Effects of Systemic Disease on Nutritional Status and Oral Health

MULTIPLE CHOICE

1. All disease processes result from a combination of the following factors except one. Which one is the exception?

a.
Failure to have an annual physical examination
b.
Presence of an etiologic agent
c.
Susceptibility of the host
d.
Resistance of the host
e.
Environmental factors

ANS: A

Although failure to have an annual examination is not recommended, it is not a major factor affecting disease process. Note that plaque biofilm is the etiologic agent in both periodontal disease and dental caries. Host susceptibility and resistance are prime factors affected by nutritional status.

REF: p. 340

2. Dental hygienists are in a key position to assess and detect signs and symptoms of systemic disease because more than one third of the patients treated in a dental office frequently do not interact with a general healthcare provider.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: A

For the more than one third of dental patients who do not interact with a general healthcare provider, clinical observations, radiographic findings, diet screening, and inquiries made while obtaining or updating the health history should be the basis for motivating the patient to visit a healthcare provider or registered dietitian. The ramifications of a patient’s systemic health are vital to the dental hygienist because they provide cues to possible oral problems and may alter treatment goals, scheduling and priorities.

REF: p. 340

3. The term appetite is applicable to each of the following statements except one. Which one is the exception?

a.
Appetite is associated with enjoyment of food.
b.
Most healthy people have very little appetite.
c.
During illness, appetite can decrease because of pain, apathy, anorexia or drugs.
d.
Poor intake can further lessen the desire to eat.

ANS: B

Most healthy people have a good appetite with no problems eating adequate amounts of food. Note that although the term anorexia nervosa is reserved for a disease associated with a distorted body image, the term anorexia can also refer to a condition in which a patient has a poor appetite for a variety of reasons.

REF: p. 342

4. Individuals with loss of smell are inclined to do each of the following except one. Which one is the exception?

a.
Use more spices.
b.
Eat less.
c.
Eat and drink more sweets.
d.
Lose weight.

ANS: C

Loss of smell (anosmia) causes people to eat and drink fewer sweet food and beverages. The foods people choose to eat are modulated by taste, smell, and oral textural perception. Taste and smell dramatically affect appetite and food intake.

REF: p. 342

5. Taste perception, especially the intensity of sweet taste, declines with age. Individuals taking three or more medications are likely to have less taste sensitivity and require greater amounts of sodium and sugar to perceive these tastes.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Although it is true that taste perception declines during the healthy aging process, the exception is intensity of sweet, which does not diminish with age.

REF: p. 342

6. The type of medication most likely to induce xerostomia is:

a.
antibiotics.
b.
diuretics.
c.
local anesthetics.
d.
anticholinergic.

ANS: D

Although medications such as antidepressants, antihistamines, antihypertensives, and diuretics can cause xerostomia, more than one third of older adults experience xerostomia primarily as a result of anticholinergic medications. These medications block impulses through the parasympathetic nerve. Xerostomia can affect nutritional status in numerous ways and is a risk factor for dental caries and periodontal disease.

REF: p. 342

7. Typical symptoms of all anemias are flushed skin and erythematous oral tissues. The type of anemia can be determined only after evaluation of blood tests.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Typical symptoms of all anemias are pallor (paleness) of the skin, oral mucosa, and conjunctival (ocular) tissues, along with overall weakness as a result of inadequate oxygen-carrying power of the blood.

REF: p. 342

8. A vegan dental patient with a nonheme iron anemia should take vitamin D supplements before invasive dental procedures because absorption of nonheme iron is enhanced by vitamin D.

ANS: E

Specifically referring to dental concerns and wound healing, this patient should be advised to assure that intake of vitamin C is sufficient because this nutrient enhances absorption of nonheme iron. Note that depending on the severity of iron-deficiency anemia, wound healing can be impaired in response to invasive dental treatment such as tooth extraction, nonsurgical periodontal therapy, and periodontal surgery.

REF: pp. 342-343

9. Clinically, the dental hygienist would expect to see each of the following except one in a patient with vitamin B12 deficient megaloblastic anemia. Which one is the exception?

a.
Angular cheilosis
b.
Dark red oral mucosa
c.
Recurrent aphthous ulcers
d.
Erythematous mucositis

ANS: B

Patients with megaloblastic anemia associated with vitamin B12 deficiency exhibit each of the conditions described except for the mucosal description. Such patients exhibit pale or yellowish oral mucosa. Patients may also complain of a painful, sore, burning tongue with signs of atrophic glossitis. Replacement therapy with vitamin B12 supplements or injections relieves symptoms within 36 to 48 hours. Note that erythematous (red) mucositis is manifested by inflamed, flat lesions with red borders on the mucosa membrane. This condition is also called pernicious anemia.

