1. Team Special Needs Assignment: Multiple Sclerosis Karaynn Cannan, Chelsea Nielsen, Candice Richins, Gayle Stone, Chelsey Urling

2. What questions would you ask to the patient and/or caregiver?  What type of MS does the patient have?  4 types: Relapsing-remitting MS (most common), clinically isolated syndrome, primary progressive MS, secondary progressive MS.  When was the patient’s last relapse?  How long has the patient had MS?  What medications is the patient currently taking?  Does the patient have full dexterity? Can they brush their own teeth?  What type of MS does the patient have?  4 types: Relapsing-remitting MS (most common), clinically isolated syndrome, primary progressive MS, secondary progressive MS.  When was the patient’s last relapse?  How long has the patient had MS?  What medications is the patient currently taking?  Does the patient have full dexterity? Can they brush their own teeth?

3. What medications are frequently used to treat MS and what are the side effects?  Medications are used in MS to modify the disease course, treat relapses, and manage symptoms.  Most common meds used to modify disease course:  Avonex (Interferon Beta-1a)-muscle pain, redness or swelling at injection site.  Betaseron, Rebif (Interferon Beta-1b)- muscle pain, headaches  Copaxone-sores or ulcers in mouth or lips, trouble swallowing.  Gilenya-sore throat, dizziness  Lemtrada-headache, dizziness, trouble sleeping  Novantrone-sores or white patches on lips, mouth or throat. Headache.  Medications are used in MS to modify the disease course, treat relapses, and manage symptoms.  Most common meds used to modify disease course:  Avonex (Interferon Beta-1a)-muscle pain, redness or swelling at injection site.  Betaseron, Rebif (Interferon Beta-1b)- muscle pain, headaches  Copaxone-sores or ulcers in mouth or lips, trouble swallowing.  Gilenya-sore throat, dizziness  Lemtrada-headache, dizziness, trouble sleeping  Novantrone-sores or white patches on lips, mouth or throat. Headache.

4. What medications are frequently used to treat MS and what are the side effects?  Most common meds used to manage relapses:  High dose intravenous corticosteroids Methylprednisolone, prednisone- increased appetite, weight gain, decreased immune system, increased thirst.  Most common meds used to manage relapses:  High dose intravenous corticosteroids Methylprednisolone, prednisone- increased appetite, weight gain, decreased immune system, increased thirst.

5. What medications are frequently used to treat MS and what are the side effects?  Most common meds used to manage systems:  Bladder dysfunction: Enablex-dry mouth. Flomax-headache. Minipress-headache.  Bowel dysfunction: Colace-sore throat, Dulcolax  Depression: Cymbalta- dry mouth, tiredness. Prozac- dry mouth. Wellbutrin-dry mouth, vomiting.  Fatigue: Prozac- dry mouth. Provigil- dry mouth, anxiety.  Pain: Dilantin- swollen glands, gingival hyperplasia. Neurontin-sleepiness, weight gain.  Spasticity-Klonopin. Valium- headache.  Tremors- Klonopin.  Walking difficulties- Ampyra- trouble sleeping, pain during urination.  Most common meds used to manage systems:  Bladder dysfunction: Enablex-dry mouth. Flomax-headache. Minipress-headache.  Bowel dysfunction: Colace-sore throat, Dulcolax  Depression: Cymbalta- dry mouth, tiredness. Prozac- dry mouth. Wellbutrin-dry mouth, vomiting.  Fatigue: Prozac- dry mouth. Provigil- dry mouth, anxiety.  Pain: Dilantin- swollen glands, gingival hyperplasia. Neurontin-sleepiness, weight gain.  Spasticity-Klonopin. Valium- headache.  Tremors- Klonopin.  Walking difficulties- Ampyra- trouble sleeping, pain during urination.

