EXTRAORAL DIAGNOSES MYASTHENIA GRAVIS

 Note pt’s posture & gait (walk)  Symptoms:

 Exposed skin surfaces o Muscle weakness, fatigue
 Vital signs o Double vision, droopy eyelids
 Cognition & mental acuity o Difficulty speaking, swallowing or chewing
 Speech & ability to communicate  Antibodies attack acetylcholine receptors at the
neuromuscular junction, leading to impaired communication
Abnormalities Apparent Through General Observation between nerves & muscles
1. Parkinson’s disease  Tx: Corticosteroids
 Degenerative disorder of the CNS causing involuntary
uncontrolled movements MUSCULAR DYSTROPHY
 Classic signs include:  Progressive weakness & loss of muscle mass
o Body rigidity  Result from abnormal gene mutations responsible for the
o Short dragging footsteps production of proteins needed to form healthy muscle
o Trembling hands (PILL-ROLLING)  Symptoms: difficulty walking, muscle stiffness

2. Arthritis IDIOPATHIC INFLAMMATORY MYOSITIS

 Tx for OA:  Inflammation of myositis resulting in widespread organ
o Glucosamine dysfunction, increased morbidity & early mortality
o Chondroitin
o Collagen 5. Vital signs irregularities
CAUSE SYMPTOMS Areas affected  Significance of learning about vital signs irregularities in
treatment planning:
Rheumatoid Inflammation Pain, swelling, Hands
o Ensure patient’s safety for risk assessment
arthritis (RA) of synovial stiffness & Wrist
o Customized treatment plans
membrane tenderness in more Feet
o Address medical emergencies
lining the than 1 joint. Joints
 Normal vital signs
joint may be hot & red.
Temperature 37°C
Osteoarthritis Breakdown Pain, stiffness & Fingers Knees
Heart rate 60-100 beats per min
(OA) of joint swelling Hips Back
Respiratory rate 12-18 breaths per min
cartilage
Blood oxygen 95-100%
Gout Buildup of Sudden onset of Big toe Elbow
uric acid burning pain, Ankle Wrist Blood pressure 120/80 mmHg
crystals in stiffness, redness & Knee
joint fluid swelling HYPERTENSION
 Risk factor for heart attack, stroke, & chronic kidney disease
3. Cerebrovascular Accident (CVA) / Stroke  A high BP reading may indicate the presence of a significant
 In dental setting, px may manifest: cardiovascular conditions such as left ventricular
o Aphonia (loss of voice) hypertrophy, aortic stenosis, or conduction defects that
o Dysphonia (hoarse voice) warrant pretreatment evaluation by a cardiologist
o Hemiplegia (paralysis of one side of body)  Antihypertensive medications have adverse oral effects, most
 Symptoms (FAST): notably hyposalivation
o Face drooping
o Arm weakness ARRHYTHMIA
o Speech difficulties  Irregular heart beat
o Time to call ambulance
 Occurs when there is disruption of blood supply & oxygen Bradycardia Tachycardia
deprivation to a portion of the brain due to: Heart rate below 60 bpm Heart rate above 100 bpm
Thrombosis Formation of blood clot w/in vessel
Resulting in decreased blood flow Abnormalities Apparent on Hands or Exposed Skin Surfaces
Embolism Embolus travels down blood vessel & becomes lodged 1. Arthritic hand
Resulting in blocked blood flow 2. Ecchymosis
3. Splinter hemorrhages
Circle of Willis  Dots/ vertical streaks of hemorrhages under nails
 Network of arteries that supply blood to the brain  Nail trauma: most common cause
 Anterior communicating artery: prone to aneurysm  Systemic diseases that cause the condition:
o Nail psoriasis
CVA / Stroke Aneurysm
o Endocarditis
Disruption of blood supply Ballooning of blood vessel
o SLE
to brain which ruptures
 Medications that cause the condition:
o Aspirin & warfarin
4. Neuromuscular disorders
4. Pitting edema
