Systemic Lupus Erythematosus Essay Paper

Systemic Lupus Erythematosus Essay Paper

Systemic lupus erythematosus (SLE) is an autoimmune disorder of connective tissue characterized by autoantibodies that target nuclear antigens (1). Patients with SLE might experience several forms of oral manifestations including dryness, soreness, oral ulcers, mucositos, glossitis and periodontal disease (2). Patients’ interpersonal relationships might be affected by the type of oral health complications the patient might experience. This makes an impact in their economic, social and psychological aspects of life, leading to an overall impairment of quality of life (2). Patients living with SLE are genetically predisposed to inflammatory response triggered by environmental stimuli (3). Patients with SLE tend to have an increased visible plaque and gingival inflammation, along with more progressed probing depth and clinical attachment (3). These type of oral manifestations can be a result of imbalance in the gingival immune response, which can lead to an increase in the periodontitis, especially when altered levels of inflammatory cytokines are present (3). Preventive oral care should be the primary intervention in patients with SLE, these way the risk of periodontal disease and oral manifestations can be mitigated. SLE patients require interdisciplinary intervention for its care. Oral health should be maintained with preventive treatment and having frequent follow ups in order to maintain an improve quality of oral health, and prevent any exacerbation of oral symptoms (2). Systemic Lupus Erythematosus Essay Paper

1- DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. T115873, Systemic lupus erythematosus (SLE); [updated 2018 Nov 30] Available from https://www.dynamed.com/topics/dmp~AN~T115873.

2- Corrêa JD, Branco LGA, Calderaro DC, et al. Impact of systemic lupus erythematosus on oral health-related quality of life. Lupus. 2017;27(2):283-289. doi:10.1177/0961203317719147.

3- Rutter-Locher Z, Smith TO, Giles I, et al. Association between systemic lupus erythematosus and periodontitis: A systematic review and meta-analysis. Front Immunol 2017; 8: 1295.

Second paragraph: Investigate the prescription medication Vanessa is on. Identify the drug class for each medication. Explore precautions for concomitant use, not just drug to drug but also drug to lifestyle and demographics

Vanessa’s list of medications include: Plaquenil 200 mg BID, Ibuprofen 300mg TID and Prednisone 5mg QD. Plaquenil is a Hydroxychloroquine (Aminoquinoline, Antimalarial Agent). Hydroxychloroquine are associated with protective effect for accrual of irreversible organ damage and bone mineral density (4). Patients taking plaquenil should be evaluated when receiving long term treatment for evidence of muscle weakness and ocular toxicity (1). Some of the side effects of plaquenil include ataxia, dizziness, emotional disturbance, emotional lability, headache, irritability, and vertigo. In severe cases it can also cause some stomach cramps and vomiting (4). Cardiomyopathy resulting in cardiac failure, sometimes fatal, has been reported and may appear during acute or chronic therapy. Monitor for signs/symptoms of cardiac compromise; discontinue treatment promptly if signs and symptoms of cardiomyopathy occur (4). The patient is also taking Ibuprofen (Nonsteroidal Anti-inflammatory Drug (NSAID)) used for the management of pain and swelling. NSAIDs should be used for limited periods of time in patients at low-risk for gastrointestinal, renal, and cardiovascular toxicity (1). Ibuprofen inhibit platelet aggregation and prolong bleeding time in some patients this can increased risk of serious adverse cardiovascular thrombotic events, including fatal MI and stroke (5). If used fro extended periods of time NSAIDs cause an increased risk of serious gastrointestinal inflammation, ulceration, bleeding, and perforation (5). The third medication that Vanessa is taking is Prednisone which is a corticosteroid. Prednisone may prevent severe flares or clinical relapse in SLE patients (1). Glucocorticoids are recommended for treatment of SLE without major organ manifestations. Some of the side effects of prednisone include emotional lability, headache, psychiatric disturbance, seizure, and vertigo (6). Systemic Lupus Erythematosus Essay Paper

4-Hydroxychloroquine. Lexicomp. https://online-lexi-com.ezproxy.library.tufts.edu/lco/action/doc/retrieve/docid/dental_f/46891. Accessed January 28, 2019.

5-Ibuprofen. Lexicomp. https://online-lexi-com.ezproxy.library.tufts.edu/lco/action/doc/retrieve/docid/dental_f/46130. Accessed January 28, 2019.

