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Physical signs for the general dental practitioner

From Volume 40, Issue 2, March 2013 | Page 157

Authors

Steve Bain

Professor of Medicine (Diabetes), University of Wales, Swansea

Articles by Steve Bain

Danielle Rhydderch

FP1, ABMU Health Board, Wales Singleton Hospital, Swansea

Articles by Danielle Rhydderch

Article

Steve Bain
Dr Danielle Rhydderch

‘Physical Signs for the General Dental Practitioner’ aims:

  • To increase awareness of the value of identifying general clinical signs.
  • To enable the interpretation of selected clinical signs that are visible in the clothed patient.
  • To indicate the potential relevance of these clinical signs to the dental management of the patient.

    • This hypertensive patient complains of episodes of swelling affecting the lips (in this image, the lower lip).

  • What other symptoms might be present?
  • What is the likely diagnosis?
  • What can cause this condition?
  • How is it treated?

    • Answers: Case 102

  • He may experience pain and itching of the swollen areas. In severe cases, stridor (gasping breath sounds) and hypoxia can occur due to airway obstruction.
  • Angioedema: rapid swelling of the deeper skin layers (dermis, subcutaneous tissue), mucosa and submucosal tissue. It affects 10–20% of people during their life.
  • It can be allergic, drug-induced, hereditary, or idiopathic:
  • Allergic angioedema results from exposure to an allergen, eg peanuts or shellfish, and often presents with an itchy raised rash known as urticaris or ‘hives’.
  • Drug-induced angioedema is most commonly related to treatment with ACE inhibitors, used to treat hypertension (as in this case).
  • Hereditary angioedema is caused by a rare genetic abnormality where episodes often affect other organs, eg GI tract, causing abdominal pain and vomiting.
  • Most cases resolve without treatment in a few days. Allergic angioedema can be managed with avoidance of the allergen, antihistamines and corticosteroids to relieve the swelling, and adrenaline in cases of airway obstruction. In hereditary angioedema, medication to boost levels of C1-INH protein can be used prophylactically (danozol, stanozolol, tranexamic acid), and acute episodes can be treated with subcutaneous Icatibant (Firazyr®).