# data[].attributes.body
Changes in face & jaw may result

Sleep apnea, dry mouth

Modifying oral hygiene

Fluoride

Orthodontic referral

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Excess secretion of hormones

Excess growth hormone= gigantism

Disease of excess longitudinal growth of bones due to excess GH before puberty

Large hands

Prominent jaw

Treatment

Medications to reduce or block GH rels

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Macrognathia

Prognathism

Open bite

Large pulp chambers

Increased risk of periodontal disease

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Failure of pituitary gland to produce & release one or all of its hormones

Decreased growth hormone= dwarfism

Reduction in growth potential in children

Change in metabolic function in children & adults

Short stature

Delayed tooth eruption, thin hair

Delayed puberty

Treatment

Give growth hormone regularly to children

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Short, early appointments

Empathy to reduce stress

Fluoride- xerostomia

Strict oral care routine

Frequent RDH care- increased periondtal disease and bone loss

Radiographs to monitor bone levels

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Glucocorticoid replacement

Aldosterone replacement (primary)

Medications can delay wound healing, increase capillary fragility & alveolar bone loss

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Depression

Severe chronic fatigue

Weight loss

Hyperpigmentation

Sparse body hair

Orthostatic hypotension

Lethargy, weakness

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Autoimmune

May be a result of TB

Secondary adrenal insufficiency as a result of hypopituitarism or hypothalamic dysfunction or corticosteroid use

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Decrease in glucocorticoids

Dysfunction in adrenal gland (primary), hypothalamus or pituitary, chronic corticosteroid (all secondary)

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Alveolar bone loss

Spontaneous mandibular fracture

Widened pulp chambers

Demineralized teeth

Increased risk of osteoporosis

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Congenitally missing teeth

Shortened roots

Delay or cessation of dental development

Enamel hypoplasia

Poorly calcified dentin

Wide pulp chambers

Mandibular tori

Chronic candidiasis

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Too little PTH

Brittle nails, dry hair, muscle cramps and spasms

Abdominal pain

Increased muscular & nerve irritability

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Too much PTH

Bone pain

Fatigue

Broken bones

Kidney stones

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Gland embedded in thyroid gland

Parathyroid hormone is produces here, controls calcium, phosphorus & vitamin D in blood &bones

Disorders occur when parathyroid is removed accidentally with thyroidectomy

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Short appointments to manage stress

Frequent breaks

Diet modifications

Regular maintenance

Flouride therapy

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Thyroid storm

Profuse sweating, nausea, abdominal pain, tachycardia, disorientation, agitation

Life threatening- terminate treatment, supine, basic life support and activate EMS

Acute anxiety

Increase in periodontal disease & caries

Increased in osteoporosis of alveolar bone

Difficulty swallowing

Increased risk of connective tissue disease like Sjrogens & lupus

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Medication that alters production of thyroxin hormone

Medications to regulate heart rate

Medication & surgery to destroy or remove thyroid tissue

If thyroid is removed or destroyed, patient will then have hypothyroidism & need artificial thyroxin

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Increased heart rate & palpitations

Increased irritability

Increased metabolism

Intolerance to heat

Increased hunger & weight loss

Bulging of eyes

Fatigue

Enlargement of thyroid- goiter

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Autoimmune

Body produces antibodies that increases production of the thyroid hormone

Not effected by the negative feedback loop

Overstimulation & excess production causes thyroid to swell

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Overactive
Excess thyroxin
Dysfunction of thyroid, pituitary or hypothalamus
Taking too uch thyroid medication
Endocrine gland malfunction will distate which hormones are affected & in which rati

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Thorough medical history

Uncontrolled? Medication?

Macroglossia

Increased rate of periodontal disease & caries

Poorly formed teeth

Burning mouth syndrome

Xerostomia

Lichen planus

Oral candidiasis

Increased bleeding

OHC

Fluoride treatment

Regular maintenance

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Replace hormone

Replace iodide

Remove cause- tumor

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Sluggish, slow thinking

Bradycardia, enlarged heart

Weight gain

Dry skin

Depression

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Autoimmune thyroiditis

Antibody destruction of thyroid tissue resulting in decreased thyroid hormone production

Results in faulty negative feedback loop

Pituitary produces more TSH b/c of the decreased thyroxin-> enlarged thyroid gland

