MEDICAL HISTORY AND RISK ASSESMENT Cancer and Cancer

MEDICAL HISTORY AND RISK ASSESMENT

Cancer and Cancer Therapy

ORAL HEALTH PROMOTION AND PREVENTION FOR OLDER ADULT

DIAGNOSIS AND TREATMENT OF COMMON ORAL LESIONS IN THE ELDERY

Herpes Zoster Another skin infection seen more frequently in the elderly population It is a disease confined to the skin and nervous system Caused by the reactivation of the varicella-zoster virus (VZV)

Herpes Zoster VZV is responsible for pediatric chicken pox Remains dormant in the dorsal root ganglia disease of the elderly and th immunocompromised As cellular immunity decreases with aging, the incidence of herpes zoster increases Adedipe A, Lowenstein R. Emerg Med Clin N Am 2006; 24(2): 433 -448.

Herpes Zoster Pain and paresthesias over a particular dermatome usually precede the characteristic rash Prodromal pain is lancinating and is easily misdiagnosed as having cardiac, abdominal, and renal etiologies Symptoms may last for several days before the hallmark lesions

Herpes Zoster

Herpes Zoster Herpes zoster is a clinical diagnosis Laboratory confirmation can be obtained via a culture of the vesicular fluid or by observing giant cells on Tzanck preparation

Herpes Zoster A long-term sequela of herpes zoster is post-herpetic neuralgia The incidence of post-herpetic neuralgia increases with age, with 50 -75% of patients > 70 experiencing chronic pain over the involved dermatome. Adedipe A, Lowenstein R. Emerg Med Clin N Am 2006; 24(2): 433 -448.

Herpes Zoster - Treatment Antiviral agents used: acyclovir - valacyclovir - famciclovir -

Influenza Although it affects all age groups, influenza causes the most severe disease in the elderly Advanced age is associated with increased rates of influenza-related hospitalizations. Caterino JM. Emerg Med Clin N Am 2008; 26(2): 319 -343.

Influenza 90% of deaths related to influenza occur in patients aged 65 years and over As is true for pneumonia, the elderly may fail to demonstrate the classic signs of influenza For example, many will not have fever or cough Caterino JM. Emerg Med Clin N Am 2008; 26(2): 319 -343.

Influenza Secondary bacterial pneumonia may occur and is most commonly caused by Strep pneumoniae, Staph aureus, and Haemophilus influenzae. Caterino JM. Emerg Med Clin N Am 2008; 26(2): 319 -343.

( پﻼﺳﻤﺎﺳیﺘﻮﻡ)ﻣﻮﻟﺘیپﻞ ﻣیﻠﻮﻡ Multiple myeloma (MM) is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin

Age MM is a disease of older adults The median age at diagnosis is 66 years Only 10 percent of patients are younger than 50 years Only 2 percent of patients are younger than 40 years

MM: Clinical Presentations Anemia – Bone pain – Elevated creatinine – Fatigue/generalized weakness - Hypercalcemia- Weight loss -

Lytic Bone Lesion

Extramedullary Plasmacytoma

Lymphoma Clonal malignant disorders that are derived from lymphoid cells: either precursor or mature T-cell or B-cell Majority are of B- cell origin Divided into 2 main types : 1. Hodgkin’s lymphoma 2. Non - Hodgkin’s lymphoma

LICHEN PLANUS (LP) . It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men (at a ratio of 3: 2)

Oral LP The reticular form The bullous form The erosive form

LP of oral mucosa

PEMPHIGUS VULGARIS Autoimmune disease. Common in Ashkenazi and Mediterranean jews. Middle aged females. Other variants are: Pemphius vegetans Paraneoplastic pemphgus

PEMPHIGUS VULGARIS PATHOGENESIS: It is an autoimmune disease There are circulating antibodies of type Ig. G. These antibodies are reactive against the desmosomes or the tonofilament complex. There destruction or disruption of these tonofilament complex , resulting in the loss of attachment from cell to cell path. cont…d

PEMPHIGUS VULGARIS

PEMPHIGUS VULGARIS histology

Mucous Membrane Pemphigoid (Cicatricial Pemphigoid) (BMMP)

Burning mouth syndrome Medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause This discomfort may affect the tongue, gingiva, lips, bucal mucosa, palate or widespread areas of your whole mouth Appear suddenly or develop gradually over time the cause often can't be determined

Symptoms A burning or scalded sensation A sensation of dry mouth with increased thirst Taste changes, such as a bitter or metallic taste Loss of taste

Primary burning mouth syndrome Secondary burning mouth syndrome

Risk factors woman postmenopausal over the age of 50

Certain factors may increase risk of developing BMS Recent illness Previous dental procedures Wearing dentures Allergic reactions to food Medications Traumatic life events Stress Anxiety Depression

Treatment Saliva replacement products Specific oral rinses or lidocaine Capsaicin, a pain reliever that comes from chili peppers An anticonvulsant medication called clonazepam (Klonopin) Certain antidepressants Medications that block nerve pain Cognitive behavioral therapy

Drink plenty of fluids to help ease the feeling of dry mouth, or suck on ice chips Avoid acidic foods and liquids, such as tomatoes, orange juice, carbonated beverages and coffee Don't use tobacco products Avoid spicy-hot foods Avoid products with cinnamon or mint Try different mild or flavor-free brands of toothpaste, such as one for sensitive teeth or one without mint or cinnamon Take steps to reduce stress