6-PredniSONE . Lexicomp. https://online-lexi-com.ezproxy.library.tufts.edu/lco/action/doc/retrieve/docid/dental_f/46180. Accessed January 28, 2019.

Third paragraph: Take everything you learned in the first two paragraphs and apply it in clinic with Vanessa. This is critical analysis of what you’ve learned in the research for the first two paragraphs. Systemic Lupus Erythematosus Essay Paper

When treating a patient with Systemic lupus erythematosus (SLE), as dentist we should ask the patient what can we do to make them fell more comfortable in the dental chair. We should be able to take a detailed medical history and understanding the medications they are taking. It is important to ask the patient how many flare ups they experience and their frequency; as well as what make the flare ups better or worse. Vanessa seem to be the type of patient that has her SLE controlled, she takes good care of her health and stays on top of her dental appointments. I think it is important to make Vanessa understand that the frequent visits to the dentist is a way of preventing oral manifestations of her SLE. We as dentist, should be able to make patients like Vanessa, understand the importance of prevention in dentistry. Given the medications Vanessa is taking, she might develop dry mouth. Reduce salivary flow has been found to increase risk of caries and is also a risk factor for periodontal disease. In order to reduce the risk of caries and maintain periodontal health, regular removal of dental plaque by brushing and flossing is very important. Systemic Lupus Erythematosus Essay Paper

Part 2

First paragraph: Identify your foreground question and what you consider to be the most important concept of it for your decision point in clinic. Identify which search concepts you ultimately searched for in PubMed and explain anything a reader looking at your working set might have a question about (for instance: a search term that might seem odd based on the PICO that you needed to select for good reason). In the last sentence, explain that you selected two articles from within this working set and identify their study types.

Foreground question- In patients with low oral hygiene motivation will motivational interviewing or patient education lead to a greater increase in self-efficacy?

I think the most important concept for decision point used in clinic will be self efficacy. The foreground question is trying to give us a tool to determine the best method to teach or improve self efficacy in patients that need to improve their oral hygiene. Systemic Lupus Erythematosus Essay Paper

My working set was:

I used oral health as a similar term to oral hygiene, since I was looking at a population that had low oral hygiene and hence low oral health. Additionally, self care and self efficacy were used as outcome given that the search for self efficacy was too narrow and self care was a higher up in the mesh term tree. From this working set I have selected two articles, one called “ Motivational Interviewing in Improving Oral Health: A Systematic Review of Randomized Controlled Trials” (7) and the second one called “Effectiveness of a motivational-behavioural skills protocol for oral hygiene among patients with hyposalivation.”(8). The first article is a systemic review of randomized controlled trials and the second article is a randomize controlled trial.

Second paragraph: Identify your first article’s study type again, as well as the year it came out. Summarize its findings and methods. Appraise its quality by identifying strengths, limitations, and applicability to your own patient population. Cite the article being discussed at the end of the first and last sentences of the paragraph, as well as at any point where direct quotes are used.

“ Motivational Interviewing in Improving Oral Health: A Systematic Review of Randomized Controlled Trials”

This study is a systemic review of randomized controlled trials, it was published June 2013. This article used four databases (PubMed MEDLINE, Web of Science, Cochrane Library, and PsycINFO) to search and to identify randomized controlled trials that evaluated the effectiveness of MI compared with CE in changing oral health behaviors and improving oral health of dental patients (7). As a result the article found 221 relevant papers, but only 20 papers met the eligibility criteria. This article explained the difference between MI and CE. During motivational interviewing (MI), patients assess their own behaviors, explain how they will change them and which behavior to focus on and professional just help the patient reflect by giving some resolutions that trigger change. On the other hand, conventional education (CE), is where professionals are the active participants in presenting problems and offering solutions. The results of the article showed how in regard to periodontal health MI had a superior effect on oral hygiene. MI outperform CE in regards to patents adherent to dental appointments, preventing caries and abstinence from illicit drugs and alcohol. Some of the limitations fo the study were that the only papers reviewed were papers published in English. Another limitations was that because MI is new to dentistry, this review included randomized controlled trials with short and long follow-up periods. “The sample size in these studies varied from 50 to 1,021. Samples were drawn from various age groups and involved dental patients, special-needs groups (adults with mental illness), disadvantaged communities (low-income families and ethnic minorities), or people in certain occupational sectors (veterans and children of medical staff)” (7). Systemic Lupus Erythematosus Essay Paper

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7- Gao X, Lo ECM, Kot SCC, Chan KCW. Motivational Interviewing in Improving Oral Health: A Systematic Review of Randomized Controlled Trials. Journal of Periodontology. 2014;85(3):426-437. doi:10.1902/jop.2013.130205.