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Underactive

Low levels of thyroxin

Caused by problem with thyroid, hypothalamus or pituitary gland

Predilection for women

Develops slowly over time

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Hypo or hyper function

Defect in hormone production

Defect in hypothalamus or pituitary systems  that controls a glands function

Defect in target organ/receptor/cell

Can affect oral health status through host response to infection, healing & stress

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Tissue Hormones

Powerful substances found in a wide variety of body tissues

Produced in a tissue & diffuse only a short distance to act on cells in that tissue

Influence many body functions, including respiration, blood pressure, GI secretions and reproduction

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Thyroid Hormone

Made in thyroid gland, stimulates metabolic rate

Gllucocorticoids

Made in adrenal gland, effects are essential in times of trauma & stress

Growth Hormone

Made in pituitary

stimulated growth/remodelling  of bone, cartilage & protein synthesis

Causes breakdown of fats & use of energy

Induces sensitivity to insulin

Gonadotropins

Causes ovary to secrete estrogen & progesterone which results in ovulation

Made in hypothalamus

Antidiuretic (vasopressin)

Made in hypothalamus

Increases blood pressure by causing smooth muscle contraction &peripheral resistence

Stimulus for release is decreased blood pressure & exercise

Oxytocin

Made in hypothalamus

Relseased by posterior pituitary

May initiate labour

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A positive feedback loop is rare & would request the increase of the release of hormones

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Negative feedback loop
Endocrine gland releases hormones that affect the target organ, the target organ then signals the endocrine gland to adjust the relsease of hormones

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Called the third eye b/c of its secretory activity on the amount of light entering the eyes

Secretes melatonin which inhibits ovarian activity and regulates the body's internal clock

Abnormal secretion of melatonin may produce SAD

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Produces parathyroid hormone

Increases blood calcium concentration by increasing the breakdown of bone with the release of calcium into the blood

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Produces hormones that control how the bdy uses energy & proteins

Thyroxine, triiodonthronin calcitonin

Plays a part in growth and development

Affects blood calcium and phosphate levels

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Produces thymosin

Plays important role in the development and function of the body's immune system

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2 parts- cortex & medulla

Cortex releases corticosteroid hormones which help maintain glucose levels, sodium & potassium balance and sex hormones

Glucocorticoids (cortisol), mineralocorticoids, sex hormones (androgens)

Medulla helps combat physical & emotional stress- epinephrine and norepinephrine

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Master gland controls the functions of many target glands and cells of target organs

Receives hormones from hypothalamus & responds to these hormones by releasing its own hormones that stimulate various glands or produces an effect on other endocrine glands

Stimulates growth

Stimulates the synthesis & secretion of adrenal, thyroid , kidney & reproductive hormones

Thyroid stimulating hormone, adrenocorticotropic hormone, follicle-stimulating hormone, luteinizing hormone, growth hormone, prolactin, antidiuretic hormone, oxytocin

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Maintains homeostasis

Coordinating center of the brain for endocrine, behavioural and autonomic nervous system function

Viewed as a bridge by which signals from multiple systems are relayed to the pituitary gland

Helps control behavious and allows appropriate responses to multiple incoming stumuli from the CNS and PNS- hunger, temperate,  pleasure & pain

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Under regulatory control of other parts of the system

Hypothalamus & pituitary gland form a complex network that links the nervous and endocrine systems

This network controls the output from many of the other glands in the body

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Regulate digestion

Storage & use of nutrients

Electrolyte & water metabolism

Growth & development

Reproduction

Synthesis, storage & secretion of hormones

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Ductless glands that secrete into intercellular spaces.

Move into blood stream or lymphatic system and then carried throughout thebody and target organ cell

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Secrete their products into ducts that empty onto a surface or into a cavity (swat glands & salivary glands)

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Glands

produce, store and secrete chemical messengers

Chemical messengers

hormones

Target cells/organs

cells acted on by hormones

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Uses chemical messengers called hormones as a means of controlling the flow of information between different cells and tissues

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Viral infection

Reactivation of varicella (chickenpox)

Virus travels through cutaneous nerve and remains dormant in the root ganglion

If imune system is compromised, the virus may reactivate

Virus travels through sensory nerve to the skin

Painful vesicles erupt and crust over

Intense pain, burning and itching may precede vesicles

Vaccination

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Compression, degeneration or infection of the 7th cranial nerve (facial)

Paralysis of some or all of the facial features innervated by the facial nerves including eyelids and mouth

Temporary

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Compression or degeneration of the 5th cranial nerve

Recurring episodes of stabbing pain radiating along the branch of the trigeminal nerve

