maria perno goldie, rdh, ms - bsdht.org.uk perno goldie.pdf · maria perno goldie, rdh, ms 2 august...

Maria Perno Goldie, RDH, MS 1

1

2

Sally Simpson

Julie Rosse

BSDHT

Philips

Mhari Coxon

3

4

5

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6


August 14-17, 2017 Capetown, South

Africa

ORAL HEALTH – VITAL LINK IN ACHIEVING TOTAL HEALTH

7

Overview Systemic Lupus Erythematosus

Rheumatoid Arthritis (RA)

Scleroderma

Pregnancy Sjögren's Syndrome (SS)

Product Review

8

http://cancerhelp.cancerresearchuk.org

/about-cancer/cancer-questions/autoimmune-disease-and-

cancer

9

What are Autoimmune Disorders?

The Hidden Link that all Autoimmune

Disorders share

The Immune System

Genetics and Research

Autoimmune Disorders and Depression

Latest Medical News

Links to other Websites

10

http://www.coeliac.org.uk/healthcare-professionals/associated-conditions-and-complications/other-autoimmune-disorders

Coeliac disease

Autoimmune thyroid disease

Autoimmune hepatitis

Primary biliary cirrhosis

Addison's disease

11

NICE (2009) Coeliac Disease:

Recognition and assessment of coeliac disease.

www.nice.org.uk

12


Understanding The

Immune System

The Immune System

SARS virus

Parasite in red blood cell

Fungus

Bacteria

Markers of Self

Muscle cell

Nerve cell

Epithelial cell

Leukocyte

Class I MHC self-marker protein Major Histocompatibility Complex

self-tolerance

Markers of Non-Self

Non-self leukocyte

Antibody

Epitope Class I MHC protein

Epitope

Antibody

Antigen

Antigen

Bacteria

Non-self nerve cell

SARS virus

Organs of the Immune System

Tonsils and adenoids

Lymph nodes

Bone marrow

Appendix

Lymphatic vessels

Lymph nodes

Thymus

Peyer’s patches

Spleen

Lymphatic vessels

Lymph nodes

Lymphocytes

Lymphatic System

Lymph node Lymphatic vessel


Immunity: Active and Passive

Artificially acquired

Passive immunity Active immunity

Naturally acquired Naturally acquired

Artificially acquired

T cells and B cells

are activated, some

become “memory” cells

“Privileged” Immunity

Chorionic villi

* Immunodeficiency • Too little

* Hypersensitivity • Too much

* Autoimmunity • Misdirected

21

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http://en.wikipedia.org/wiki/Image:SEM_Lymphocyte.jpg


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27 28

Autoimmune diseases are the third most

common major illness in the U.S. after cancer and heart disease .1

Autoimmune diseases are the eighth

leading cause of death for women aged 15 to 84.2

1. Rose, Noel R. “The autoimmune diseases: United they stand.” The Bridge: Quarterly Newsletter of the Thyroid Foundation of America, Inc. 15 (3): 1-2, Fall 2000.

2. Walsh, S.J., Rau L.M. Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States. Am J Public Health. 2000: 90(9):1463-1466.

29

Women are 2.7 times more likely than men to acquire an autoimmune disease.3

Women have enhanced immune systems compared to men, which increases women’s resistance to many types of infection but also makes them more susceptible to autoimmune diseases.4

3. Jacobson, Denise L., Gange, StephenJ., Rose, Noel R., and Graham, Neil M.H. “Short analytical review: Epidemiology and the estimated population burden of selected autoimmune diseases in the United States.” Clinical Immunology and Immunopathology. 84 (3): 223-39, September 1997.

