Koplik's Spots are seen in

# "Koplik's spots" are associated with:

A. Smallpox (Variola)

B. German measles (Rubella)

C. Mumps

D. (Rubeola)

The correct answer is. D. Measles (Rubeola)

Before immunization, measles was very common during childhood so that 90% of the population had been infected by age 20.

Measles (also called Rubeola) is a highly contagious viral illness characterized by a fever, cough, and a spreading rash. It is caused by a paramyxovirus. The incubation period is 1 to 2 weeks before symptoms generally appear. The oral lesions are pathognomonic of this disease. These characteristic "Koplik's spots" usually occur on the buccal mucosa. They are 1-2 mm, yellow-white necrotic ulcers that are surrounded by a bright red margin.

Rubella (or German measles) is a fairly benign viral disease. The symptoms usually include

a red, bumpy rash, swollen lymph nodes (most often around the ears and neck), and a mild fever. Some people will feel a little achy. The virus can manifest in the oral cavity as small petechiae-like spots of the soft palate. The defects of congenital infection from an infected mother are more severe -enamel defects, hypoplasia, pitting, and abnormal tooth morphology.

Smallpox (Variola) is an acute viral disease, it manifests itself clinically by the occurrence of a high fever, nausea, vomiting, chills, and headache. The skin lesions begin as small macules and papules which first appear on the face, but rapidly spread to cover much of the body. Oral manifestations include ulceration of the oral mucosa and pharynx. In some cases, the tongue is swollen and painful, making swallowing difficult.

Mumps is an acute contagious viral infection characterized chiefly by unilateral or bilateral swelling of the salivary glands, usually the parotid (parotitis). Although it is usually a disease of childhood, mumps may also affect adults. The papilla of the opening of the parotid duct on the buccal mucosa is often puffy and reddened.

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Seizure in the dental clinic

# Which of the following is true concerning a young epileptic who has a grand mal seizure in the dental office?
A. It is generally fatal
B. It is best treated by injecting insulin
C. They generally recover if restrained from self-injury and oxygen is maintained
D. It can be prevented with antibiotics

 The correct answer is C. They generally recover if restrained from self-injury and oxygen is maintained

Of the multiple types of seizures, the tonic-clonic (grand mal) type is the most frightening and the one that most often requires treatment. Grand mal seizures are manifested in four phases: the prodromal phase, the aura, the convulsive (ictal) phase, and the postictal phase.

The prodromal phase consists of subtle changes that may occur over minutes to hours. It is usually not clinically evident to the clinician or the patient. The aura is a neurologic experience that the patient goes through immediately prior to the seizure. It is specifically related to trigger areas of the brain in which seizure activity begins. It may consist of a taste, a smell, a hallucination, motor activity, or other symptoms. As the CNS discharge becomes generalized, the ictal phase begins. The patient loses consciousness, falls to the floor, and tonic, rigid skeletal muscle contraction ensues. This usually lasts 1 to 3 minutes.

As this phase ends, the muscles relax and movement stops. A significant degree of CNS depression is usually present during this postictal phase, and it may result in respiratory depression. Management of the seizure consists of gentle restraint and positioning of the patient in order to prevent self-injury, ensuring adequate ventilation, and supportive care, as indicated, in the postictal phase, especially airway management. Single seizures do not require drug therapy because they are self-limiting.

Important: Should the ictal phase last longer than 5 minutes or if seizures continue to develop with little time between them, a condition called status epilepticus has developed. This may be a life-threatening medical emergency. This condition is best treated with intravenous diazepam, and transport should be arranged to take the patient to the hospital.

Oral manifestation of Achondroplasia

 # An outstanding oral manifestation of achondroplasia is:

A. Rampant caries

B. Periodontal disease

C. Overcrowding of teeth

D. Supernumerary teeth

The correct answer is C. Overcrowding of teeth.

Achondroplasia is the most common form of short-limb dwarfism. It occurs in all races and with equal frequency in males and females. An individual with achondroplasia has a disproportionate short stature -- the head is large and the arms and legs are short when compared to the trunk length. Other signs are a prominent forehead and a depressed bridge of the nose. Many of these children die during the first year of life. Deficient growth in the cranial base is evident in many children that survive.

Important: The maxilla may be small with the resultant crowding of the teeth.

Note: A Class III malocclusion is very common.

Remember: The oral manifestations of the following disorders in children:

• Gigantism: enlarged tongue, mandibular prognathism, teeth are usually tipped to the buccal or lingual side, owing to enlargement of the tongue. Roots may be longer than normal.

• Pituitary dwarfism: the eruption rate and the shedding of the teeth are delayed, clinical crowns appear smaller as do the roots of the teeth, the dental arch as a whole is smaller causing malocclusion, and the mandible is underdeveloped.