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