6. Risk FactorsInterventionsAnticipated Outcomes Patient’s AttitudeFace hurts Difficulty brushing teeth Educate with modified OH devices Patient understands modified techniques Medical History Physical Appraisal Multiple Sclerosis -Currently in period of remission Short Appointments with many breaks Oral Exam: E/I Exam Lack of salivation Sensitivity in facial area Refer to DDSHumidifier and saliva replacement therapy Dental ExamClinical CariesRefer to DDSCarries Restored Educate Patient on Importance of Daily Oral Hgiene Periodontal ExamRed Rolled, Inflamed marginal gingiva Bulbous papilla Gen. probe depths >4mm 20 BOP Localized NSPT Irrigation w/ Iodine NaF varnish application Reduce biofilm and pocket depths, reduce BOP by ½ Oral HygieneGeneralized moderate biofilm present Self care: Modified hygiene Devices Patient and Caregivers Understand modifications for OH

7. Care Plan Appointment Sequencing Appointment 1: HHX Review: Keep appointment time short, with breaks Take BP Local Anesthesia w/ Lido 2%, 20% Benzocaine Topical Localized NSPT Irrigation w/ 10% Iodine Introduce Biotene Dry Mouth Oral Rinse Appointment 2: HHX Review: Keep appointment time short, with breaks Take BP Local Anesthesia w/ Lido 2%, 20% Benzocaine Topical Localized NSPT Irrigation w/ 10% Iodine Introduce toothbrush with built up handle (tennis ball) Explain benefits of electric toothbrush Appointment 3: HHX Review: Keep appointment time short, with breaks Take BP Local Anesthesia w/ Lido 2%, 20% Benzocaine Topical Localized NSPT Irrigation w/ 10% Iodine Introduce idea of weighted glove use while brushing Appointment 4: HHX Review: Keep appointment time short, with breaks Take BP Local Anesthesia w/ Lido 2%, 20% Benzocaine Topical Localized NSPT Irrigation w/ 10% Iodine Remind patient to use humidifier to manage dry mouth, and to sit during teeth brushing to avoid fatigue.

8. What and how would you implement oral hygiene recommendations?  Involve family/caregiver in patient hygiene instructions  Short, early morning appointments with breaks to lessen stress  Would advise against choking hazards such as dentures  Explain the importance of maintaining clean teeth to avoid such measures  And to keep patient self esteem up (avoiding depression)  Involve family/caregiver in patient hygiene instructions  Short, early morning appointments with breaks to lessen stress  Would advise against choking hazards such as dentures  Explain the importance of maintaining clean teeth to avoid such measures  And to keep patient self esteem up (avoiding depression)

9. What Human Needs Theory Will and Will not be met?  Protection from health risks  No dentures, breaks in appts  Freedom from stress and pain  Short morning appts, use of local anesthesia,  Wholesome facial image  Assure that healthy teeth are maintained to improve patient sense of wellbeing  Skin and Mucus Membrane Integrity  Routine hygiene services  Functional and Biologically sound Dentition  Refer to DDS for any restorative needs, apply fluoride to reduce carries risk.  Conceptualization and Problem Solving  Educate patient/caregiver with OHI modifications  Responsibility for Oral Health  Encourage caregivers to help patient seek regular dental hygiene services.  Protection from health risks  No dentures, breaks in appts  Freedom from stress and pain  Short morning appts, use of local anesthesia,  Wholesome facial image  Assure that healthy teeth are maintained to improve patient sense of wellbeing  Skin and Mucus Membrane Integrity  Routine hygiene services  Functional and Biologically sound Dentition  Refer to DDS for any restorative needs, apply fluoride to reduce carries risk.  Conceptualization and Problem Solving  Educate patient/caregiver with OHI modifications  Responsibility for Oral Health  Encourage caregivers to help patient seek regular dental hygiene services. Will be met:

10. What Human Needs Theory Will and Will not be met?  Freedom from head and neck pain  Patient may always have “pins and needles” type neck pain as a symptom of MS, along with trigeminal neuralgia.  Freedom from head and neck pain  Patient may always have “pins and needles” type neck pain as a symptom of MS, along with trigeminal neuralgia. Will not be met: