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Physical signs for the general dental practitioner

From Volume 40, Issue 1, January 2013 | Page 73

Authors

Steve Bain

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

Articles by Steve Bain

Alice Richards

FY1, ABMU Health Board, Wales, Singleton Hospital, Swansea

Articles by Alice Richards

Article

Steve Bain
Dr Alice Richards

‘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.

    • The series will contribute to non-verifiable CPD requirements.

    This 66-year-old lady has long-standing limitation of movement affecting both hands. More recently, she has complained of shortness of breath which is getting progressively worse.

  • What clinical signs are seen?
  • What is the likely diagnosis?
  • What other parts of the body are affected?
  • What specific therapy is available?

    • Answers: Case 101

  • There is diffuse soft tissue swelling of the fingers accompanied by thickened, tightened skin (scleroderma). This leads to a loss of skin elasticity causing contractures of the digits (sclerodactyly). Erythema surrounds white subcutaneous deposits of calcium (calcinosis). Other features which may be seen in the hands are telangiectasia and Raynaud's phenomenon.
  • The diagnosis is systemic sclerosis. This is an autoimmune connective most commonly seen in middle-aged women. The diagnosis is made on clinical grounds but specific autoantibodies are usually detectable.
  • The kidneys, oesophagus, heart and lungs can be affected, with pulmonary hypertension carrying a poor prognosis.
  • There is no specific therapy. Immunosuppression is targeted at severe skin or internal organ involvement using agents such as methotrexate and cyclophosphamide along with high dose steroids. Control of hypertension is essential and patients often require high levels of physiotherapy input to maintain movement.