 Significance of learning about neuromuscular disorders in
 Abnormal accumulation of fluid in extracellular
treatment planning:
space of lower limb tissue resulting in swelling
o Px are prone to superinfections due to
that can be dimpled w/ finger pressure
immunosuppressant medications
 Associated w/ CHF, kidney failure, liver cirrhosis
o Such disorders can suppress bone marrow
5. Nevi
o Problems w/ maintenance (fine motor skills)
 Dark brown or black macules or papules on the
skin of the face & neck
MULTIPLE SCLEROSIS
6. Seborrheic keratosis
 Symptoms:
 Light/ dark brown lesions that are flat or slightly
o Vision problems
elevated on the skin of older individuals
o Muscle weakness, numbness & spams
 Vary in size but usually less than 1 cm in diameter
o Loss of balance
& have a velvety to finely verrucous surface
o Difficulty w/ cognitive function
7. Solar keratosis
 Damaged myelin sheath disrupts saltatory conduction (nerve
 Premalignant skin condition caused by sun
impulses jump from one node of Ranvier to another), leading
damage & occurs in older individuals w/ light
to impaired signal transmission
complexions who have experienced prolonged
sunlight exposure
HUNTINGTON DISEASE
 Solar cheilosis: solar keratosis of the lower lip
 Progressive degeneration of nerve cells in the brain
8. Basal cell carcinoma (BCCA)
 Caused by mutation in HTT (Huntingtin) gene
 History of long exposure to sun; rarely metastasize
 Symptoms: involuntary movements, cognitive decline
 INTRAORAL DIAGNOSES
9. Squamous cell carcinoma (SCCA) Developmental Lesions
 Less common but higher mortality 1. Ankyloglossia (tongue-tie)
10. Melanoma  Lingual frenum is attached too far anteriorly
 Malignant neoplasm of melanocytes in the basal toward the tip of tongue
layer of epidermis & epithelium  Effects of defects of frenum attachment
11. Urticaria (Hives) o Speech defects
 Ig-E mediated o Maxillary & mandibular constriction
 Form itchy welts due to release of histamine o Difficulty swallowing
which causes bronchoconstriction  Letters difficult to pronounce
12. Angioedema o T, D, L, Th
 Involves wider & deeper portion of dermis &  Tx: Frenectomy
subdermis, resulting in swelling over larger area
13. Contact Dermatitis (Dermatitis Medicamentosa) 2. Hairy tongue
 T cell-mediated delayed hypersensitivity reaction  Long filiform papillae; similar to tufted carpet
 A variety of topical medicaments, including  Causes:
antibiotics & anesthetic are the cause: Neomycin o Poor oral hygiene
& Lidocaine o Pernicious anemia (vit. B12)
14. Herpes Zoster (Shingles) o Soft diet
 Spread in a belt-like pattern & is a recurrent  Tx: Tongue scrape or brush tongue
episode of latent varicella zoster virus;
reactivation of chickenpox 3. Varix/ varicosity
 Dilation of vein
Types of Antibodies
IgA Found in saliva, tears, colostrum 4. Exostoses
IgD B-cell receptor that stimulates release of IgM  Benign protuberances of bone that may arise on
IgM Main antibody for primary purposes cortical surface of jaws
IgG Main antibody for secondary responses; crosses placenta TORUS PALATINUS
IgE In allergic reactions, mast cells & basophils release histamine.  Exostosis in the midline of hard palate
In antiparasitic reactions, eosinophils release toxic proteins  RPD of choice: CAPPS or horseshoe plate
TORUS MANDIBULARIS
Types of Hypersensitivity Reactions  Appears on the lingual surface of mandible
Type I Type II Type III Type IV  RPD of choice: labial bar
IgE mediated IgG or IgM Immune complex T-cell mediated
mediated Traumatic & Reactive Lesions
Onset: Within 1 hr Hours to days 1-3 weeks Days to weeks 1. Chewing/ biting of oral mucosa (morsicatio)
