Jesika Knitter Special Needs Dental Patient

Lupus is an autoimmune, chronic inflammatory disease that may affect any part of the body.

Etiology is unknown Hard to diagnose since symptoms can mimic other diseases Women are 8x more likely to have lupus Symptoms can vary drastically from patient to patient Patients experience “flares” and “remissions”

Joint pain Extreme fatigue Inflammation Mouth ulcers Chest pains High fever Skin lesion Seizures Photo from

1.Systemic lupus erythematosus – any part of the body. 2.Discoid lupus erythematosus – skin lesions that worsen when exposed to light often result in a scar due to slow healing process. 3.Acute cutaneous lupus erythmatosus – classic butterfly rash on the face, specifically the nose or cheeks. Usually heals without scarring. 4. Subacute cutaneous lupus erythematosus- light sensitive body lesions that appear as red circles.

When reviewing the medical history with the patient it is important to remember that lupus can affect different parts of the body. If the patient has an involved case or severe lupus affecting organs, he or she is probably under the care of a specialist. The dental hygienist plays an important role in communicating with the patient and specialist to achieve optimum dental and systemic health.

1.Are you experiencing anxiety? Patients with anxiety are more likely to have an angina attack. 2. Do you experience fatigue? Assess the need for shorter visits or frequent breaks during treatment. 3.Which organs have been effected by lupus? Heart = cardiovascular trouble, hypertensive Lungs = respiratory problems, chest pains Circulatory system = seizures

Give patient homecare tools that require the least amount of hand manipulation. Offer the patient a neck pillow or blanket Evaluate the need for anti-xerostomic therapeutics Practice stress relieving tools

Keep the lines of communication open to ensure your patient is comfortable in the dental chair. Keep in mind that some people may feel embarrassed about incompetency's due to joint pain or fatigue. Establish and maintain rapport with patient for maximum communication. During the appointment, ask how they are feeling and if they are comfortable.

Ulcers Gum Inflammation Lesions Xerostomia

 Advil – anti-inflammatory  Prednisone – corticosteroids  Imuran – cytotoxic  Amoxicillin – antibiotic  Malarone – anti-malaria

Increase frequency of treatment to 3-4 month recall appointment. Keep appointments short, take breaks as needed. Assess xerostomic related conditions. Long term goals may change depending on the patients level of pain and dexterity in joints.

Respiratory Stroke Cardiovascular Seizures Emergency situations depend on the patients individual case type

ALWAYS Always always thoroughly review and update the patients medical history Compare baseline vitals Stress reduction techniques

Question #1 Lupus is a/an _______ disease? A. Respiratory B. Autoimmune C. Circulatory D. Cerebral Question #2 Lupus has a trademark skin lesion in the shape of what? A. Worm B. Lady bug C. Butterfly D. Spider Question #3 Skin lesion associated with lupus worsen when exposed to light. A. True B. False

1. B - Autoimmune (Source: Ferenkeh-Koroma) 2. C – Butterfly (Source: Ibsen) 3. A – True (Source: Ibsen)

References: Ibsen, Olga A.C. "Oral Pathology for the Dental Hygienist." Linda Duncan, Ferenkeh-Koroma, Ada. "Systemic Lupus Erythematosus: Nurse And Patient Education.“ Nursing Standard (2012): CINAHL with Full Text. Web. 2 Feb. 2014