Lecture 10: Oral Cavity Health Part 3 (9min)

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来自 University of Pennsylvania 的课程

Introduction to Dental Medicine

297 个评分

University of Pennsylvania

Introduction to Dental Medicine

297 个评分

The mouth is the window into human health. This course provides an overview of dental medicine to engage, educate, excite and assist you in improving the oral health of your patients and members of your community. We will review topics in dental medicine including scope of the field, what to expect in function, and some of the many ways that dysfunction may present for different patients. This will include discussions of mouth, jaw, and tooth anatomy, pathology, and treatment. We will talk about differences between patients and the unique roles that different members of the dental field may play in treatment depending on the patient and condition. This course starts from basic concepts and proceeds to review trends in current research and technology. We offer scientific background, some skills for patient evaluation and interview, and some suggestions for further learning for those interested in or involved in dental education.

从本节课中

Week 6 - The Science of Pain Affecting the Intraoral and Extraoral Structures

These modules address oral and facial pain from common conditions to rare ones, including an exploration of the psychological aspects of oral and facial pain. Dental pain can originate not only from diseased dentition, but also from various disorders affecting the TMJ, nerves, soft and hard tissue infections and other sources. Dental pain can have underlying psychosocial etiology as well, and the diagnosis in such cases can be challenging.

Lecture 1: Introduction to Orofacial Pain (8min)8:29

Lecture 2: Biopsychosocial / Biobehavioral Aspects of Orofacial Pain (7min)7:04

Lecture 3: Common Orofacial Pain Conditions: Temporomandibular Disorders (13min)13:32

Lecture 4: Common Orofacial Pain Conditions: Articular Disc Disorders and Arthritic Conditions (14min)13:50

Lecture 5: Imaging and Management of TMDs (7min)6:59

Lecture 6: Trigeminal Neuralgia (11min)10:48

Lecture 7: Persistent Idiopathic Facial Pain (11min)10:37

Lecture 8: Oral Cavity Health Part 1 (9min)9:30

Lecture 9: Oral Cavity Health Part 2 (9min)9:10

Lecture 10: Oral Cavity Health Part 3 (9min)9:43

与讲师见面

Dr. Uri Hangorsky
Associate Dean for Academic Affairs/ Director PASS
School of Dental Medicine
Dr. Thomas P. Sollecito
Professor and Chairman of Oral Medicine
School of Dental Medicine
Dr. Eric Stoopler
Associate Professor of Oral Medicine
School of Dental Medicine

[MUSIC]

The next category of patients that I would like to discuss regarding

the dental health is those that are going to be treated with chemotherapy.

As you already probably know, different chemotherapuetic

regimens really have different impact.

There are some patients undergoing chemotherapy that have very little

significance in the oral cavity, whereas there are others, the majority of them,

whereby chemotherapy will have a profound effect on the oral cavity.

And the oral cavity may have a profound effect on the patient's overall health.

One thing that I think is important is that we differentiate the chemotherapeutic

regimens to those that are myeloablative.

Those that will actually have a significant effect on the patients bone

marrow because if the chemotherapy affects the bone marrow,

patients will be at a much greater risk of infection and bleeding.

So the dentist might get consulted prior to chemotherapy.

Once again, to eliminate any risk during the chemotherapeutic period.

And that risk, again, could be associated with infection, or

it could be associated with bleeding.

Once again, the dentist must consult with the patient's oncologist regarding

the patient's blood counts, and their ability to withstand dental treatment.

If in fact their white blood count, specifically their neutrophil count is

low, antibiotics prior to dental procedures are often recommended.

Also it's important to understand that the oral cavity once again is susceptible

to varied infections when the blood counts are diminished and,

the patients may be at risk of bleeding

if in fact the chemotherapy will affect the patient's platelet count.

So taking care of patients that are undergoing chemotherapy, or

contemplating chemotherapy, it is important to maximize the oral

health of that individual, once again, as their

medical stability permits.