REF: p. 343

10. Pain in the tongue is called:

a.
glossopharyngeal.
b.
glossitis.
c.
glossodynia.
d.
macroglossia.

ANS: C

Pain in the tongue is technically called glossodynia. Glossopharyngeal is a term describing anatomic features occurring in the junction of the tongue and pharynx. Although glossitis may be painful, the term refers to the more general condition of inflammation of the tongue. Macroglossia is an enlarged tongue.

REF: p. 343

11. Each of the following is a complication of neutropenia except one. Which one is the exception?

a.
Mucositis
b.
Stomatitis
c.
Fungal infections
d.
Viral infections
e.
Candidiasis

ANS: B

Stomatitis, an inflammatory condition of the mouth, is not a complication of neutropenia. Because neutropenia is characterized by a diminished number of white blood cells, it causes infections. Although inflammatory conditions can progress to infections, they are not characterized by decreased white blood cells. Note that the risk of infection with neutropenia is directly proportional to its duration and severity. Mucositis can result in large ulcerative and necrotic lesions with extensive tissue destruction. Candidiasis is a fungal infection. When neutropenia is present, invasive dental treatment should always be approved by a healthcare provider.

REF: p. 344

12. Each of the following is a gastrointestinal problem except one. Which one is the exception?

a.
Gastroesophageal reflux disease
b.
Hirsutism
c.
Hiatal hernia
d.
Esophagitis

ANS: B

Hirsutism is excessive hair growth caused by a state of hypercortisolism called Cushing syndrome. Gastroesophageal reflux disease, characterized by return of gastric contents into the esophagus, is commonly associated with hiatal hernia, pregnancy, and obesity. With hiatal hernia, the stomach partially protrudes through the esophageal opening into the chest cavity. Esophagitis is an inflammation of the lower esophagus and can cause discomfort when swallowing.

REF: p. 345

13. Each of the following is a chronic disease or condition associated with poor nutrient absorption except one. Which one is the exception?

a.
Crohn disease
b.
Ulcerative colitis
c.
Gluten-sensitive enteropathy
d.
Celiac disease
e.
Ischemia

ANS: E

Ischemia is inadequate blood flow and lack of oxygen delivery within the cardiovascular system; it is not associated with malabsorptive disorders. Diarrhea and malabsorption associated with these disease states create deficiencies of nutrients and trace elements. Nutritional requirements of these patients are usually increased; however, abdominal cramping, anorexia, and intolerance to many food components often inhibit intake of food. Small, frequent feedings are advised because they are better tolerated and increase adequacy of intake. For patients with malabsorptive conditions, a diet high in kilocalories and protein with limited fat and fiber is often recommended.

REF: pp. 345-346

14. The dental hygienist should encourage a patient who has gastroesophageal reflux to:

a.
bring his or her blood glucose monitor.
b.
avoid eating for two hours prior to the appointment.
c.
avoid iron-rich foods.
d.
drink orange juice before beginning treatment.

ANS: B

To reduce the risk of regurgitation, the patient should be encouraged not to eat for 2 hours before treatment. The patient’s neck should be positioned above the stomach. Nitrous oxide sedation should be not be used because it can relax the lower esophageal sphincter.

REF: p. 345

15. Cardiovascular disease (CVD) produces numerous oral effects. A causative relationship has been established between periodontal disease and CVD.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: B

In contrast to its many ill effects in other body sites, CVD produces few oral effects and usually does not have oral manifestations that affect food intake. However, medications prescribed for cardiovascular conditions may have oral effects. There may be a risk of CVD from periodontal pathogens. More research is needed because not all studies support a causative relationship.

REF: p. 346

16. A blood clot blocking an artery that is capable of causing a cerebrovascular accident is called an aneurysm. Atherosclerosis, caused by an accumulation of fatty materials, results in narrow and rough arterial walls.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

A blood clot blocking an artery that is capable of causing a cerebrovascular accident is called a thrombus. An aneurysm is a weak or thin spot in an arterial wall. Note that cerebrovascular accidents (CVAs) are commonly called strokes. As with cardiovascular disease (CVD), evidence-based research has not produced consistent results in regard to the association between periodontal disease and stroke.