4. Cannon, J.G., St. Pierre, B.A. Gender Differences in host defense mechanisms. J Psychiatr Res. 1997: 31(1): 99-113.

30


Organ Specific • Insulin dependent diabetes mellitus (IDDM) -

Type I

• Graves’ disease

• Goodpasture’s syndrome

• Myasthenia gravis

• Multiple sclerosis

Systemic • Systemic lupus erythematosus

• Rheumatoid arthritis

• Sjogren’s syndrome

31

More common among pregnant

women

Abnormal antibodies can cross

the placenta and affect the fetus

Pregnancy affects autoimmune

diseases in different ways

32

Thyroid Disease

› Graves’ Disease

› Hashimotos’ Disease

Crohn’s Disease

SLE

Myasthenia Gravis

Immune Thrombocytopenic Purpura

Rheumatoid Arthritis

Pemphigoid Gestationis

33

Occurs in 5-10% of all pregnancies

May occur after delivery or pregnancy loss

May decrease milk volume

Transient hyperthyroidism followed by

transient hypothyroidism

May recur in subsequent pregnancies

Risk may be reduced by selenium supplements

34

Tiredness

Depression Sensitivity To Cold Weight Gain

Muscle Weakness And Cramps Dry Hair Tough Skin

Constipation Sometimes There Are No Symptoms

35

Heat Sensitivity

Sweating

Fine Brittle Hair

Weakness In Your

Muscles

Light Menstrual Periods

Weight Loss

Without Dieting

Irritability

Insomnia

Bulging Eyes

Shaky Hands

Sometimes There Are No Symptoms

36


Goiter

37

Comparable to effect of moderate smoking

Increased risk of preterm delivery and IUGR

Higher risk if disease active at conception

Careful monitoring during pregnancy

38

39 40

Type I diabetes

Multiple sclerosis

Scleroderma

Lupus

Rheumatoid arthritis

Pemphigus Vulgaris

Sjögren’s syndrome

And others…

41

They are estimated to cost the

nation $86 billion a year1

1. “Autoimmune Diseases: A Major Women’s Health Issue.” American Autoimmune Related Diseases Association,

Inc. www.aarda.org

42


The Office of Research on Women’s

Health, a unit of the National Institutes of Health (NIH), has named autoimmunity

and autoimmune diseases one of the priority women’s health issues for the 21st

century.1

1. U.S. Department of Health and

Human Services, Public Health Service, National Institutes of Health.

Agenda for Research on Women’s Health for 21st Century. Report of the Task Force on the NIH Women’s Health

Research Agenda for the 21st Century. Vol. 2. Bethesda, MD. NIH Publication No. 99-4399.

43

In about 2% of cases, the body’s immune

system goes awry and fails to recognize its own parts as “self,” which results in an

attack on healthy cells

This can occur from before birth, as in type 1 diabetes, into old age

44

45

Discoid (DLE) form affects the skin

› Chronic, erythematous scaly plaques on head region

› Rare to have systemic manifestations

Systemic (SLE) form affects multiple organ systems including skin, heart, lungs,

kidneys, neurological system

46

Systemic lupus erythematosus

47

An inflammation of the connective

tissues, SLE can afflict every organ system

It is up to nine times more common in women than men

It strikes black women three times as

often as white women

The condition is aggravated by sunlight

Diseases: A Major Women’s Health Issue. American Autoimmune

Related Diseases Association, Inc. www.aarda.org. 48

http://www.aarda.org/


Also more common in Hispanic women

Common complications include

psychiatric problems, infections, CAD, osteonecrosis

5 year survival rate 90% and 10 year

survival rate 80%

49

Malaise, fatigue, fever, weight

loss, butterfly rash across nose and cheeks

Migratory arthritis, oral ulcerations,

recurrent pharyngitis

Renal failure best clinical indicator of patient’s prognosis

Raynaud‘s phenomenon

50

Vasculitis

“Hitch-hiking thumb

51

52

Neuropsychiatric problems include

psychosis, seizures, movement disorders, high risk of stroke

Pulmonary risks include pleuritis, edema,

hypertension

Cardiac risks include pericarditis, endocarditis, valvular abnormalities

53

Antinuclear antibody

(ANAs) test has 95% specificity

Patient’s may have

hemolytic anemia, leukopenia, lymphopenia,

and thrombocytopenia

Also risk for elevated PTT time, may have clotting

abnormalities

54

http://www.archrheumatol.net/atlas/img07.html

http://www.archrheumatol.net/atlas/img68.html


55

In general, clotting should occur

between 25 to 35 seconds

56

No cure, not an infection

Treatment is palliative

Avoid sun –exposure may exacerbate disease

NSAID’s,COX2 inhibitors, aspirin

Antimalarials › Hydroxychloroquine or quinacrine

Corticosteroids

Immunosuppressive drugs › Imuran & Methotrexate

Rituximab - monoclonal antibody

57

LUPUS: The Disease with a Thousand

Faces

http://www.lupuscanada.org/english/living/1000faces.html

58

Antibiotic prophylaxis according to AHA

guidelines due to high risk of heart valve irregularities

Leukopenia may make patient more at

risk for infection along with steroid use

May need to supplement steroids for high stress procedures

59

High risk for altered drug metabolism due

to renal disease (nephritis)

