Precautions. Significance to Dental

Gout, a disease that has been around since ancient times, has long been referred to as the “king’s disease.” Due to the incorrect assumption that it is caused by overindulging oneself in foods that only the rich could afford, it mostly affected the wealthy during ancient days. However, we know a today gout is a common form of arthritis that can affect anyone, although adult obese men are the most susceptible to developing the disease (CDC, 2018). Currently, gout affects more than 3 million Americans, including women after menopause and those with kidney disease.

Due to some genetic factors, gout can be hereditary and passed down to generations, however, it usually occurs later in life and rarely affects children (Ralph Schumacher, 2012). Thankfully there are many ways to manage Gout and victims of this disease can still lead a fulfilled happy life.

Description and Signs/Symptoms

Gout could be disabling to a patient, interfering with normal daily activities. It is identified by severely painful attacks at the joints, especially the big toe.

Severe tenderness and swelling are accompanied by painful attacks, usually at night, making the joints feel warm and very much “on fire.” The attacks can be so severe that even a light bed sheet can feel intolerable (Mayo Clinic, 2018). When the attacks happen, the initial pain can last anywhere from 4-12 hours from the time that it started. After the initial attack passes, lingering pain may be present for a few days, even a week, and some skin peeling may happen at the affected site.

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After it ends though, it can also remain in remission for long periods, could be even a few years until it flares again. When it attacks again, however, most times the pain is more intense and lasts longer than it did the first time. Gout usually affects the joints of the feet or arms, and in most cases, only one joint at a time is affected. The main joint is the big toe, the other sites that may be affected can be the wrists, fingers, smaller toe joints, ankles, or knees (CDC, 2018). The patients must be encouraged to seek medical attention if such episodes occur where their joint feels hot and they are experiencing severe pain. If left untreated the pain will worsen and may cause permanent damage to joints and surrounding tissue.

Cause and Treatment

Gout is caused by hyperuricemia, which is a condition where excessive amounts of uric acid exist in the body. This happens when there is an increase of uric acid in the body or the kidneys cannot keep up with removing enough uric acid from the body (Ralph Schumacher, 2012). Too much uric acid can cause uric acid crystals to gather up at the joints and in the fluid and tissue surrounding the joint. Gout is also connected to those patients with hypertension, hyperlipidemia, and diabetes. Because some other kinds of arthritis can mimic gout, its diagnosis can be difficult. There is no actual treatment for gout, one can only control it with medication and a healthy diet. Examples of some foods that may increase a person’s chance of developing gout include: red meat, excessive alcohol consumption, and sugary drinks; avoiding these can help reduce the tendency for gout to flare up. Colchicine is a medication that can be used to treat the symptoms of gout if administered early enough in the attack. NSAIDs are also a great choice in relieving the pains of gout flares, high doses of short-acting are ideal for fast relief of symptoms. For patients unable to take NSAIDs due to other medical conditions, the corticosteroid is a good choice. Since these medications only treat the symptoms, patients with hyperuricemia are encouraged to seek treatment that lowers their levels of uric acid. Allopurinol is most often used to reduce uric acid levels, this medication does not help with the pain but it should be used after the pain subsides to prevent future flares. Normal uric acid levels are 6mg/dL, once levels are dropped to normal crystals tend to break down and new ones don’t form anymore.

Gout is usually associated with other diseases as well, such as high blood pressure, diabetes, or heart and kidney disease. The dental hygienist needs to check contraindications in medicine and local anesthesia, treatment must be monitored closely for such complicated cases. Lifestyle and diet changes may be encouraged by the physician, as a healthcare worker the dental hygienist should counsel the patient on nutritional choices and physical activity. Gout is a chronic disease and should be treated as such. Lifestyle changes must be made if the patient wishes to get well. Controlling weight, lowering the amount of alcohol consumed, and limiting red meat and meals rich in purines all help to control the symptoms of gout disease (Ralph Schumacher, 2012).

Oral Manifestations and Medical Considerations Arthritis is a disease that affects the full-body, manifestations in the oral cavity may include xerostomia from the medications and also gingival hyperplasia. The uric acid building up in the body can cause an acidic environment in the mouth increases the risk of caries and decay for the patient. There has also been a handful of reports on gout affecting the TMJ causing pain when opening and closing the mouth (Indraneel et al., 2010). The dental hygienist should be aware of this and communicate with the patient’s physician on what’s the best approach to treatment. Another consideration is if gout affects the hands the patient won’t be able to brush or floss their teeth and achieve good oral hygiene. It will be very important for the hygienist to speak to the caregiver and make sure he/she has the skills to be able to help the patient with their oral needs. With a complicated medical history, there may be several medications that the patient is taking, if the medications are immunosuppressants the hygienist should be aware of fungal infections during the Intra Oral exam.