REF: p. 347

17. Patients having experienced mini-strokes may have dysphagia, because gastronomy has impaired the swallowing reflex.

ANS: C

This question confuses several aspects of neurologic impairment form cerebrovascular accidents (CVAs). Dysphagia, difficulty swallowing, often results from CVAs (strokes). Occasionally patients who have ministrokes do not seek medical attention because the attribute symptoms to the aging process. A dental hygienist may suspect dysphagia in a patient who has facial muscle weakness or who coughs or chokes frequently. Patients who have severe dysphagia and are unable to eat receive their nutrition via gastrostomy, which is a tube that provides the feeding directly into the stomach, until the swallowing reflex improves.

REF: p. 347

18. Neurologic deficits can cause patients to be unaware of the presence of food in the mouth. Pocketed foods remain in the mouth, especially the vestibule, after meals in patients.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: A

After meals, the mouth should be checked for any pocketed foods retained in the mouth, especially in the vestibule. These materials should be removed to decrease risk of aspirating the food and developing dental caries.

REF: p. 347

19. Blood pressure consistently 140/90 mm Hg or higher is stage 1 hypertension. Diuretics are frequently prescribed for patients with hyperlipidemia.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

Diuretics are frequently prescribed for patients with congestive heart failure or hypertension to help eliminate excess fluid. Note that these medications also decrease salivary flow causing xerostomia. Hyperlipidemia is another type of heart disease involving elevated cholesterol levels. Patients with hyperlipidemia are advised to limit saturated, trans, and total fat consumption because these products increase the risk of atherosclerosis. Dental hygienists should recommend noncariogenic snacks relatively low in fat, such as low-fat or nonfat cheese or skim milk.

REF: p. 347

20. Each of the following should be recommended for patients with cardiovascular disease except one. Which one is the exception?

a.
Salt substitutes
b.
Xylitol
c.
Fluoride
d.
Nitrous oxide during dental treatment

ANS: A

Most salt substitutes contain both potassium and chloride. The dental hygienists should remind patients to check with their healthcare provider for advice on use of salt substitutes. Antihypertensive drugs may be responsible for reduced salivary flow and increased dental caries. Fluoride and xylitol products minimize damage. Nitrous oxide is recommended for cardiovascular patients because it helps minimize stress.

REF: p. 348 | Nutritional Directions

21. Which statement most accurately reflects current thinking on prescription of bisphosphonates as they relate to osteonecrosis?

a.
All patients taking bisphosphonates develop osteonecrosis.
b.
The risk of osteonecrosis in patients taking bisphosphonates is negligible.
c.
Patients at risk for osteonecrosis have a history of large doses of intravenous bisphosphonates.
d.
Osteonecrosis occurs in 1 of 10 people taking bisphosphonates.

ANS: C

Bisphosphonates are medications primarily prescribed for postmenopausal osteoporosis. A growing concern with this drug is the risk for osteonecrosis (bone death of the jaw) after invasive dental procedures. Patients at risk of for osteonecrosis have a history of large doses of intravenous bisphosphonates. Additionally, they have a history of poor healing following invasive dental procedures. Osteonecrosis occurs in approximately 1 of every 1000 women taking bisphosphonates.

REF: p. 348

22. Few dental and periodontal changes and no oral mucosal changes are observed in well-controlled diabetes. The fruity-smelling breath characteristic of diabetes is more common in type 2 diabetes.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

The dental hygienist should educate patients about the importance of working with their healthcare provider to control their condition. Note that, although current evidence supports an interrelationship between diabetes and oral health, periodontal disease is considered a long-term complication of diabetes. In addition, poorly controlled diabetes results in more severe periodontal disease and alveolar bone loss even in children and adolescents and can contribute to the progression of diabetes. The fruity-smelling breath characteristic of diabetes is more prevalent in type 1 diabetes.

REF: p. 349

23. The dental hygienist should have three or four glucose tablets available because some oral diabetes medications are often combined with an oral agent that causes hypoglycemia.

ANS: A

Some oral diabetes medications do not cause hypoglycemia by themselves; however, they are often combined with an oral agent that does. In this scenario, the patient may require a glucose source. The dental hygienist should have three or four glucose tablets available for such events.