Patient’s may be at high risk for excessive bleeding, a coagulation profile should

be obtained

60


Seen in 5-25% of patients

May resemble lichen planus or leukoplakia

Oral lesions are increased with sun exposure

Erythematous lesions with white spots can

be seen on the lips, palate, and on the insides of their cheeks in 5-25% of patients, not associated with active disease

61

Red ulcers surrounded by a white halo

and white radiating lines, more typical "discoid" lesions

May or may not be sore

Also Burning

Xerostomia

› Meds

› Salivary gland disease

62

NSAIDs and COX-2 inhibitors

Antimalarial drugs

Calcium channel blockers

ACE inhibitors

Cholesterol lowering agents

Rituximab

Cyclosporine

63

Changes in pigment of the lining of the

mouth

› Common side effect of antimalarial drugs

Drug reaction to medication

Opportunistic oral infection

64

Herpes simplex virus infection occurs in

80-90% of the general public

Candidiasis, caused by fungal organisms, can develop secondary to

dry mouth, diabetes, and dentures

65

Treat with appropriate antifungals,

antivirals, and antibiotics

Disinfection of dentures with chlorhexidine

Referral not necessary unless

patient does not respond

66

http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=283


67

Medical for Dentures disinfects and cleans without causing corrosion or discoloration or distortion all types of removable dentures made of acrylic, silicon, nylon and elastomer

Every day for 2 weeks

After, use Medical Interporous twice per week as part of the denture cleansing routine

http://www.msi-lab.com/

68

Orabase Paste Overview

– Indication

• Oral irritations / Mouth sores

– Active Ingredient

• 20% benzocaine

– Benefits

• Maximum strength pain relief

• Shields wound from further irritation

• ADA approved and alcohol-free

Source: Pharmacy Times OTC Supplement, 2007.

69

http://www.aphthasol.net/professional/

70

99% of toothbrushes are contaminated

with micro-organism biofilm

Worse if stored in the bathroom in the open air

71

72


Lupus Guide to Dental Care

by Heather Galusha-Phillips

http://www.niams.nih.gov/H

ealth_Info/Lupus/Lupus_Guide/lupus_guide.pdf

73

Boutonnière deformity

Hyperextension at the metacarpophalangeal joint, flexion at the proximal interphalangeal joint, and hyperextension at the distal

interphalangeal joint

74

A systemic disorder in which immune

cells attack and inflame the membrane around joints

Of the estimated 2.1 million Americans

with rheumatoid arthritis, approximately 1.5 million (71 percent) are women

75

76

77

Peak incidence: young adults and

premenstrual women

Common (1-2% of population) severe inflammatory disorder which can affect

men and women of all ages

Marked by variable course, with exacerbations and remissions

78


Many patients have chronic progressive

course resulting in severe morbidity and mortality

Main target organ is synovium

› Inflammation vasculitis

› Edema

› Infiltration by lymphocytes and macrophages

› Synovial proliferation and cartilage erosion

79 80

Inflamed and/or deformed joints, loss of

strength, swelling, pain

81 82

In the morning generally

lasts longer than 45 minutes

Other symptoms

include fatigue, anemia, weight loss,

and low-grade fever

83

Rest and exercise

Anti-inflammatory drugs when

necessary

Drug treatment includes:

› Analgesics for pain;

› Anti-inflammatory drugs

› Disease-modifying drugs (DMARDS)

84

http://ard.bmj.com/current.shtml


Can be a secondary reaction to

rituximab and ACE-inhibitors, used to treat hypertension

This reaction can also be a result of anti-

seizure medications and immunosuppressants, such as calcium

channel blockers

Michael A. Weber and Franz H. Messerli . Angiotensin-Converting Enzyme Inhibitors and Angioedema: Estimating the Risk. Hypertension. 2008;51:

1465-1467; published online before print April 14 2008, doi:10.1161/HYPERTENSIONAHA.108.111393

85

Inflammation of the temporomandibular

joint

Secondary Sjögren’s syndrome

› Xerostomia treatment (43%)

86

Before application Following application

87

Active Ingredient

• 1.1% sodium fluoride (5,000 ppm)

Benefits

• Significantly remineralizes caries in 3 months*

• Helps prevent decay

• One step brushing

• Safe for ceramic crowns

Patient Problems

• High caries risk/rate

• Crown and bridge work

• Xerostomia

• Soda pop syndrome

Colgate® PreviDent 5000 Plus

®

*Baysan, A. et al. Reversal of primary root caries using dentifrices containing 5,000 and 1,000 ppm fluoride. Caries Res 2001;35:41-46.

