WWA #11

anemias

iron-deficiency

megaloblastic (pernicious)

Increased needs during growth periods, such as infancy or pregnancy

Excessive bleeding

oral manifestations

Gingival and mucosal pallor

Angular cheilosis

Aphthous ulcers

Candidiasis

Atrophic glossitis

May impair wound healing

considerations

Encourage iron-rich foods like meat

Encourage vitamin C to enhance absorption

dilute iron supplements with water or juice and drink with straw to minimize tooth staining

Vitamin B12 only in animal products; vegans at risk of deficiency

malabsorption common in elderly

oral manifestations

Erythematous mucositis

Pale or yellowish oral mucosa

Recurrent aphthous ulcers

Atrophic glossitis; beefy red color

Angular cheilosis

causes

poor diet

medications that interfere w/ absorption (ex: phenytoin or methotrexate

considerations

Encourage folate-rich food sources and supplements

Encourage intake of foods from animal sources high in vitamin B12

Gastroesophageal Reflux Disease

etiology

Hiatal hernia

Obesity

Pregnancy

recommendations

eat small meals

semisupine position

avoid fatty foods

tobacco cessation

GI malabsorptive conditions

oral manifestations

Swollen, bleeding, erythematous gingiva

Diffuse pustular eruptions on buccal gingiva

Oral ulcerations

Swelling of the lips

Cobblestone-like, raised hypertrophic lesions

Metallic dysgeusia

Cerebrovascular Accident

monitor BP

if dysphagia present, using water for rinsing or ultrasonic may be contraindicated

pt may be unaware of presence of food in mouth, so check for any pocketed foods

pt may have softer, cariogenic diet

Hypertension

Minimize stress for the appointment

Monitor blood pressure

Manage medication-induced xerostomia

recommend fruits, vegetables, low fat/nonfat dairy; limit sodium, alcohol, caffeine, tobacco; exercise, lose weight, stress reduction

Diabetes

fruity smelling breath (more prevalent in type 1 diabetes

polydipsia - increased thirst

Polyuria: Frequent urination

Polyphagia: Increased hunger

oral manifestations

Poor healing

More severe periodontal disease

Tissue necrosis from minor trauma

Xerostomia

Candidiasis

Cushing Syndrome

High blood pressure

o Pre-diabetes or diabetes

o Obesity

o Muscle weakness

o Bruise easily

o Acne

o Hirsutism

o Osteoporosis

o Depression

Renal Disease

Platelet abnormalities may cause gingival bleeding

o Gingival pallor

o Slow wound healing

o Bad taste (from urea); malodor

o Stomatitis

o Hairy leukoplakia

Parkinson's Disease

Involuntary muscle tremors

o Bradykinesia (slowness of movement)

o Muscular weakness

o Rigidity

o Stooped posture

o Decreased fine motor coordination

o Orthostatic hypotension

Dental Caries

oral infectious disease that is multifactorial, transmissible, and of bacterial origin

contributing factors

Susceptible host or tooth surface

o Sufficient quantity of cariogenic microorganisms in the mouth

o Presence of fermentable carbohydrates

o Particular composition or flow of saliva

host factors

• Food selection and dietary patterns

• Oral hygiene habits

• Genetics

• Race or ethnic group

• Age

• Socioeconomic status

saliva

Act as buffer by neutralizing much of acids produced by plaque biofilm

• Normal saliva contains bicarbonate, phosphate, and protein

• Availability of essential nutrients during development of salivary glands

• Protection provided by adequate salivary flow and saliva’s buffering capacity

cariostatic/noncariogenic properties

nonnutritive sweeteners

Aspartame, saccharin, sucralose, neotame, acesulfame

Not metabolized by microorganisms; do not promote caries

protein and fats

Meat, seafood, poultry, eggs, nuts, seeds, margarine, and oils

Considered cariostatic because do not lower plaque pH

anticariogenic

sugar alcohols - fermented more slowly than mono and disaccharides; xylitol inhibits S. mutans

phosphorus and calcium provide buffering effect

dental hygiene considerations

Encourage meticulous oral self-care; regular preventive dental visits

• Promote sealants for deep pits and fissures

• In high-risk patients encourage use of a chlorhexidine, fluoride, xylitol protocol

• Encourage healthy eating habits with minimal fermentable carbohydrate intake between meals

• Eating low-fat cheese as snack or at end of a meal could provide anticariogenic effects