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Flashcards in sjogren's syndrome Deck (65):
1

sjogren's syndrome

a chronic, autoimmune, inflammatory disorder of exocrine glands, characterized by diminished lacrimal and salivary gland secretion in association with autoantibody production or a CT disorder

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epidemiology of sjogren's syndrome

-one of the most common autoimmune rheumatic disease--9:1 ratio of women:men
-1-4 million individuals affected in USA
-typical diagnosed patient in perimenopausal or postmenopausal female
-documented pediatric cases exist

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ACR criteria

-positive sjogren's specific antibody (Ro or La)
-positive lip biopsy
-positive eye test

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signs + symptoms of sjogren's

-asymptomatic or complain of dry mouth
-hoarse voice
-may experience trouble eating/chewing/speaking/ swallowing or taste sensation
-frequent need to sip water while eating dry food
-awakening at night with oral dryness
-difficulty in wearing oral prostheses
-sore and painful mouth
-pain in the ear due to blocked parotid glands

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Sjogren's syndrome associated with

GERD

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as dry as a desert.. severe mucosal problems have a moderate to severe impact on a patient's quality of life

-tongue fissuring occurs but creates spaces for microorganisms to reside

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complications from radiation

taste loss
mucositis
hyposalivation
radiation caries
susceptibility to osteoradionecrosis

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door to all systemic infections

mucositis

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mucositis

painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually an adverse effect of chemotherapy and radiotherapy

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chemotherapy mechanism

initiation
upregulation
signaling and amplification
ulceratoin
healing

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reactive oxygen species

ROS created after radiation and chemo

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outcome of chemotherapy

intact epithelium
tissue "appears" normal
residual angiogenesis
tissue you start with is NOT the tissue you end with

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ibrutinib

med for leukemia
-complication; virus was activated and led to ulceration of the tongue

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treatment duration

injury starts on day 1 of cancer therapy

15

acute oral toxicity

pain, mucositis, salivary and taste loss, infection

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long term oral toxicity

pain, infection, tissue necrosis, caries, periodontal disease, candida, trismus, swallowing and speech problems

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before treatment

-consult the oncologist
-determine hematologic status within 24 hrs of tx (plateley count, clotting factors, absolute neutrophil count

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use prophylactic antibiotic treatment if

-patient has catheter or ports, low absolute neturophil count

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platelet count

can treat patients with count as low as 50-80,000

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WBC count

can treat as low as 1000 with antibiotic coverage

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indications for extractions

-dental nonrestorable carious lesions
-active periapical disease (not if chronic or well localized) symptomatic teeth
-moderate to advanced periodontal disease
-lack of opposing teeth
-compromised hygiene
-partial impaction/incomplete eruption
-bifurcation involvement

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after radiation tx, avoid

invasive surgical procedures like extractions and periodontal surgery

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if an invasive procedure is required, use

hyperbaric oxygen therapy before and after surgery is advised

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complications of systemic therapies in oral cavity

xerostomia
mucositis
oral bleeding
increased dryness and erythema

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most prevalent side effect reported by patients receiving radiation therapy for head and neck cancer

xerostomia

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mucositis

-extremely painful often requiring morphine
-a painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy tx of cancer

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oral bleeding

decreased platelets and clotting factors are frequently associated with the effects of chemotherapy and bone marrow transplantation

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a significant cause of death in immunosuprssed patients is oral infection

mucositis ?

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consequences of salivary hypofunction

increased infection
loss of remineralizatoin
decreased lubrication

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increased infection from salivary hypofunction

salivary gland infections, swellings, sialotliths, candidasis, periodontal disease

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loss of remineralization from salivary hypofunction

dental caries erosion

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decreased lubrication from hypofunction

trouble speaking and swallowing

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taste buds

need saliva to solubilize chemicals in food

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lubrication

mastication, swallowing, and speech

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what glands are the first to be affected by radiation

serous glands like parotid glands

36

mucous is thick and viscous saliva

patients with sjorgren's feel that they have lots of saliva in their mouth

37

candidiasis

35% in autoimmune vs. 4% peer controls

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candida can penetrate deep into the tissue and bother nerve endings causing

burning sensation and irritated mucosa

39

niastatin

medicine for candidasis, full of sugar so may cause caries

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angular cheilitis

chapped lips at the angle of the mouth

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sialoliths can lead to

retrograde infection

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protective factors in the mouth that remineralize

saliva, fluoride, chlorhexidine and other antimicorbials, calcium phosphate

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pathological factors that demineralize

saliva hypofunction, acid producing bacteria, frequent consumption of fermentable carbs and acidic drinks, GERD

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loss of saliva can lead to

demineralization

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post radiation therapy contains what 2 bacteria in the mouth

s. mutans + lactobacillus

46

acid erosion is common from diet and

GERD

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red palate is seen in

GERD

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acid erosion caused by

sipping fruid drinks and eating acidic fruit with a dry mouth

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osteoradionecrosis is caused by

radiation tx

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trismus

-secondary to surgery
-fibrosis due to radiation therapy effect on masticatory muscles
-occurs 6 mos post RT

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treatment for mucositis

stretching exercises, mechanical devices like therabite, saliva flow stimulants

52

stimulate flow of saliva

xylitol gum
salagen
evoxac (take w/ food)

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pilocarpine effect on unstimulated parotid flow

given 1 hr prior to radiation may spare some salivary gland tissue

54

percent of oncology patients that stop fluoride tray tx

70%, time consuming and reminds them of their cancer

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high fluoride toothpastes

1.1% , enamel pro, controlRx, Oral B neutraCare, PreviDent

56

duraphat

high potency sodium fluoride varnish

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artificial saliva

-duration of effect is short
-do not provide same protective roles as saliva
-removed during swallowing

58

examples of artificial saliva

caphosol and neutrasal
-1 box has 30 doses
-1 dose is 2 ampules mixed together

59

caphasol reduces the amount of ....intake

morphine

60

other tx for mucositis

magic mouthwash
gelclair-oral gel for pain relief and oral lesions, no eating or drinking after one hour after use

61

frequent use of what can paralyze vocal cords and interfere with swallowing

magic mouthwash, or gelclair-lidocaine

62

biotene

-does not have abrasives and irritans so is good to use toothpaste during tx
-xylitol gum helpful in stimulating saliva without increasing caries

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MI paste

paste with lots of calcium and phosphate

64

lubricants

vitamin E, borage seed oil, oil pooling

65

what should you do first in a patient who is a young female, history of smoking, B cell lymphoma on left tonsil, scheduled for therapeutic radiation and hemopoetic stem cell transplant

fluroride varnish before any tx
-no big sips of water
-dental visit every 3 mos