Anaphylaxis Hemolytic Serum sickness Rash  Habit or stress induced
anemia SLE Steven-Johnson 2. Linea alba
syndrome  Linear thickening of buccal mucosa along OP
 Often presents w/ a scalloping shape, representing
Abnormalities in the Head, Face, and Neck Region occlusal indentation
1. Thyroid Gland Enlargement/goiter 3. Traumatic ulcers
HYPERTHYROIDISM HYPOTHYROIDISM  Result from a cut, abrasion, or irritation of mucosa
 Grave’s disease  Hashimoto’s disease  Appear as yellowish area reflecting the fibrinous
 Weight loss  Weight gain exudate that has formed a pseudomembrane
 Exophthalmos  Cretinism (mental 4. Leukoplakia
(bulging eyes) retardation)  Cannot be scraped off; presents w/ no symptoms
 Tachycardia  Bradycardia 5. Hyperkeratosis
 Premature eruption  Delayed tooth eruption  Microscopic layer of thickened parakeratin
6. Amalgam tattoo
Symptoms of a Thyroid Storm:  Caused by metal oxidation from PFM crowns
 Tx: Gingivectomy
 High fever  Congestive heart
 Agitation failure  If esthetics is a concern, place Emax veneers
 Not zirconia, it is NOT biocompatible for RCT
 Delirium  Loss of consciousness
treated tooth
2. Lymphadenopathy 7. Nicotine stomatitis
 Occurs on posterior hard palate & anterior soft
 Abnormal cervical lymph nodes
palate of pipe smokers
Lymphadenopathy Lymphadenitis
 Consists of papules w/ opaque white surface & red
Enlargement of nodes but NO pain Inflammation of nodes & pain
dot in the center
 Whiteness represents hyperkeratosis & red dot is
3. Mumps
the dilated opening of inflamed salivary duct
 Caused by paramyxovirus affecting parotid gland
8. Pyogenic granuloma (pregnancy tumor)
 Prevention: get MMR vaccine
 Overgrowth of young, highly vascular granulation
tissue; reaction to chronic irritation/ plaque
4. Cleft Lip & Palate
 Appears as a bright red enlargement caused by
 Defects that arise during gestation because of
the vascularity of granulation tissue & frequent
improper merging of soft tissues and/or bones
loss of epithelium over the lesion
CLEFT LIP
9. Fibroma
 Failure of medial nasal & maxillary process to fuse
 Reactive overgrowth of fibrous tissue and is NOT a
CLEFT PALATE
true neoplasm
 Manifest as bifid uvula (involving only soft tissue)
 Well-circumscribed firm swelling on the lip or
buccal mucosa, less than 1 cm in dimension
 Tx: Excisional biopsy
10. Hematoma
 Extravasated blood pooling under the epithelium
Infection/ Inflammation Neoplastic Lesions
1. Parulis (gum boil) 1. Pleomorphic adenoma (“benign mixed tumor”)
 Localized & often acute swelling on the gingiva w/  Dome-shaped mass on palate w/out ulceration
fluctuation  Tx: Surgical excision
2. Patent sinus tract (draining fistula) PERIODONTAL DISEASES
 Drainage of pus through formed sinus tract Gingivitis
3. Herpes  Reddening & swelling of marginal gingiva w/ loss of
 Caused by HSV-1, HSV-2, & VZV stippling & rolling of margins
4. Candidiasis (oral thrush) Two primary reasons in treating px w/ gingivitis in a timely fashion:
 Candida albicans: commensal in the GI tract & 1. The difficulty in predicting the rate of progression from
lower female reproductive tract gingivitis to periodontitis because of individual differences in
 Can be scraped off, presents w/ throat pain immune response
 Clinical forms: pseudomembranous, 2. The possibility of potential systemic effects resulting from the
erythematous, median rhomboid glossitis, angular presence of a persistent inflammatory burden
cheilitis, denture stomatitis
 Tx: Antifungals Chronic Periodontitis
5. Angular cheilitis Distribution Severity of CAL
 Caused by Candida albicans, S. aureus