Can involve any or all branches

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Many conditions involving peripheral nerves involve inflammation
Neuritis
Neuralgia
Sciatica
Trigeminal Nerualgia/ Tic Douloureux

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3 times more likely to have periodontal disease & gingivitis

Increased dental erosion

Self-injurious behavior- falls, bruxing, biting tongue/cheek/lip

Generally have malocclusion- abnormal tongue & muscle movement

Gingival hyperplasia- anticonvulsants

Gag reflex problem- chair positioning

Include caregiver for OHC

Fluoride- chlorhexidine

Use bite block

Impaired motor ability

Impaired muscles of head and neck

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Brain damage that  occurs just before, during or soon after birth
Physical trauma to brain resulting
inneuron damage
Motor dysfunction
Not progressive

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No appointments within 6 months of episode

Stress reduction

Record vitals

Assess bleeding- anticoagulant (INR)

Minimize anesthetic with vasoconstrictors

No epinephrine

Medications may cause cough, loss of taste and burning sensation- scalded mouth syndrome

Loss/difficulty speaking

Unilateral paralysis

Loss of sensory stimuli of oral tissues

Flaccid tongue

Tongue deviates on extrusion

Gingival overgrowth due to medication

Xerostomia

Regular maintenance

Assistance  to maintain oral health

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Face dropping
Arm Weakness
Speech difficulty
Time to call

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Sudden unilaterla weakness, numbness, paralysis
Aphasia  (difficulty speaking)
Pupils- unequal size
Hemorrhagic stroke : severe headache, nausea, vomiting loss of consciousness

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Previous TIA
HBP
Diabetes
Smoker
Obese
Physically inactive

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Damage in control area of brain

Paralysis on opposite side of body (motor neuron paths cross in cerebrum)

Hemiplegia: paralysis on one side of body

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Blood vessel breaks in brain

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Due to build up in arteries (most common)

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Blockage of blood flow through cerebral blood vessels
Lack of oxygen to cerebral tissue leads to neuron cell death and injury

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Terminate therapy

Do not restrain client

Lower chair & place in supine position

Protect from injury

Do not place anything in clients mouth

Provide basic life support- establish airway, suction vomit, place in recovery position

Monitor vitals

If duration is longer than 5 mins, call EMS

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Young vs old
Posterior vs anterior
Facial/lingual vs proximal
Biofilm vs calculus
Mouth breathing
Overhangs & defective margins
Fibrotic vs non-fibrotic
Stress importance of OHC and regular hygiene appointments

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Be prepared

Reduce stress

Complete medical history including primary physicians contact information

Contact MD if unable to acquire information from client

Ensure patient takes medication when prescribed

Ask when last seizure occured

Ask if any triggers for seizures

Fractured teeth

Consider pit and fissure sealants

Diet counselling

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Medications (anticonvusants, anti-seizure, Phenobarbital, tegretol, dilantin, Topamax)

Some medications cause gingival hyperplasia

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Altered consciousness

Prodrome premonition of seizure

Aura- sensation (numbness, tingling, twitching, muscle stiffness) that seizure is eminent

Seek a safe place for client

Client may know and ask for help to prepare

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Stress

Tired

Sensory stimuli

Alcohol or addictive drug withdrawal

Fever- febrile seizures

Menstruation

Exercise

Trauma

Neonatal conditions

Lack of homeostasis

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Genetic

Unknown

Structural/metabolic

Congenital conditions- rubella

Perinatal injuries

Brain Tumor

Stroke

Trauma

Infection (meningitis, encephalitis)

Degenerative brain disease (Alzheimer's)

Lead exposure

Alcoholism and drug addictions

Complications from cancer

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Abrupt loss of consciousness

Common in children

Blank stare, do not fall but may drop what is being held

Pale

Rhythmic twitching or eyelids, eyebrows or head

Recovers normal, unaware of occurence

Ends abruptly

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Loss of consciousness

Muscular contraction (tonic) with rigidity followed by intermittent muscular contraction and relaxation (clonic)

Pale or blue in colour- may stop breathing

Possible incontinence

Foamy saliva

May bite tongue

When recovered, may be confused, tired and complain of muscle soreness or injury

May move onto status epilepticus

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Chronic seizure episodes with unknown cause

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Generalized

When hyper excited neurons fire generally throughout the brain

Focal/partial

Consciousness is not lost

Unknown origin

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Sudden uncontrolled discharge or neurons in the brain producing changes in brain function often resulting in convulsion