88

Chlorhexidine Gluconate 0.12%

oral rinse - 16oz

89

Narrowed joint

spaces

Flattened condyles

Erosions

Subchondral sclerosis

Cysts

Osteoporosis

Severely destroyed

rheumatoid GH joint

Flattened Condyles

Note the narrowing of the joint spaces and

the increased density around the joints due to the subchondral sclerosis (black arrows).

90


Difficulty brushing and flossing

91

Patients with RA may

require antibiotic prophylaxis

http://www.ada.org/

prof/resources/pubs/jada/reports/report_

prophy_statement.pdf

92

93

Scleroderma is an activation of immune

cells which produces scar tissue in the skin, internal organs, and small blood

vessels

It affects women three times more often than men overall, but increases to a rate

15 times greater for women during childbearing years, and appears to be

more common among black women

94

From the Greek words skleros for hard,

and derma for skin, it literally means hard skin

Chronic; often disabling; potentially life

threatening

95

Localized scleroderma affects the skin

and underlying tissue, hardening or tightening the skin

Systemic scleroderma affects the skin

and internal organ systems

Both forms can cause debilitating physical changes

96

http://www.waterpik.com/oral-health-products/

http://www.radiustoothbrush.com/index.asp?PageAction=VIEWCATS&Category=14

http://www.scleroderma.org/images/SD_Images/pages/facial-changes_jpg.htm


Approximately 300,000 Americans

80 percent are women

Between the ages of 25 and 55

Scleroderma can strike anyone at any

age

97

Currently, there is no cure for

scleroderma

The Scleroderma Foundation and the National Institutes of Health fund

research to find answers and a cure

As this is a complex disease, more research lies ahead

98

Common symptoms include:

› Hands or feet overly sensitive to the cold, with pain and color changes

› Thickening of the skin

› Shortness of breath

› Trouble swallowing

› Stiffness of the hands

› Joint or bone pain

› Fatigue

99

Also known as systemic sclerosis, is a

disorder that leads to thickening, hardening and tightening of the skin and

connective tissue

100

Localized scleroderma, the damage is

confined to the skin and the tissue just beneath it

101

Calcinosis

Reynaud’s

Esophogeal dysfunction

Sclerodactyly

Telangiectasia

Calcinosis

Sclerodactyly &

Reynaud’s

Sclerodactyly

Telangiectasia. 102

http://www.scleroderma.org/images/SD_Images/pages/Gayla-4_jpg.htm

http://www.scleroderma.org/images/SD_Images/pages/gangrene_jpg.htm

http://www.scleroderma.org/images/SD_Images/pages/curled-hands_jpg.htm

http://www.scleroderma.org/images/SD_Images/pages/Gayla-3_jpg.htm

http://www.scleroderma.org/images/SD_Images/pages/morphea-face_jpg.htm

http://www.emedicine.com/derm/images/1048885-1064663-3315.JPG

http://www.emedicine.com/derm/images/1048885-1064663-3316.JPG

http://www.emedicine.com/derm/images/1048885-1064663-1031.jpg

http://www.emedicine.com/derm/images/1048885-1064663-1035.jpg


103

The drug D-penicillamine has been shown to decrease skin thickening (Cuprimine and Depen)

Symptoms involving other organs such as the kidneys, esophagus, intestines, and blood vessels are treated individually › Calcium channel blockers › Prostaglandins › Antidepressants › Phosphodiesterase enzyme inhibitors › Histamine H2 antagonists › Proton-pump inhibitors › Antihypertensive agents