Localized: <30% Slight: 1-2 mm
 Common in CD px due to low VDO Generalized: >30% Moderate: 3-4 mm
6. Verruca vulgaris (common wart)
Severe: ≥ 5 mm
 Caused by HPV 1, 2, & 4
 Pedunculated or sessile papule w/ whitish or pink
Pulpal Diagnosis
cauliflower-like surface
Normal pulp No symptoms; responsive to pulp
Autoimmune Processes
testing
1. Aphthous ulcers (canker sores, RAS)
Reversible pulpitis Inflammation resolves; pain ceases
 Ulcerations w/ no known cause & a wide spectrum
after removal of stimulus
of severity & frequency of recurrence
Symptomatic irreversible Lingering thermal pain, intermittent
2. Lichen planus (OLP)
pulpitis spontaneous pain, referred pain
 Pruritic, purple eruptions w/ white streaks
Asymptomatic irreversible Due to caries, trauma
(Wickham striae) on surface
pulpitis
 No known cause
Pulp necrosis Nonresponsive to pulp testing
 Tx: Steroids
3. Lichenoid reaction Previously treated RCT was done
 Oral mucosal condition clinically & histologically Previously initiated therapy Pulpotomy, pulpectomy
indistinguishable from OLP
 Cause: drugs like beta-blockers, metallic drugs, Periapical Diagnosis
Indomethacin (NSAID), antibiotics Normal apical tissues Intact lamina dura, uniform PDL
 Tx: removal of causative factor space, no pain on percussion
4. Atrophic glossitis (burning/ bald tongue) Symptomatic apical Pain on biting, percussion,
 Papillary atrophy of tongue characterized by periodontitis palpation
absence of filiform & fungiform papillae Asymptomatic apical Apical radiolucency; no symptoms
periodontitis
Cysts/ Tumors/ Neoplasias of Soft Tissue Origin Acute apical abscess Rapid onset, spontaneous pain,
1. Developmental odontogenic cysts pus formation, swelling, mobility
DENTIGEROUS CYSTS Form around unerupted teeth Chronic apical abscess Gradual onset, little or no
RESIDUAL CYSTS Develop after tooth extraction discomfort, draining sinus tract
ODONTOGENIC KERATOCYSTS Occur in the ramus part of mandible Condensing osteitis Diffuse radiopaque lesion; low-
LATERAL PERIODONTAL CYSTS Have teardrop shape grade inflammatory stimulus
2. Leukoplakia (“white patch”)
 It has no specific histologic implication Cellulitis
 Diagnosis of exclusion, occurring after other white  Painful swelling w/ diffuse borders
lesions such as frictional keratosis, hyperplastic  Elevated temp, lymphadenopathy, malaise
candidiasis, & smoker’s keratosis ruled out Cellulitis Ludwig’s angina
3. Erythroplakia Edema typically on the Bilateral swelling of sublingual,
 Bright red, velvety plaque cannot be characterized side of affected tooth submandibular, submental space
clinically or pathologically as being due to any Mylohyoid muscle separates these spaces
other condition Submandibular & submental swelling
4. Erythroleukoplakia (speckled leukoplakia/erythroplakia) moves inferiorly & then posteriorly,
 Clinical diagnosis of oral leukoplakia w/ red constricting airway
component or oral erythroplakia intermingled w/ Sublingual swelling moves superiorly
white plaque Tongue will impede oral cavity
5. Squamous cell carcinoma (SCCA) Tx: Tracheotomy
 Most common sites: lateral border of tongue,
oropharynx, & floor of mouth PRIMARY LESIONS
Macules
Salivary Gland Abnormalities
 Flat well circumscribed colored area of tissue
Nonneoplastic Lesions
 Erythematous, Petechiae & Ecchymosis, Pigmentary
 Extravasation Phenomenon Lesions
1. Mucocele: found on mucosal surface of lower lip
Erythematous Petechiae & Ecchymosis
2. Ranula: found in floor of the mouth
Localized congestion in Red color does not disappear on
 Sialolithiasis (salivary stones)
vascularized bed. pressure.
