dh201 clinicial sciences iii lisa mayo, rdh, bsdh “you must learn a new way to think before you...

MUSCULO-SKELETAL

DISORDERSDH201 CLINICIAL SCIENCES III

Lisa Mayo, RDH, BSDH

“You must learn a new way to THINK before you can master

a new way to BE.”Marianne Williamson

SUBJECTS FOR TODAY1. Scoliosis2. Muscular Dystrophy3. Arthritis4. Scleroderma

SCOLIOSIS

SCOLIOSIS

Curving of spine as a ‘C’ or ‘S’ shape more than 10◦ Wedging & rotation of the vertebrae

Secondary scoliosisResult of a neuromuscular conditions (ex: spina

bifida, CP) May see radiopacity in center of a pano Best results = tx’d when young

SCIOLIOSIS

People having reached skeletal maturity are less likely to have a worsening case

S&SUneven musculature on one side of the

spineA rib prominence or a prominent shoulder

blade, caused by rotation of the ribcage Uneven hips, arms or leg lengthsDiminished lung capacityPressure on heart

MUSCULAR DYSTROPHY

MUSCULAR DYSTROPHY (MD)

Atrophy of skeletal, striated muscles Types

1. Duchenne type2. Limb-girdle dystrophy3. Facioscapulohumeral dystrophy

4. Becker: Similar to Duchenne type, but more benign with a later onset (5–15yrs)

5. Emery–Dreifuss: 5–30yrs, severe cardiomyopathy and risk for sudden death

6. Oculopharyngeal & myotonic dystrophies: Rare, 20–50yrs, slowly progressive, extensive involvement of orofacial muscles

MUSCULAR DYSTROPHY (MD) Characteristics

Swelling of affected muscles, destruction of striated bands, cytoplasm & fatty deposits replace muscle

Muscular weakness and pain

Oral characteristics Mastication problems Speech problems Mouth breathing – HALITOSIS Drooling, excessive salivation Increased perio, caries

DUCHENNE MUSCULAR DYSTROPHY

Males (transmitted by female carriers) Present at birth – apparent 2-5yrs of age Weakness of hips, lordosis, waddling gait,

balance issues, muscle wasting Arrhythmias and cardiomyopathy common

Cardiomyopathy makes it harder for your heart to pump & deliver blood to the rest of your body

Rarely live past 30 Fully disabled by puberty, confined to

wheelchair

FACIOSCAPULOHUMERAL MD Males:Females equal 6-20yrs (average age 13yrs) Oral side effects

Facial, eye muscle issuesGaping of lips - similar to mouth breathersMalocclusion, TMD

Systemic side effectsCardiac involvement rareScapulae prominent, shoulder muscles weak

= difficulty raising arms Progression slower than Duchenne &

progression may arrest

LIMB-GIRDLE DYSTROPHY Affects hips, shoulders, pelvis Progression varies: rapid vs slow Manifests in late childhood/early

adolescence Cardiomyopathy common May become wheeelchair bound

MUSCULAR DYSTROPHY (MD)Tx Considerations

Protect airway Powered oral hygiene devises may be

contraindicated Wheelchair transfer Premed if heart conditions present Consult with MD

ARTHRITIS

ARTHRITIS

Inflammation in a joint Most common causes of chronic illness in

USA Acute & chronic forms Contributing factors

Infectious agents, traumatic disorders, endocrine abnormalities, tumors, allergy and drug reactions, inherited

ARTHRITIS FORM1. Rheumatoid arthritis2. Juvenile RA3. Degenerative joint

disease/Osteoarthritis

RHEUMATOID ARTHRITIS

Chronic, immunologic systemic disease in which inflammation of the joints occurs in exacerbations & remissions

Etiology: Unknown Onset 20-40yrs More women than men

RHEUMATOID ARTHRITIS

S&S Joint pain & swellingFingers, hands, knees affected 1st Stiffness: morning, after periods of

inactivityWeakness, fatigue, loss of appetite, loss of

weight, anemia, low-grade feverSubcutaneous nodules in elbows, wrists,

fingersTMD commonDifficulty chewing

RHEUMATOID ARTHRITIS

Medical treatment1. Pain relief2. PT & OT3. Nutritional counseling4. Meds

NSAIDsTrexall(Methotrexate): autoimmune diseases

& cancerGold compounds(Ridaura)Imuran(azathioprine): immunosuppressiveCyclosporin: immunosuppressiveHumera: TNF (tumor necrosis factor)-blocker

(TNF-α causes joint swelling & inflammation)5. Joint replacement surgery

RHEUMATOID ARTHRITIS

Relationship to periodontal diseaseRA & perio are both chronic inflammatory

diseasesPathogenesis of both is similarExtent & severity of perio disease with RA

under research

JUVENILE RA Under 16yrs of age Differs from adult RA Onset more acute, prolonged fever,

enlargement of the spleen & lymph nodes Inflammation of many joints (esp knees,

wrists, spine) TMD, limited opening Progression: complete remissions or ↑

disability that continues for yrs Tx: meds, activity to maintain function

OSTEOARTHRITISDEGENERATIVE JOINT DISEASE

Affects weight-bearing joints Inflammation is not the joint problem like

RA Predisposing factors

Repeated trauma (athletes)ObesityAge-related change in tissuesMechanical/loading stressGenetics

85% cases >70yrs Progression of disease leads to pain,

deformity, limited movement TMJ usually not involved

ARTHRITIS & DH CARE Joint pain and impaired motor function Joint replacement and antibiotic

premedication Oral self care if hands involved

Offer home care aids that accommodate issues

NB QUESTIONA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:

a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus

NB ANSWERA chronic immunologic systemic disease in which joint inflammation occurs during periods of exacerbation and remission defines:

a. Progressive systemic sclerosisb. Rheumatoid arthritisc. Tubular sclerosisd. Lupus erythematosus

NB QUESTIONWhich of the following devises would you recommend for an arthritis patient?

a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush

NB ANSWERWhich of the following devises would you recommend for an arthritis patient?

a. Flossing instructionb. Oral irrigatorc. Manual toothbrushd. Electric toothbrush

SCLERODERMA

SCLERODERMA Chronic autoimmune disorder

Affects connective tissue – over production of collagen

Hardening, thickening, shrinking of ct Immobility & rigidity of skin Limits opening of mouth

Death = renal, cardiac failure, pulmonary insufficiency, intestinal malabsorption

Etiology Collagen synthesis irregularities, immunologic

disorders, microvascular abnormalities

RAYNAUD’S PHENOMENON

1st symptomEpisodic vasoconstriction of handsDiscoloration of fingers when cold

SCLERODERMA

Oral CharacteristicsXerostomiaWidened PDLThin, rigid lipsDifficulty in opening and closing mouthThin, pale, tender, rigid mucosa &

gingiva↑ mobilityDifficult masticationTongue may be immobileSpeech difficult

NB QUESTIONWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?

a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis

NB ANSWERWhich of the following diseases is an autoimmune disorder of connective tissue characterized by an overproduction of collagen?

a. Sclerodermab. Systemic lupusc. Multiple sclerosisd. Rheumatoid arthritis