104

Hematopoietic stem-cell transplantation

can be an effective treatment in patients with refractory systemic sclerosis

The dermal sclerosis improved

immediately after transplantation, but thrombocytopenia and Graves’ disease

developed

n engl j med 357;26 www.nejm.org 2736 december 27, 2007 105

Tell the dental hygienist that you have

scleroderma

Schedule short exam and care appointments for one area at a time or

one tooth at a time

Schedule appointments for the best time of day for you

Wear gloves and bring a blanket in case

the office is cold

106

The appointment can be made more

comfortable by:

› Mouth prop

› Rubber dam

› Patience of both parties

› Short appointments and/or breaks

107

Lips and tongue can become rigid and

the mouth narrows

The folds of skin around the mouth disappear, giving the face a masklike

appearance

Living a legacy: 1953-2002

108

http://www.google.com/imgres?imgurl=http://www.wowsmile.com/Rubber_Dam.jpg&imgrefurl=http://www.wowsmile.com/InfectionControl1.htm&h=279&w=360&sz=8&tbnid=4_Ozt0XfnkoJ::&tbnh=94&tbnw=121&prev=/images?q=rubber+dam&usg=__iXWVKNWhnhYnNWha3nGL4J9n1FI=&sa=X&oi=image_result&resnum=1&ct=image&cd=1

http://www.hu-friedy.com/product/product.aspx?CategoryIndex=0&CategoryID=Surgical&GroupIndex=0&GroupID=MPG&ProductID=MP54


109

Mask-like or “mouse” facies

Widened palpebral fissures

Xerophthalmia

Xerostomia

110

111

112

Claw like form of her

hands

Resorption of the

condyles and mandibular ramus bilaterally

113

Gastroesophageal reflux disease

Thickened periodontal ligament and

blunting of mandibular angles on dental radiographs

Microstomia

Poor oral hygiene

Pathologic mandibular fracture

114


Tongue blade exercise

115

Antimicrobial rinses

Scaling and root planing

Surgery

Local antibiotic administration

Extraction as needed

116

TMJ, Temporomandibular Joint

Dysfunction

117

http://www.myoacademy.com/

118

119 120

http://www.discusdental.com/products/product_detail_new.php?group_skey=151&category=oral_hygiene&prev_key=4520&product_list=clorhexadine_gluconate_products&sub_category=clorhexadine_gluconate


121 122

Chronic, slowly progressing inability to

secrete saliva and tears

Incidence

Women

Men

123 124

ANA (Anti-Nuclear Antibody)

RF (Rheumatoid FactorSS-A (or Ro) and

SS-B (or La): Marker

Antibodies for Sjögren’sESR (Erythrocyte Sedimentation Rate)

IGs (Immunoglobulins

125

Schirmer test: Measures tear production

Rose Bengal and Lissamine Green: Use

dyes to examine the surface of the eye for dry spots

126

http://www.sjogrens.org/


Salivary flow: Measures the amount of

saliva produced over a certain period of time

Salivary scintigraphy: A nuclear medicine

test that measures salivary gland function

Salivary gland biopsy (usually in the lower

lip): Confirms lymphocytic infiltration of the minor salivary glands

127

It can occur alone or

with rheumatoid arthritis, scleroderma, or systemic lupus erythematosus

Nine out of 10 cases occur in women,

most often at or

around mid-life

Sjögren's Syndrome

Women

Men

128

The most serious condition associated

with Sjögren's syndrome (SS) is malignant lymphoma

The risk of developing lymphoma is up to

44 times higher for patients with primary SS than for age- and sex-matched

controls

129

Dryness of the eyes and mouth

Swollen neck glands

Difficulty swallowing or talking

Unusual tastes or smells

Thirst

Tongue ulcers

Severe dental caries

130

Interventions to keep the mouth and

eyes moist include drinking a lot of fluids and using eye drops, as well as good

oral hygiene and eye care

131

Loss of saliva results in the loss of the

antibacterial and antifungal capacities of saliva, as saliva keeps the oral soft

tissue moist and healthy, and buffers the oral environment, helping to neutralize

acids that cause dental decay

Destruction of the salivary glands inhibits that buffering effect

132


2% sodium fluoride (NaF) gel for four

minutes in a tray

5% sodium fluoride varnish applied directly to the teeth, four times a year

133

Daily five-minute application of 1.1% sodium fluoride in a custom tray

Daily 0.05% NaF rinse for one minute

Use of extremely high-fluoride-content toothpaste once daily

Many xerostomic patients complain that the flavors of mint or cinnamon are too spicy › Consider using products with gentler taste

profiles such as vanilla, melon, chocolate, or fruit

134

“Currently, there is no cure for Sjögren's

syndrome, and treatment is mainly palliative”