 Found in submandibular gland (Wharton’s duct)
Blanches on pressures. Does not blanch under pressure.
 Salivary fluid blockage, ductal or glandular swelling
Cause: chemical (caustic drugs) or Physical trauma or blunt
 Hyposalivation (hypoptyalism)
thermal (hot/cold) traumatic insult to tissue
 Diminished secretion of saliva
Common sites: Palate Floor of mouth
 Xerostomia (dry mouth)
Buccal & palatal mucosa Buccal mucosa
 Secondary xerostomia side effect of medications
Tx: analgesic, hydrocortisone Self-limiting
 Sjögren Syndrome
 Dry eyes & dry mouth Example: DD: trauma from fellatio,
 Primary: vaginal/nasal dryness, chronic bronchitis Aspirin burns mononucleosis
 Secondary: lupus, scleroderma, sarcoidosis, RA Mononucleosis (“kissing disease”): caused by EBV (Epstein-Barr Virus)
 Petechia Purpura Ecchymosis Ulcers
< 3 mm; pinpoint red dots 3 mm – 1 cm; > 1 cm; bruises on  Edges are rugged, punched out appearance
Symptom of DHF (dengue larger purple/ the skin  Base is soft/ indurated
hemorrhagic fever) red spots  Floor is smooth, granular, glazed, pus covered
 Ex: Sickle cell anemia, Ill-fitting dentures
Physiologic Pigmentary Macules: due to sun exposure  Seen in herpetic gingivostomatitis, ANUG, RAU
Ephelis Freckles  Tx: Kenalog in orabase (hydrocortisone)
Melanoplakia Black pigmentation
Melanosis Abnormal melanin pigmentation of oral mucosa Pseudomembranous
Cigarette smoking: stimulates melanocytes  Plasma exudates from the vessels & spreads to the eroded
Albinism Melanin formation is impaired by congenital surface it coagulates & encloses a necrotic epithelium
decrease in tyrosinase  Ex: ANUG, Diphtheria (caused by Corynebacterium)

Pathologic Pigmentary Macules: result from underlying conditions Eschars

 Ex: Formocresol burn, Aspirin burn
Systematic lupus “Butterfly rash” pattern on face
 DD: Erythematous macules, ulcers, pseudomembranous
erythematosus (SLE) Tx: Corticosteroids
Addison’s disease Reduced cortisol production
Desquamatous
Peutz-Jeghers syndrome Polyps in small intestine (jejunum)
 Shedding of epithelial elements in scales/ sheets
McCune Albright Precocious puberty
 Scales: results of inflammation (dry), due to continuous
syndrome Polyostotic fibrous dysplasia
wetting of saliva
(GNAS1 gene) Café-au-lait spots
Von Recklinghausen Multiple neurofibromatosis
Crusts
syndrome Café-au-lait spots
 Constant drying of coagulated blood, tissue, fluids & debris
(NF1 gene) Lisch nodules (pigmented hemartomas of the iris)
 Composed of pus, blood, dried serum, epithelial debris
 If removed, it forms a pseudomembrane
Papules
 Circumscribed superficial elevated areas
SIGNIFICANCE OF DRUGS
 Causative factors: DM, irritation, galvanic currents
 Site: buccal mucosa (85%) Drug Interactions
 Tx: Topical cortisone (3x a day) Potentiation A drug which has no effect enhances the effect of
5 Forms: the second drug
Reticular lacework of intersecting white lines; Wickham striae Diazepam + Alcohol
Antagonism Drug inhibits the effect of another drug
Papular
Opiates + Naloxone
Erosive presence of squamous cells
Addition Response elicited by combined drugs is EQUAL TO
Atrophic presence of carcinoma
the combined responses of the individual drugs
