Objectives: Immunity Gone Wrong: Autoimmune Diseases in Dental Hygiene Practice

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1 Objectives: 1) Understand the concept of self- tolerance versus non- self- tolerance. 2) Recognize systemic and oral indicators of autoimmune diseases. 3) Identify various autoimmune diseases and their effects on patient whole health. 4) Implement treatment protocol in accordance with the dental hygiene process of care. 5) Discuss home oral health management for the patient with an autoimmune or multiple autoimmune diseases. Autoimmune diseases can be stealth, but a careful assessment of patient health history, along with thorough extraoral and intraoral exams can reveal previously unconnected indicators. Dental hygienists are on the frontline of systemic disease detection, and autoimmune diseases are no exception. By recognizing multifactorial indicators we can help our patients achieve whole health and shorten the frustrating process of diagnosis. Patients with established diagnosis need special considerations during planning and preventive treatment, as well as oral self- care tips. The course will review known and newly recognized autoimmune diseases with oral manifestations and treatment protocol in accordance with the dental hygiene process of care.

2 Definitions: Acquired (Specific) Immunity: A memory of antigens that the body has been exposed to before are stored in antibodies and lymphocytes that lay waiting to be activated again should the antigen present itself again. Innate Immunity: The part of the immune system that destroys antigens without the ability to remember them for future invasions. Antibodies/Immunoglobulins: (Abbreviated as Ig) Proteins that reside in the blood and other bodily fluids that recognize and destroy antigens (viruses, bacteria, fungi) Antigen: Foreign invaders that activate the immune response. Self- tolerance: The immune system distinguishes between self- antigens and foreign- antigens. Non- self- tolerance: A failure to recognize the body s own cells, allowing the immune system to attack healthy cells, or host cells are altered and unrecognizable as the host cell, leading to attack as a foreign entity.

3 The dental hygiene process of care: Assess Documentation Dental Hygiene Diagnosis Evaluation Planning Implementation **Autoimmune disease discovery will rely heavily on the Assess phase of treatment

4 Assessing patient health: Questions to ask patients: 1) Have you experienced changes in: a) Weight b) Appetite c) Stress level 2) Have you experienced any illnesses? a. Increases in fevers, colds, flu? 3) Have you had any surgeries? 4) Have your medications changed? 5) Which over the counter medications are you taking? 6) Has there been a change in how you are taking these OTC medications? 7) How is your sleep? 8) How is your energy level? 9) How is your stress level? Systemic Indicators: Oral Indicators: Diagnosed patients & the Dental Hygiene Process of Care: Highlighted AA diseases: Scleroderma & Related AI s Sjogren s Syndrome Diabetes Type I Rheumatoid (Autoimmune) Arthritis & Related AI s Grave s Disease

5 Common Meds: Immunity Gone Wrong: Hormone Replacement: Replaces missing or inadequately produced hormone. Insulin and thyroid hormone replacement therapy are examples. NSAIDS: Ease pain and swelling, do not address root of AI. Often used first line or as adjunctive pain and swelling relief. Biologic Drugs: Genetically engineered drugs that mimic the effects of substances made by the immune system. Inactivate IL- 1 or TNF cytokines. Insulin is a biologic drug. Lowers patient resistance to infections. Biosimilar Drugs: Not yet approved by the FDA. A cell line is used, but the process is slightly different than biologic drugs. They are not a generic form of biologic drugs. DMARDS: Disease modifying antirheumatic drug. First line of treatment following NSAIDS for autoimmune arthritis patients. Slow acting and often used in combination with Biologics or NSAIDS. Corticosteroids: Mimics the effects of cortisol, normally produced by the adrenal glands. Have been shown to reduce joint damage, especially when used early in the treatment process. Immunosuppressive Drugs: Just as the name says, suppresses the immune system. Broad suppression that also increases susceptibility to all infections. Alterations to Process of Care: Recommendations for home oral care:

6 Web Resources: information/list- of- diseases/ Contact Karen Siebert, RDH, MA for a list of specific references used for this presentation:

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