135

136

Moisturizes the mouth, locks in moisture

Helps protect from dryness

Enamel-safe pH, mild mint flavor

Sugar-free, alcohol-free, and contains no

known allergens

Available OTC

137

138


139

Salese is a sustained release product that

delivers active ingredients efficiently and continuously in small doses

Ingredients: • Xanthan gum • Essential oils • Xylitol • Sodium Bicarbonate • Zinc

140

5000 ppm fluoride

Prescription-strength

141

142

http://www.alignpharma.com/

143

Includes acidic, bitter, or sour foods and

beverages that are known to stimulate salivary flow

These should be limited because low pH

foods and beverages promote mucosal soreness, dental erosion, and dental

caries

144


Use of sugar free chewing gum to

stimulate saliva

Lozenges of anhydrous crystalline maltose also stimulate saliva in dry

mouth patients

http://www.xlear.com/

145

Xylitol

Stevia Leaf Extract (Rebaudioside A)

Kettle Cooked & Over Stirred

Made in the USA

Magnolia Bark Extract

Natural Flavors

http://www.puredentgum.com

146

Eight to 10 8-oz glasses of water per day promotes adequate hydration

Sip water frequently to replace, at least in part, the missing saliva

Using a cool air humidifier during sleep, especially during winter months, can be helpful › The humidifier should be turned on

approximately 1 hour prior to bedtime and left on all night, and cleaned frequently

147

Electrical stimulation can also increase

salivary flow

Electrical stimulation with a TENS (transcutaneous electrical nerve

stimulator) unit is used to stimulate salivary flow

148

Acupuncture increases salivary flow,

ability to eat and speak, and improved sleep in patients affected with Sjogren’s

syndrome

Acupuncture points on hands and ears are used to increase salivation

149

Limit between-meal ingestion of

fermentable carbohydrate

Use noncariogenic sweetening agents such as acesulfame K, aspartame,

saccharin, sorbitol or xylitol

150

http://www.inhalesolutions.com/

http://www.puredentgum.com/wp-content/themes/folioelements/ajax/pageloader.php?postnum=311

http://www.google.com/imgres?imgurl=http://www.healiohealth.com/Images/digital-TENS-open.jpg&imgrefurl=http://www.healiohealth.com/pulled-muscle-treatment.html&h=400&w=429&sz=30&tbnid=ZAgeBOpp2TYJ::&tbnh=117&tbnw=126&prev=/images?q=TENS+unit+photo&usg=__p3INDySh-BOo4jTFbAcKI5NS1c0=&sa=X&oi=image_result&resnum=1&ct=image&cd=1

http://www.google.com/imgres?imgurl=http://www.electrostimulation360.com/uploaded_images/electrostimulation-paddle-717899.gif&imgrefurl=http://www.electrostimulation360.com/labels/electrostimulation paddle.html&h=840&w=998&sz=217&tbnid=8B9cyi79pMcJ::&tbnh=125&tbnw=149&prev=/images?q=TENS+unit+photo&usg=__AfNdujiG7x_rC8DDunnpuwzma_c=&sa=X&oi=image_result&resnum=2&ct=image&cd=1


The nerve damage is

caused by inflammation

The body's own immune

cells attack the nervous system

Repeated episodes of inflammation can occur along any area of the

brain, optic nerve, and spinal cord

151

MS is a Demyelinating Disease

Myelin – provides

insulation to nerve

processes (axons)

Blood vessel

Blood vessel

Blood vessel

Inflammation

Inflammation

Inflammation

Myelin – provides

insulation to nerve

processes (axons)

Blood vessel

Blood vessel

Blood vessel

Blood vessel

Blood vessel

Blood vessel

Inflammation

Inflammation

Inflammation

Inflammation

Inflammation

Inflammation

152

Risk of Developing MS and Region

of Origin

153

Risk is modified by

Environmental factors

› Sunlight

› Diet (e.g., vitamin D)

› Other lifetime experiences

(infections?)