REF: pp. 349-350 | Dental Considerations

24. Each of the following is true of blood glucose levels except one. Which one is the exception?

a.
Before dental treatment, blood glucose level should be between 70 and 200 mg/dL.
b.
Long and stressful appointments may require testing during the appointment.
c.
A glycated hemoglobin A1c is less than 6.5%, indicating that diabetes is well controlled.
d.
The dental hygienist should have injectable glucose available.

ANS: D

The dental hygienist should have an understanding of the blood glucose testing ranges considered stable. Under no circumstances should the dental hygienist administer injectable glucose; however, it is advisable to have three or four glucose tablets available. In addition, request that the patient bring their blood glucose monitor to each appointment.

REF: p. 350 | Dental Considerations

25. Childhood hypopituitarism results in diastemata between most teeth because increased skeletal growth results in enlargement of both the mandible and the maxilla.

ANS: E

In childhood hypopituitarism, decreased skeletal growth results in disproportionate retardation of mandibular growth. Because of normal-sized teeth erupting into the arch, proper alignment is impossible and teeth are typically crowded. Recall that the term diastema means a lack of a contact area between adjacent teeth, which results in a space. Delayed eruption and malocclusion are principal oral problems of hypopituitarism.

REF: p. 350

26. Which condition can be caused by inadequate iodine and results in short stature, poor muscle tone, and intellectual disabilities when it occurs at birth or in young children?

a.
Hypothyroidism
b.
Hyperparathyroidism
c.
Parkinson disease
d.
Kaposi sarcoma

ANS: B

Hypothyroidism can be related to numerous factors, including inadequate consumption of iodine, an inborn error of metabolism, and treatment of hyperthyroidism. When hypothyroidism occurs at birth or in young children, the child is short in stature and has intellectual disabilities. Poor muscle tone results in macroglossia, manifested by a large protruding tongue with indentations on the lateral borders. Hyperparathyroidism, associated with alterations in calcium, phosphorus, and bone metabolism results from hypersecretion of the parathyroid hormone. Parkinson disease is a progressive neurological condition characterized by involuntary muscle tremors, slowness of movement (bradykinesia), stooped posture, and masklike expression. Kaposi sarcoma is a highly malignant tumor of blood vessel origin that occurs on the skin and oral mucosa. These lesions appear in many HIV-positive patients.

REF: p. 351

27. Crowded teeth resulting from retarded growth of the mandible occur in hyperparathyroidism. Systemic bone disturbances are reflected orally in patients with hypopituitarism by jaw enlargement.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: B

Both statements are incorrect because the condition and its descriptive information are reversed. Stated correctly, crowded teeth resulting from retarded growth of the mandible occur in hypopituitarism. Systemic bone disturbances are reflected orally in patients with hyperparathyroidism by jaw enlargement.

REF: p. 351

28. Oral manifestations of renal (kidney) disease include each of the following except one. Which one is the exception?

a.
Delayed eruption
b.
Enamel hypoplasia
c.
Pulp calcifications
d.
Dysphagia
e.
Tooth mobility

ANS: D

Dysphagia is not associated with kidney disease. It is a common complication of Parkinson disease and cerebrovascular accidents (CVA). The remaining selections are among the numerous oral manifestations of renal disease. Note that numerous manifestations are seen in the bone, such as radiolucent fibrocystic lesions, brown tumors, and metastatic soft tissue calcifications.

REF: p. 351

29. Nutrients potentially harmful to renal (kidney) patients on dialysis include each of the following except one. Which one is the exception?

a.
Phosphorus
b.
Magnesium
c.
Protein
d.
Some vitamins

ANS: C

High-quality protein intake is recommended to reduce nitrogen waste products (urea) between dialysis treatments. Potentially harmful intake of phosphorus, magnesium, aluminum, and some vitamins must be avoided.

REF: pp. 351-352

30. Patients receiving dialysis are likely to be deficient in each of the following vitamins and minerals except one. Which one is the exception?

a.
Vitamin K
b.
B-complex vitamins
c.
Vitamin C
d.
Iron
e.
Zinc

ANS: A

Vitamin K is a fat-soluble vitamin. Patients who receive dialysis are likely to be deficient in water-soluble vitamins (B and C) and the minerals iron and zinc.

REF: p. 352

31. A generalized malignant disease characterized by distorted proliferation and development of white blood cells (WBCs) is called:

a.
leukoplakia.
b.
leukemia.
c.
human papillomavirus.
d.
micrognathia.

