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Dental Management of Patients with Autoimmune Disorders

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Systemic Lupus Erythematosus. Hashimoto's Disease. A chronic inflammatory disease of the thyroid ... Systemic Lupus Erythematosus ... – PowerPoint PPT presentation

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Title: Dental Management of Patients with Autoimmune Disorders


1
Dental Management of Patients with Autoimmune
Disorders
  • Adrienne J. Yoon, D.D.S.
  • November 18, 2004

2
Autoimmune Disorders
  • Hashimotos Disease
  • Rheumatoid Arthritis
  • Sjogrens Syndrome
  • Systemic Lupus Erythematosus

3
Hashimotos Disease
  • A chronic inflammatory disease of the thyroid

4
Incidence
  • Most common cause of primary thyroid deficiencies
    (thyroid burns out)
  • Common in women and adolescents
  • Familial predisposition

5
Laboratory Values
  • Assay the free thyroxine (T4) level
  • Primary thyroid disease TSH levels are elevated
  • Secondary thyroid disease caused by pituitary
    dysfunction and TSH level is normal or borderline

6
Medical Management
  • Thyroid hormone replacement once in the
    hypothyroid phase

7
Dental Management
  • Aggressively treat infections
  • Avoid thyrotoxic crisis
  • Closely monitor vitals
  • Stress management

8
Rheumatoid Arthritis
  • A chronic nonsuppurative inflammatory destruction
    of the joints

9
Incidence
  • 3 of general population
  • Genetic predisposition
  • Female to male ratio 31
  • Average age of onset of 40 years

10
Pathogenesis
  • Synovium is transformed into hyperplastic
    chronically inflammed tissue
  • Intimal lining increases in size due to local
    proliferation of fibroblast-like cells and
    macrophage-like synoviocytes
  • Prominent angiogenesis
  • Rheumatoid factor is synthesized in the synovium
    and detected in synovial fluid

11
Signs and Symptoms
  • Polyarthritis sometimes associated with fever and
    weight loss
  • Joint pain
  • Generalized fatigue
  • Gelling phenomenon
  • morning stiffness difficult to
    resume motion

12
Extra-Articular Manifestations
  • 20 of patients have rheumatoid nodules
  • Carpel tunnel sydrome
  • Synovial cysts
  • Pleuropulmonary disease
  • Systemic rheumatoid vasculitis

13
Laboratory Values
  • High elevation of rheumatoid factor (RF)
  • Antinuclear antibody (ANA) detected in about 50
    of patients
  • Active phase patients have elevated erythrocyte
    sedimentation rate (ESR)
  • Some affected patients have mild anemia

14
Medical Management
  • NSAIDs
  • Glucocorticoids
  • Immunosuppression

15
Dental Management
  • AHA Guidelines
  • Short dental appointments
  • Assess if aspirin or NSAIDs are affecting
    platelet function

16
Sjogrens Syndrome
  • Inflammation of the lacrimal and salivary glands

17
Incidence
  • 0.2-3.0 of population
  • More common in females
  • 15 of patients with rheumatoid arthritis
  • 30 of patients with SLE

18
Signs and Symptoms
  • Dry mouth, skin, eyes, nose and vagina
  • Tongue becomes fissured and exhibits atrophy of
    the papillae
  • Oral mucosa red and tender
  • Parotid enlargement

19
Extra-glandular Signs and Symptoms
  • Lymphadenopathy
  • Vasculitis
  • Interstitial nephritis
  • Interstitial lung fibrosis
  • Primary biliary cirrhosis (PBC)
  • Raynauds phenomenon
  • Peripheral neuropathies
  • Scleroderma

20
Laboratory Values
  • High erythrocyte sedimentation rate and serum
    immunoglobulin levels (IgG)
  • 75 of patients have RF regardless of rheumatoid
    arthritis
  • Antinuclear antibodies (ANA) also present

21
Medical Management
  • Local manifestations can be treated
    symptomatically

22
Dental Management
  • Prevention of caries
  • daily use of fluoride, frequent recalls
  • Enhance salivary output
  • sugarless gum/candy, saliva substitutes
    (salivart, biotene, oral balance, mouth kote,
    glandosane, prescription medication (salagen,
    evoxac)
  • Treatment of oral candidiasis
  • antifungals
  • Pain control for enlarged salivary glands

23
Systemic Lupus Erythematosus
  • A chronic multisystem disease of unknown origin
    that exhibits wide variations in its clinical
    expression and disease course

24
Incidence
  • Females are affected 8-10 times more than men
  • Average age is 31 years

25
Signs and Symptoms
  • Fever, weight loss, arthritis, fatigue, and
    general malaise
  • Butterfly rash on the malar area and nose
  • 40-50 of patients have affected kidneys
  • Cardiac involvement
  • -Libman-sacks endocarditis found in 50 of
    patients upon autopsy
  • -pericarditis, myocarditis, endocarditis, CAD
  • Oral lesions
  • -5-25 of patients have affected palate, buccal
    mucosa, and gingiva

26
Laboratory Values
  • 95 of patients have elevated ANA
  • 70 of patient have antibodies directed against
    double-stranded DNA

27
Medical Management
  • Avoid excessive exposure to sunlight
  • NSAIDS for mild active disease with antimalarial
    drugs
  • Topical corticosteroids

28
Dental Management
  • AHA Guidelines
  • Assess adrenal function for possible suppression
  • Consult with physician regarding systemic
    manifestation
  • Assess if NSAIDS are affecting platelet function
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