The next group of patients that I'd like to discuss are those undergoing

radiation therapy.

And patients undergo radiation therapy for various cancers.

And in this case, I'll focus on those patients that are undergoing head and

neck cancers.

Often, once again, the dentist will be asked to evaluate the dentition and

eliminate any potential infections prior to radiation therapy to

the head and neck region.

It is important, in fact, that the dentist recognizes infection and

potential infection.

As the teeth and dental, as well as, periodontal

infection can lead to a serious condition known as osteoradionecrosis.

Since the bone has a limited capacity after radiation to repair.

Since the blood flow is not as good to that area as it was before the radiation,

patients are susceptible to this necrosis of bone that occurs post-radiation.

There are other significant changes that occur post radiation in which the dentists

will play a significant role in helping the patient's quality of life.

Those conditions include, dryness in the mouth,

which can lead to both dental decay or caries, as well as periodontal disease.

Further, yeast infections, mucositis and even trismus, which is the difficulty of

opening the mouth, are all potential sequelae to radiation therapy.

As I mentioned earlier, perhaps the most significant sequelae

of radiation therapy is when a patient develops osteoradionecrosis,

which is described as a significant necrosis of bone.

Due to the bones inability to repair itself post-radiation and

often associated with dental infection.

Once again, the dentist plays a vital role in protecting the patient from some or

all of these sequelae.

Additionally, the dentist will play a vital role

in improving the patient's quality of life.

The dentist may want to prescribe salivary substitutes so that the patient

is much more comfortable with the dryness that is associated with radiation therapy.

Additionally, the dentist may also want to initiate fluoride therapy to prevent

carries post radiation.

Lastly, let's talk about patients that are to receive antiresorptive therapy.

This is therapy that strengthens the bone.

In patients that are under going antiresorptive therapy.

They are at risk of medication related osteonecrosis of the jaw.

In this group of patients,

we have to understand exactly why they are taking antiresorptive therapy.

Antiresorptive therapy is used for two main reasons.

One is as part of cancer therapy for various types of cancer

including things like multiple myeloma or metastatic cancers that affect the bone.

And these medications are also used osteopenia and osteoporosis.

So it's very,

very important to understand the reasoning why patients are using the medication.

In addition to that it's important to understand if the patient

is being administered intravenously this medications or

if in fact they're taking them orally.

One, would also want to know the type of medication used.

And how long it has been used, understanding

the parameters of these antiresorptive medications helps

you understand the risk of developing osteonecrosis of the jaw.

For instance, the risk of osteonecrosis of the jaw in

patients with cancer trials do not receive any

antiresorptive therapy is about 0.019%, or

1.9 cases per 10,000 patients with cancer.

Medication-related osteonecrosis of

the jaw is range from just under 1% to 6.7%.

If in fact, however, a patient is taking medication to prevent osteporosis and

their using long term oral antiresorptive therapy.

This equates to approximately a 0.1% or

10 cases per 10,000, which increases to approximately 21 cases

per 10,000 if the patients are using that medication longer than four years.

What else puts a patient at risks who were taking these medicines, clearly,

it is associate with pre-existing oral inflammatory disease, and that is why

the dentist often gets quarried prior to starting this medications.

If, in fact, there is any pre-existing oral inflammatory disease,

with the understanding that that should be eliminated prior to

starting these medications.

With antiresorptive therapy used for osteopenia,

osteoporosis, there's often time available to do it.

However, cancer patients who are at greater risk because they

are taking IV antiresorptive therapy and usually more potent agents,

often do not have the time to undergo significant

dental treatment or pretreatment, dental screening.

So other things that put patients at risk are the length of time that they

are actually using the medications.

If in fact there is a denture that is supported by the soft tissue, but

perhaps the highest risk for a patient developing

a medication related osteonecrosis of the jaw is a dental extraction.

So as we can see, the health of the oral cavity prior to major medical or surgical

procedures is very important in improving the overall outcome for the patient.

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