not curing, slow action which needs monitoring

Question 8

What are the triple therapy conventional DMARDs used for rheumatoid arthritis management?

Answer 8

Methotrexate
Sulphasalazine
Hydroxychloroquine

Question 9

In dentistry when a patient is taking biologic therapy drugs, what should you be aware of?

Answer 9

Less likely to notice disease symptoms of disease - ‘abscess’

Question 10

What other systems are affected in ankylosing sponylitis?

Answer 10

Iritis and conjunctivitis
Pulmonary fibrosis
Fatigue
Aortic valve disease

Question 11

What drug treatments can be used in ankylosing spondylitis?

Answer 11

NSAIDs/ coxibs
DMARDs - for peripheral arthritis
Anti-TNF drugs for peripheral and spinal disease

Question 12

What is the moll and wright classification?

Answer 12

1. Distointerpharyngeal joints
2. Arthritis mutilans
3. Clinically indistingushable from rheumatoid arthritis
4. Asymmetrical oligoarthritis
5. Ankylosing spondylitis

Question 13

What drug treatment is involved for psoriatic arthritis treatment?

Answer 13

Analgesics

DMARDs: arthritis - sulfasalazine, arthritis and psoriasis -methotrexate/anti-TNF

Question 14

Who is affected by reactive arthritis?

Answer 14

Commonly affecting young people

Question 15

How does reactive arthritis occur?

Answer 15

10-14 days after infection:

• GI: campylobacter, salmonella
• Urogential - chlamydia

Question 16

What is reiter’s syndrome?

Answer 16

Reactive arthritis + conjuctivitis/urethritis

Question 17

What is the recurrence rate of reactive arthritis?

Answer 17

50%

Question 18

What is the F:M of sjogrens syndrome?

Answer 18

9:1

Question 19

What are the oral features of sjogrens syndrome? and what can be given to overcome this?

Answer 19

Xerostomia

Oral sprays/gels/lozanges

Question 20

What are the 3 LeFort fractures?

Answer 20

I –> Palate
II –> Through nasal bridge
III –> Passes through zygomatic bone

Question 21

What is ORIF?

Answer 21

Open reduction internal fixation

Question 22

What are the 5P’s of compartment syndrome?

Answer 22

Pale, Pulse, Paraesthesia, Pain, Paralysis

Question 23

How much calcium is in the body?

Answer 23

1kg

Question 24

What happen in chronic high PTH?

Answer 24

Bones deteriorate and release calcium

Question 25

How is calcium transported around the body?

Answer 25

1/2 bound to albumin in the blood | 1/2 ionised in the blood

Question 26

What scan is used to diagnose osteoporosis

Answer 26

DEXA

Question 27

What does a vitamin D deficiency in 1.adults and 2.kids cause?

Answer 27

1. osteomalacia | 2. rickets

Question 28

What is paget's disease?

Answer 28

Uncoordinated bony remodelling and disorganised bone turnover in localised areas

Question 29

What treatment is used for paget's disease and how does it work? give an example.

Answer 29

Bisphosphonates by inhibiting osteoclast activity and prevent bone resorption E.g. alendronate/risedronate orally weekly, can also get other injective treatment quarterly/annually Can also treated with monoclonal --> Denosumab

Question 30

How does phossy jaw occur?

Answer 30

Exposed to phosphorus

Question 31

What is myeloma?

Answer 31

Malignancy of plasma cells in bone marrow

Question 32

When a patient presents with blue sclera, what could this be?

Answer 32

Impact on collagen formation

Question 33

What to do for an extraction if patient is on 1.IV or 2. oral bisphosphonates?

Answer 33

1. Refer to a specialist | 2. Can treat in primary care if bone is stable

Question 34

What is osteopetrosis?

Answer 34

Spongy bone not there, all compact bone | Marrow absent, less haematopoiesis = anaemia

Question 35

What is pagets disease of the bone?

Answer 35

Periods of bone deposition/resorption - mosaic appearance

Question 36

What do patients complain of to the dentist when they have pagets disease of the bone?

Answer 36

Dentures don't fit due to bone deposition

Question 37

Why do people need to be dentally fit before starting cytokine inhibitor treatment?

Answer 37

Affects immune response

Question 38

How long should extractions be avoided for after radiotherapy? and why?

Answer 38

6 months to 1 year | Osteoradionecrosis

Question 39

What should be considered when doing an extraction on a patient post radiotherapy?

Answer 39

Minimal trauma - small flap for increased blood perfusion No vasoconstrictor used Trim sharp bone edges Prophylaxis 1month/until socket heals

Question 40

What does a marfan's syndrome palate look like?

Answer 40

High arched palate is typical

Question 41

What are the dental abnormalities of cleidocranial dysostosis?

Answer 41

Delay/non-eruption or supernumerary teeth

Question 42

How do NSAIDs protect against periodontal disease?

Answer 42

Prostaglandin synthesis interference

Question 43

What oral side effects can arise from cox 2 inhibitors?

Answer 43

Stomatitis and taste disturbances

Question 44

What oral side effects can arise from the anti-rheumatic drug, penicillamine?

Answer 44

Lichenoid reactions | Oral ulceration

Question 45

What oral side effect occurs from allopurinol and what does it treat?

Answer 45

Gout treatment | Taste disturbances

Question 46

What is baclofen used for and what oral side effect does it have?

Answer 46

Antispasmodic agent | Causing xerostomia