CE Course 11 - Tables


Table I. Stages of Alzheimer’s disease and associated impairments

Early Stage
Forgetfulness
Personality changes
Employment performance problems
Social withdrawal
Apathy
Errors in judgment
Inattentiveness
Personal hygiene neglect

Middle Stage
Disorientation
Loss of coordination
Restlessness and anxiety
Language difficulty
Sleep pattern disturbance
Progressive memory loss
Catastrophic reactions
Pacing

Advanced Stag
Profound comprehension difficulty
Gait disturbances
Bladder and bowel incontinence
Hyperoralia
Inability to recognize family members
Seizures
Aggression
Lack of insight regarding impairments

Terminal Stage
Physical immobility
Contractures
Dysphagia
Emaciation
Aphasia
Pathological reflexes
Unaware of environment
Total helplessness

From Fabiszewski KJ: Caring for the Alzheimer’s patient. Gerodontology 1987;6(2):53-58.


Table II. Top 10 medications of 2001 by total number of

prescriptions dispensed
Drug
name
Therapeutic

classification
Oral

complication(s)

Management
1. Lipitor® Cholesterol-lowering xerostomia, vomiting

aphthous/stomatitis


artificial saliva substitutes and toothpastes formulated to reduce
the sensation of oral dryness; fluoride; avoid mouthwashes with alcohol;
avoid sugars, tobacco, caffeine; sip water; chew sugarless gum; use
a humidifer; and use rinses or ointments with topical anesthetic
2. Synthroid® Thyroid hormone none none
3. Premarin® Estrogen replacement candida, vomiting,

gingivitis
antifungal agents;
bactericidal rinse; fuoride; meticulous plaque control; and toothpastes
formulated to help maintain a balanced oral flora
4. Hydrocodone/APAP Narcotic analgesic vomiting, mucosal

atrophy of tongue,

dysgeusia
Fluoride, favor
foods; meticulous oral hygiene
5. Norvasc® Calcium channel
blocker
xerostomia,

gingival hyperplasia,

dysgeusia
artificial saliva
substitutes; ?uoride; toothpastes formulated with antibacterial enzymes
to support natural salivary defenses; avoid mouthwashes with alcohol;
avoid sugars, tobacco, caffeine; sip water; chew sugarless gum; use
a humidifier; consult physician regarding an alternative medication
that does not affect gingival tissue; and flavor foods
6. Prilosec™ Antisecretory
compound
xerostomia, candida arti?cial saliva
substitutes; ?uoride; toothpastes formulated with antibacterial enzymes
to support natural salivary defenses; avoid mouthwashes with alcohol;
avoid sugars, tobacco, caffeine; sip water; chew sugarless gum; use
a humidifier; flavor foods; antifungal bactericidal rinse
7. Zoloft™ Antidepressant xerostomia, bruxism arti?cial saliva
substitutes; fluoride; toothpastes formulated to relieve the sensation
of oral dryness; avoid mouthwashes with alcohol; avoid sugars, tobacco,
caffeine; sip water; chew sugarless gum; humidi?er; fabricate mouthguard
8. Claritin® Antihistamine xerostomia, dysgeusia,

vomiting
artificial saliva
substitutes; fluoride; toothpastes formulated to relieve the sensation
of oral dryness; avoid mouthwashes with alcohol; avoid sugars, tobacco,
caffeine; sip water; chew sugarless gum; humidifier; ?avor foods
9. Prevacid® Antisecretory
compound
xerostomia; dysgeusia avoid mouthwashes
with alcohol; toothpastes formulated to relieve the sensation of oral
dryness; avoid sugars, tobacco, caffeine; sip water; chew sugarless
gum; use a humidifier; flavor foods
10. Celebrex™ NSAID, COX-2
selective
xerostomia, dysgeusia

vomiting, aphthous

stomatitis
avoid mouthwashes
with alcohol; toothpastes formulated to relieve the sensation of oral
dryness; avoid sugars, tobacco, caffeine; sip water; chew sugarless
gum; use a humidifier; flavor foods; use rinses or ointments with
topical anesthetic
       


Table III. Categories of drugs known to cause xerostomiad
Anorexiant

Antiacne

Antianxiety

Antiarthritic

Anticholinergic/Antispasmodic

Anticonvulsant

Antidepressant

Antidiarrheal

Antihistamine

Antihypertensive

Antiinflammatory/Analgesic

Antinauseant

Antiparkinsonian

Antipsychotic

Antisecretory

Antiviral

Bronchodilator

Central nervous system stimulant

Decongestant

Diuretic

Migraine

Muscle relaxant

Narcolepsy

Narcotic analgesic

Ophthalmic

Sedative


Table
IV. Dietary deficiencies and associated oral complications
Type
of deficiency
Dietary
sources
Oral
symptoms
Vitamin B2 (Riboflavin) Meats, poultry,
fish, dairy products, enriched and fortified cereals, pasta, and bread
Cheilosis and
glossitis
Vitamin B6 (Pyridoxine) Chicken, fish,
kidney, liver, pork, egg, unmilled rice, soybeans, oats, whole-wheat
products, peanuts, and walnuts
Cheilosis and
glossitis
Vitamin B12 (Cobalamin) Liver, kidney,
meat, fish, eggs, dairy products, oysters, and nutritional yeast
Tip and margins
of the tongue may be red, smooth, and numb or have a burning sensation
Vitamin C Citrus fruits,
tomatoes, cabbage, cauliflower, melons, strawberries, and dark green
vegetables
Petechiae, gingival
enlargement, and bleeding
Folic acid Green leafy vegetables,
legumes, liver, oranges, peanuts, sunflower seeds, and wheat-germ
Cheilosis and
glossitis