154

Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues

Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety

155

A chemical messenger has been shown to have a previously unknown major role in autoimmune diseases like arthritis and lupus

Investigators found interleukin 17 plays a major role on shaping B cells' ability to create more and more disease-causing antibodies, which may generate new ideas in the ongoing search for better drug targets

Nature Immunology, Jan 2008

156


Alopecia areata

Antiphospholipid antibody syndrome (aPL)

Autoimmune hepatitis

Celiac disease

Guillain-Barre syndrome

Hemolytic anemia

Inflammatory myopathies

Primary biliary cirrhosis

Psoriasis

Vitiligo

157

American Autoimmune Related Diseases Association (AARDA), Inc. Phone: 586-776-3900; 800-598-4668 (for literature requests)

National Heart, Lung, and Blood Institute (NHLBI), NIH, HHS Phone: 301-592-8573

National Institute of Allergy and Infectious Diseases (NIAID), NIH, HHS

Phone: 866-284-4107

158

National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS), NIH, HHS Phone: 301-495-4484; Toll-Free: 877-226-4267

National Institute of Diabetes and Digestive and Kidney Diseases, NIH, HHS

Phone: 301-496-3583

National Institute of Neurological Disorders

and Stroke (NINDS), NIH, HHS Phone: 800-352-9424

159

The Oral Hygienists’ Association of South Africa

presents: OHASA

Pre-congress HOD meeting

IFDH Governing body tri-annual meeting

Date:

12-13th August 2013

Venue:

The Lord Charles Hotel

Town:

Somerset West, CT

The official meeting of the house of delegates of the IFDH member countries

Elections of new Executive Council members

Forming IFDH policies and procedures

HOUSE OF DELEGATES MEETING 2013

Congress Venue: The Cape Town Convention Centre CTICC

As one of the top ten

tourist destinations in the

world, Cape Town is no

ordinary city. So it stands

to reason that the CTICC

would be no ordinary

convention centre—IT IS

WORLD CLASS

Widely regarded as one of

the leading convention

centres in the southern

hemisphere

GREEN CONFERENCE

INITIATIVE

[email protected]


T H I S E V E N T W I L L T A K E P L A C E I N T H E C A P E T O W N I N T E R N A T I O N A L C O N V E N T I O N C E N T R E ( C T I C C )

T H E S O U N D O F T H E A F R I C A N D R U M S W I L L C A L L I N A L L

D E L E G A T E S F R O M A R O U N D T H E W O R L D T O T A K E P A R T I N T H I S P R E S T I G I O U S E V E N T

WELCOME RECEPTION & OPENING CEREMONY 19TH

ISDH 2013

GALA DINNER

M SPIER

O WINE

Y ESTATE

O Stellenbosch

A unique

destination for a sophisticated African experience

Sponsored by

Sunstar

Foundation

Date: 16/08/2013

Time: 19:00 hrs AVOID DISAPPOINTMENT-

BOOK NOW!

VISIT US AT :http://www.embassyconferences.co.za/portfolio/present/19th-international-symposium-on-dental-hygiene/10

KEYNOTE SPEAKER PROPOSALS 19TH ISDH 2013

Please submit the attached ‘Keynote Speaker Proposal Form’ not

later than 31 st October 2012 to:

Marie Ferreira, Chair Scientific Committee

Postal Address:

206 Kings Terrace

Brooks Hill Drive

Humewood

Port Elizabeth

6001

South Africa

Email Address: [email protected]

We welcome your proposal, support and participation.

.

P L E A S E S U B M I T T H E ‘ A B S T R A C T S S U B M I S S I O N F O R M ’ B Y

3 1 S T O C T O B E R 2 0 1 2 T O :

M A R I E F E R R E I R A C H A I R S C I E N T I F I C C O M M I T T E E

P O S T A L A D D R E S S : 2 0 6 K I N G S T E R R A C E

B R O O K S H I L L D R I V E

H U M E W O O D

P O R T E L I Z A B E T H 6 0 0 1

S O U T H A F R I C A

E M A I L A D D R E S S : M A R I E F E R @ I A F R I C A . C O M

CALL FOR ABSTRACTS 19TH ISDH 2013

PROFESSIONAL CONGRESS ORGANIZER

Save the date !

VISIT US AT :http://www.embassyconferences.co.za/portfolio/present/19th-international-symposium-on-dental-hygiene/10

Please join us for this once in a

lifetime African congress

experience

www.ifdh.org

REGISTRATION FOR 19TH ISDH 2013

[email protected]

[email protected]

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