ANS: B

Leukemia, a neoplastic process with many oral manifestations that detrimentally affect food intake, is a generalized malignant disease characterized by distorted proliferation and development of WBCs. Gingival tissues are especially susceptible to gingivitis because of an exaggerated inflammatory response to local etiologic factors, including calculus, plaque biofilm, and soft white deposits (material alba). Leukoplakia is an asymptomatic white, yellow, or gray patch or plaque on the oral mucosa that cannot be removed by scraping or rubbing. Human papillomavirus (HPV) is a common sexually transmitted infection that can occur in the oral cavity, esophagus, and larynx. Some high-risk strains have shown a strong association with cancer. Micrognathia is a term used to describe abnormally small jaw development. Micrognathia occurs with many developmental disabilities and with hypopituitarism that occurs early in life.

REF: p. 353 | p. 355

32. Chemotherapeutic drugs cause each of the following detrimental effects except one. Which one is the exception?

a.
Hypogeusia
b.
Anosmia
c.
Slow cellular turnover rate in alimentary tract
d.
Stomatitis
e.
Mucositis

ANS: C

Chemotherapeutic drugs are used to destroy malignant cells without loss of an excessive number of normal cells; they cause a rapid cellular turnover rate in the alimentary tract. This leads to stomatitis or mucositis, oral ulcerations, and decreased absorptive capacity. Decreased senses of both taste (hypogeusia) and smell (anosmia) are a result.

REF: p. 355

33. Individuals with bulimia may be described as achievement-oriented perfectionists. Bulimia, which is synonymous with anorexia nervosa, is characterized by intentional and controllable secret periods of overeating usually followed by purging.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: B

Individuals with anorexia nervosa are typically perfectionists who seek to rule their lives by refusing to eat in an effort to control their bodies. Anorexia nervosa and bulimia are not synonymous terms. Criteria for diagnosis of anorexia nervosa include weight loss equal to or exceeding 15% below expected or original body weight and an excessive desire for slimness with a distorted body image. Conversely, bulimia not associated with significant weight loss is characterized by intentional, although not necessarily, controllable, secret binges (periods of overeating). This event is usually followed by purging, a means of counteracting the effects of overindulgence. Vomiting can be induced by sticking a finger down the throat or drinking syrup of ipecac, an emetic drug.

REF: p. 357

34. Dental hygienists should encourage patients with eating disorders such as bulimia to brush immediately after vomiting because self-induced vomiting causes erosion of tooth enamel and dentin hypersensitivity.

ANS: D

To prevent damage to the teeth, the dental hygienist should caution the patients against brushing immediately after vomiting. Other damaging factors include abrasive toothpaste, hard toothbrushes, and a scrubbing method of brushing. Because rinsing with tap water reduces protective effects of saliva, advise patients to rinse with sodium bicarbonate to neutralize the oral environment. Daily fluoride and dentinal hypersensitivity products should be encouraged.

REF: p. 357

MULTIPLE RESPONSE

1. Intake of which nutrients is most frequently cited as being negatively affected by oral problems and dentate status? (Select all that apply.)

a.
Protein
b.
Vitamin C
c.
Fiber
d.
Vitamin D
e.
Vitamin K

ANS: A, C, D

Nutrients most frequently cited as being deficient because of oral problems and dentate status include protein, fiber, some B vitamins, vitamin D, iron, magnesium, and phosphorus. It is well documented that food preferences are affected by one’s ability to chew. Patients with decreased masticatory efficiency usually choose soft food, which typically do not provide adequate amounts of essential nutrients.

REF: p. 340

2. For a patient with megaloblastic anemia caused by folic acid deficiency, which of the following suggestions are appropriate for a dental hygienist to provide? (Select all that apply.)

a.
Daily intake of folate is necessary.
b.
Take oral vitamin B12 or iron supplements without food.
c.
Patients with permanent gastric or ileal damage need vitamin B12 supplementation for several months.
d.
Vitamin B12 shots are always indicated for “tired blood.”
e.
Raw vegetables are a better source of folate than cooked vegetables.

ANS: A, E

These patients should be advised to take oral vitamin B12 with vitamin C–rich foods to enhance absorption. Patients with permanent gastric or ileal damage need vitamin B12 to live. Vitamin B12 shots are not always indicated for “tired blood.” Vitamin B12 provides folic acid (folate).