Bullous malignant lesion
Aspirin + Paracetamol + Caffeine
Synergism The response elicited by combined drugs is
Nodules
GREATER THAN the combined responses of the
BOHN’S NODULES EPSTEIN’S PEARLS
individual drugs (RIPES)
Buccal mucosa of newborns Palate of newborns
Reduction in clearance, Inhibition of metabolism,
Potentiation, Enhanced adverse effects, Synergism
Vesicles
 Circumscribed single or group elevations of the epithelium
Antibiotics
which consist of serum, plasma, blood
Bactericidal Bacteriostatic
 Seen in primary herpetic stomatitis, herpes & varicella
Inhibits cell wall Inhibits protein Inhibits DNA
synthesis synthesis synthesis
Pustules
-cillin -mycin, micin Sulfa-
 Cutaneous lesion (skin) seen as which contains pus
Cef/ ceph- -cycline -floxacin
 Cause: Staphylococci & Streptococci
-penem -thromycin
 Ex: Psoriasis, Impetigo -> (-) Nikolsky sign
 Tx: Antibiotics
1. Amoxicillin
 250-500 mg 8 hourly
Bullae or Blebs
 Larger than vesicles, deep seated & has a roof cavity more  750-1000 mg 12 hourly
resistant to rupture 2. Co-amoxiclav (amox + clavulanic acid)
 Cause: autoimmune mucocutaneous disease characterized by  500 mg TID
intra-epithelial blister formation 3. Erythromycin
 250-500 mg 6-12 hourly; increased up to 4g daily
 Ex: Pemphigus, SJS -> (+) Nikolsky sign
 Tx: Corticosteroid therapy  Associated w/ P. colitis
4. Clindamycin
Tumescences  Anaerobic infections, gram (+)
 Ex: Tumor, Cyst, Epulis, Exostosis, Torus, Papilloma, Polyps  150-300 mg 6 hourly

Analgesia Anesthesia
SECONDARY LESIONS
Reduces pain sensation Reversible loss of sensation
Erosion
 Circumscribed, linear, irregular, punctuate
Analgesics
 Loss of outer layer of mucosa
IBZM: commonly used for arthritis & dental pain
 Only epidermis is lost
1. Ibuprofen
 Cause: trauma or sequalae of primary lesion
 200 mg 4-6 hourly
 Ex: Lichen planus, Desquamative gingivitis
 Max dose: 1200 mg daily
 Should be taken w/ food
Fissures
2. Benoprofeb
 Superficial, deep, linear, radiating, longitudinal, transverse
3. Zompirac
 Occurs at the mucocutaneous junction of mouth
4. Mefenamic acid
 Ex: Angular cheilitis
 500 mg TID
o Tx: Nystatin (antifungal)
5. Paracetamol
 More ex: Scrotal/ fissured tongue, Syphilitic rhagades, Cleft
 500-1000 mg 4-6 hourly
 Max dose: 4000 mg daily
 Adverse reaction: Hepatic injury
 Antidote: Acetylcysteine
 6. Celecoxib Angina Myocardial infarction (MI)
 200 mg BID if needed Chest pain/ discomfort Heart attack
 May be taken with or without food Typically relieved by rest Requires hospitalization
7. Etoricoxib
 90 mg once daily (max 3 days) Anti-arrythmia
 May be taken with or without food  Quinidine
8. Aspirin + IBZM o Cause thrombocytopenia
 Reduced biologic half-life through accelerating its o Most common cause of bleeding disorders
excretion o Low number of platelets
9. Mild analgesic + anticoagulants  Procainamide
10. Moderate analgesics  Phenytoin
 Propoxyphene  Codeine  Propranolol
11. Narcotics
 Meperidine  Hydromorphone Anti-hypertensive
 Oxycodone  Morphine  Diuretics  Angiotensin
 Sympathetic depressants antagonists
Biologic Half-life  Vasodilators
