Josh Allen is a 37 year-old patient of the practice who has been diagnosed with multiple sclerosis. His condition has deteriorat
ed so that he now uses a wheelchair. He has called the office to schedule an appointment to have two teeth restored. 1.Do you think a certain time of day would be better for the dental team to see Josh? What would be the best time for his appointment:
2. As you are reviewing the health history update, Josh indicates that he has recently been diagnosed with trigeminal neuralgia. What is this disorder and how will it affect his dental care:
3. Are there any specific drugs that Josh may be taking that should be noted before the time of treatment? If so, what would they be:
4. Josh cannot be transferred to the wheelchair. Where should Josh be seen and how would this be handled:
5. On the basis of his disease, should Josh be put in an upright or supine position:
The best time for Josh to be attended is that he feels most comfortable and that the clinic has available.
Trigeminal neuralgia is a disease that causes high sensitivity in people's faces, causing bouts of severe pain. It is estimated that the pain felt by those who have this disease is stronger than the pain in the kidney that is already very strong. This disease is believed to occur by the loss of the myelin sheath that surrounds the nerves. In the case of Josh Allen, it would be necessary for the dentist to give him an appropriate medication to avoid the pain caused by the disease, before the procedure begins.
There are drugs that Josh can take, like carbamazepine and oxycarbazepine, which are drugs with high efficiency in reducing these crises.
Since Josh cannot be transferred to a wheelchair, he would need to be attended to at home. For this, it would be necessary to install the necessary equipment in his home for the procedure he needs, in addition to promoting a very high level of hygiene in the place.
Josh should be placed in the supine position, where he will lie with his shoulders and head slightly raised. This is because multiple sclerosis has damaged Josh's muscles and leaving him in an upright position may hinder the dental procedure, in addition to making Josh very uncomfortable.
Explanation:
Multiple Sclerosis is an autoimmune disease where the nervous system causes nerve damage causing various muscle and brain disorders throughout the body. The disease causes different parts of the body to stop working properly, becoming completely immobilized and without functionality.
This disease greatly limits people's ability to move, speak and reason, making it necessary that common day-to-day activities and even medical care are carried out in adapted ways, promoting the minimum possible comfort to the patient, as was done with Josh .
The major hormones that are responsible for normal calcium homeostasis are parathyroid hormone and 1,25-dihydroxyvitamin D; these hormones control extracellular fluid calcium on a chronic basis.
Answer: Yogurt, milk, fruit and nuts were the most nutrient-dense snacks reported; while candy, ice cream, cake and sugar-sweetened soft drinks were the most nutrient-poor. Other snacks like potato chips, crackers, popcorn and tea fell somewhere in the middle.
Depending on your goals for which you train, your health status overall and your body type you will need different amounts of macronutrients during the day. Some people who train a lot or are athletes may need to eat a lot more protein and overall calories from nutrients during the day when compared to someone who doesn't train at all. Also, certain health conditions like heart problems or diabetes can change what and how much we eat during the day.