REF: p. 343

3. Which of the following is correct and advisable for patients with gastrointestinal problems? (Select all that apply.)

a.
Avoid foods that increase the likelihood of reflux.
b.
Limit caffeine, chocolate, alcohol, and carbonated beverages.
c.
Commonly called heartburn, enzyme tablet supplementation is advisable.
d.
Eating small meals throughout the day is advisable.
e.
Nitrous oxide during dental treatment decreases the likelihood of an episode.

ANS: A, B, D

Although heartburn is the common term, this condition is not caused by inadequate digestion. Supplementation with digestive enzyme tablets is inappropriate. Nitrous oxide is contraindicated during dentistry because it can relax the lower esophageal sphincter, resulting in a return of gastric contents to the stomach (gastroesophageal reflux).

REF: p. 345

4. Which of the following are associated with diabetes mellitus? (Select all that apply.)

a.
Oral candidiasis
b.
Severe periodontitis
c.
Bradykinesia
d.
Micrognathia
e.
Resistance to infections

ANS: A, B, E

Periodontal disease is considered a long-term consequence of diabetes. Poorly controlled diabetes results in more severe periodontal disease and alveolar bone loss, even in children. Oral candidiasis—common in patients with longstanding, poorly controlled diabetes—is partly due to increased glucose levels in saliva, which provide a substrate for fungal growth. Bradykinesia, slowness of movement, is associated with the progressive neurological damage caused by Parkinson disease. Micrognathia, an abnormally small jaw, is a developmental disability often present in neuromuscular diseases such as cerebral palsy, muscular dystrophy, and Down syndrome.

REF: pp. 348-349

5. Which of the following are describe oral conditions diabetic patients and dental hygienists should watch for? (Select all that apply.)

a.
Changes in the fit of partial denture or bridges
b.
Pain when chewing
c.
Pale gingiva
d.
Teeth feeling “tight”
e.
Gingival hyperplasia

ANS: A, B

In uncontrolled diabetes, gingival tissues appear red, swollen, or tender. With advancing periodontal disease, teeth become mobile. Gingival hyperplasia is associated with long-term use of phenytoin for epilepsy (psychomotor seizures). When good oral self-care techniques are routinely practiced, inflammation and gingival overgrowth are reduced.

REF: p. 349

6. Which of the follow accurately describe function and disease of the kidneys? (Select all that apply.)

a.
The kidney is second to the liver in the elimination of waste products.
b.
Progressive loss of nephrons leads to acute kidney failure.
c.
During kidney dysfunction, complications arise as by-products accumulate from protein metabolism.
d.
Calcium-phosphorus imbalances cause various changes in bone.
e.
Odynophagia results from alterations in electrolyte and pH levels.

ANS: C, D

The kidney is the primary organ that eliminates significant amounts of waste products. Progressive loss of nephrons in the kidney leads to chronic failure. (Progressive changes equate with chronic disease processes.) When kidney function diminishes, complications arise as by-products accumulate from protein metabolism, and alterations occur in electrolyte level and acid-base balance (pH). Various changes in bones are observed because of calcium-phosphorus imbalances. This syndrome is called renal osteodystrophy. Note that odynophagia is difficulty swallowing associated with cancer or disease of the esophagus.

REF: pp. 351-352

7. Which of the following are oral complications of acquired immunodeficiency disease? (Select all that apply.)

a.
Candidiasis
b.
Lipodystrophy
c.
Oral hairy leukoplakia
d.
Necrotizing ulcerative gingivitis
e.
Polyphagia

ANS: A, B, C, D

Susceptibility to various opportunistic infections, including candidiasis, is a hallmark of HIV. Lipodystrophy (rearrangement of fat cells in the face) and lip hypertrophy (accumulation of fat on the back or the neck) occur in HIV-positive patients who are taking highly active antiretroviral therapy (HAART). Similarly, lipoatrophy (loss of fat from specific areas of the body) occurs. Oral hairy leukoplakia, commonly is found predominately on the lateral borders of the tongue; it consists of white lesions of filamentous growths that do not rub off. Note that polyphagia (increased hunger) is a manifestation of diabetes.

REF: pp. 355-356

MATCHING

It is important that the dental hygienist understand the effects of systemic disease on nutritional status and oral health. Match each disease, condition, or medication with its most appropriate description.

a.
Phantom taste
b.
Pernicious anemia
c.
Neutropenia
d.
Bisphosphonates
e.
Goitrogens
f.
Hypopituitarism
g.
Brown tumors
h.
Osteosclerosis
i.
Neoplasia