Third paragraph: Identify your second article’s study type again, as well as the year it came out. Summarize its findings and methods. Appraise its quality by identifying strengths, limitations, and applicability to your own patient population. Cite the article being discussed at the end of the first and last sentences of the paragraph, as well as at any point where direct quotes are used.

“Effectiveness of a motivational-behavioural skills protocol for oral hygiene among patients with hyposalivation.” Systemic Lupus Erythematosus Essay Paper

This study is a randomize controlled trial, published Nov. 2012. This article used a randomised, evaluator-blinded, controlled trial, 60 subjects with hyposalivation (12 men and 48 women) were randomly assigned to two groups (8).The control group received basic oral hygiene instruction. The intervention group received oral hygiene instruction based on motivational interviewing (MI). Both groups were given oral hygiene instruction once every 15 days, with a total of four sessions over a 2-month period. During this article “both control and intervention group patients showed significantly lower plaque indices, bleeding indices and an improvement in probe depth after the 2-month study period. Interproximal brushing was significantly more frequent among the intervention group (p = 0.016)”(8). Some of the limitations of this study was that it focused on patients with hyposaliovation and it only lasted 8 weeks. During this study, no significant different was found in regards to the frequency and duration of tooth brushing. However, both groups seem to have improved in regard to regular oral hygiene input. It was seen during the study that most adults brush daily, but they might not do it using the correct technique. This study found significant differences in brushing methods among the intervention group that may be attributable to the oral hygiene instruction given. Lastly it is clear that for “patients with hyposalivation, correct adherence to oral hygiene instructions is the key to success in maintaining oral health. For this reason, effective interventions aimed at improving patient adherence are a necessity”(8).Systemic Lupus Erythematosus Essay Paper

8- López-Jornet P, Fabio C-A, Consuelo RA, Paz AM. Effectiveness of a motivational-behavioural skills protocol for oral hygiene among patients with hyposalivation. Gerodontology. 2013;31(4):288-295. doi:10.1111/ger.12037.

Fourth paragraph: explain the answer to your question based on the evidence you have found and what you will do to help Vanessa increase her self-efficacy. Re-cite your selected articles as necessary.

In patients with low oral hygiene motivation will motivational interviewing or patient education lead to a greater increase in self-efficacy? Systemic Lupus Erythematosus Essay Paper

After reading the evidence based articles, motivational interviewing seem to have better results in helping patients maintain a good oral hygiene. I think in the case of Vanessa, finding the right intervention to improve her adherence to oral hygiene instructions is a necessity. Both articles demonstrated superiority of MI over conventional education. In order to evaluate and enhance the willingness of the patient to follow what was discussed during MI, psychologic measures, such as stage of change, self-rating on importance and confidence, and self-efficacy should be rated (7). During the second article one of the studies had a systematic method of doing the motivational interviewing, it had six steps that will guide the patient into making effective lifestyle changes. “It consisted of the following steps: step 1: creating confidence and commitment; step 2: increasing self-awareness of behavior; step 3: developing and implementing an action plan; step 4: evaluating the plan; step 5: maintaining change; and step 6: preventing relapse” (8). I think using this guideline on Vanessa will be beneficial in creating awareness and increasing her self-efficacy in regards to her oral health. Vanessa is diagnose with SLE, given this condition and the medications she is taking, she is prone to having hyposalivation and risk of periodontal disease. The primary mechanism fro preventing the progression of periodontal disease and caries involves the patient adherence to oral hygiene regimes along with correct brushing and flossing techniques (8). Our job as dental professionals is to provide the right tools to the patient and provide adequate instructions on oral health, as well as the etiology of the disease and to help the patient identify the obstacles to behavioral improvement. Systemic Lupus Erythematosus Essay Paper

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