 Eliminate half amount of substance that has entered body  Side effects: Postural hypotension, xerostomia

Anti-anxiety Anti-histamine
 Tranquilizers  Alprazolam (Xanax)  Loratadine  Cetirizine
 Benzodiazepines  Lorazepam (Ativan)  Diphenhydramine  Fexofenadine
 Clonazepam  Diazepam (Valium)  Effects: sedation, xerostomia (anticholinergic effect), caries
 Side effects: Sedation, Drowsiness, Xerostomia susceptibility, candidiasis

Anti-depressants Bronchial dilators

 Tricyclic antidepressants (TCA)  Epinephrine  Theophylline
o Potentiate w/ LA  Isoproterenol  Corticosteroids
 MAOI (Monoamine Oxidase Inhibitor) + Demerol  Adrenergic drugs
o Severe reaction such as coma, respiratory  For tx of bronchial asthma & emphysema
depression & hypotension  Side effects: Xerostomia & tachycardia which is
o Intensified by LA
Anti-convulsants
 Phenytoin (Dilantin)  Diazepam (Valium) Anti-spasmodics
 Carbamazepine (Tegretol)  Phenobarbital  Atropine  Hyoscyamine
 Belladonna  Propantheline
Sedatives & Hypnotics  Relax GI smooth muscle
 Tranqs + barbiturates  Hyoscyamine  Used for tx such as peptic ulcer & pancreatitis
 Butalbital  Side effects: Xerostomia
 Central depressant effect
o Potentiated by narcotics used for pain control Diuretics
 Accurate history of frequency & quantity of use of Potassium-sparing Spironolactone & triamterene
barbiturate-containing medications is essential Potential side effects: Hyperkalemia, cardiac
o Due to their high potential for dependence, arrhythmia
tolerance, & addiction Thiazides Cause potassium wasting
 Habituation Loop diuretics Furosemide
 Increase K & Ca excretion
Anti-anemic
 Iron compounds  Used primarily & adjunctive tx in hypertension & CHF
 Vit. B12  Used in renal failure, glaucoma & edema
 Folic acid: prevent neural tube defects such as spina bifida &  Side effects: Xerostomia
anencephaly
 Liver extract Adrenocorticotrophic
 Mostly given to women  Corticosteroids + barbiturates
o Due to their higher risk of developing iron  Treat infantile spasms
deficiency anemia, related to menstruation,  Dental implication
pregnancy, & childbirth o Dose < 5mg will not cause suppression
 Signs & symptoms: o Dose < 15mg will cause suppression
o Burning tongue o Suppression of corticotropin
o Atrophy of papillae  ALWAYS obtain medical clearance
o Chronic fatigue
o Weakness & tingling sensation of extremities Anti-gout
 Allopurinol  Sulfinpyrazone
Effects of RAAS System (Renin-Angiotensin-Aldosterone)  Probenecid  Ticrynafen
1. Release renin in response to low blood pressure  Aspirin: inhibits action of uricosurics
2. Angiotensinogen produce angiotensin I -> converted tp
angiotensin II which causes vasoconstriction Hormone therapy
3. Activates aldosterone which promotes  Does not require modification of dental tx
4. Sodium & water retention & potassium excretion
Anti-neoplastics
Anti-angina  Alkylating agents  Antibiotics
Nitroglycerine Widest use  Antimetabolites  Immunosuppressants
Angina pectoris  Osteoradionecrosis
Amyl nitrate Inhalant for emergency relief of angina pain
Not routinely prescribed for angina
Propranolol Beta-blocker
Causes bronchial constriction
 Use minimum concentration of vasoconstriction in LA to
reduce effect of epinephrine