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

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来自 University of Pennsylvania 的课程

Introduction to Dental Medicine

300 个评分

University of Pennsylvania

Introduction to Dental Medicine

300 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]

Let's turn our attention now to the dental management of the transplant patient.

Transplant patients are often medically compromised patients and

they pose significant risks,

both to themselves as well as concerns to the practicing dentist.

What I'd like to do in discussing a transplant patient is to divide up

the transplantation period,

to those patients that present to you pre-transplant, and

what the dentist should be thinking about in managing or in seeing these patients,

as well as the post-transplant considerations that you have as a dentist.

And in the post-transplant dental considerations,

we'll divide up that time from the immediate post-transplant period

through a stable post-transplant period and also, if in fact,

post-transplant that organ is slowly starting to chronically reject.

In the pre-transplant period, patients will be coming to their dentists and

often being consulted by transplant centers to once again

eliminate dental infection prior to that transplant placement.

The dentist must be mindful however,

that these are significantly ill patients with end organ damage.

So before any dental treatment is initiated,

a medical consultation is required.

In addition, one should consider postponing elective dental

treatment based upon their underlying medical condition.

Remember, these are significantly ill patients.

Dentists often, once again are consulted to rule out acute dental alveolar or

dental infections, as well as rule out potential dental infectious sources.

They're often asked to stabilize the oral disease.

Occasionally they're even asked to remove sources of chronic infection that may

lead to acute complications within the transplant process and

immediately post-transplant.

If, in fact, treatment is necessary prior to transplant,

a medical consultation with the transplant team can

help determine the medical risk:benefit ratio.

So one must obtain appropriate lab information and

supplemental inflammation as needed.

And they need to become acquainted with specific management issues,

based upon that particular organ which has significant disease.

And they may need to employ special precautions prior to

any type of treatment in preparing somebody for an organ transplant.

How about post-transplant.

We will be seeing patients after they've had their transplant and

once again I'd like to divide this up into the immediate transplant period,

the stable period after the organ is functioning correctly, and

during the time where chronic rejection may be setting in.

Immediately after transplant,

elective dental treatment is typically not recommended.

Emergency treatment is and should be performed only with medical

consultation and consideration of specific management needs.

During the period of time when the organ is fully functioning and integrated,

we consider this the stable period and elective treatment should and will be

performed, once again after medical consultation with the transplant team.

The dentist must understand issues of immunosuppression.

Oral mucosal disease related to that immunosuppression or sometimes related to

the medications given for the transplant itself must be diagnosed and treated.

Evaluate oral hydration and salivary flow.

Occasionally patients will need supplements to treat their oral cavity and

eliminate the dryness.

The dentist must also be mindful that the patient in

a stable period may be on high dose glucocorticosteroids and

may require a steroid boost prior to dental surgical procedure.

Some consideration must also begin for

antibiotic prophylaxis during the immune suppressed period of time.

This will be directly related to the level of immunosuppression and should be

discussed with the transplant team prior to even routine dental procedures.

Once again, the organ that gets transplanted often will be

functioning to an appropriate level.

However, occasionally the organ may not be at 100%.

So the dentist again must consider specific management needs

based upon the functioning of the organ that had been transplanted.

Lastly, during the chronic rejection period,

I think of these patients as the most difficult to treat dentally.

That is because they are often immunosuppressed with various medications,

and their organ is again starting to fail.

It's advised to the dentist that only emergency treatment

be performed on these patients.

In fact, if patients need treatment during this period,

close consultation with a transplant team is absolutely necessary.

I referenced earlier that oral mucosal diseases need to be

evaluated in the transplant patient.

And that is because of the level of immunosuppression.

These patients tend to be more susceptible to bacterial infections,

some that we recognize very easily, and others that may not

be overly recognizable on a quick cursory examination.

These patients are also susceptible to various

viral infections and fungal infections.

Once again, often this will be directly related to the level of immunosuppression.

Later on, in a transplant process when a patient has been on immunosuppression for

quite some time, they are at risk of developing

a post-transplant related lymphoproliferative disease.

We often think of this as a lymphoma.

Some of these lesions may be seen in the oral cavity.

And once again any lesion that's persistent for

greater than two to four weeks needs to be aggressively diagnosed.

Dry mouth, I alluded to earlier is also a significant concern in

many post-transplant patients.

Once again, this is often related to medications but, in fact,

could also be related to end organ function, particularly with the kidney.

Dry mouth is one of those conditions in which the dentist plays a significant

role in improving the patient's quality of life post-transplant.

Dry mouth also leads to an increased amount of dental decay.

A dentist should consider, in absence of saliva,

placing patients on supplemental fluoride to help preserve their dentition.

Another condition associated with a post-transplanted patient and

often directly related to dryness in the mouth is a superficial mucocele.

Occasionally, we can see the thickening of the salivary flow through

the minor salivary glands pooling submucosally, that is,

just underneath the surface, leading to a superficial mucocele.

As you can see, taking care of patients during

the pre-transplant through the post-transplant period,

for the dentist, is often a very, very difficult task.

And the dentist really needs to keep very close consultation with

the transplant team, or the transplant physician.

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