Case 5:

Definitions:
 GMP
 Stomatitis
 Auscultation
 Oral Miconazole Gel

Cues:
 Aged 68
 emigrated from Jamaica
 good deal of social support
 has lived out of tins or on ‘butties’ (education?)
 difficulty swallowing his food
 sticking in his throat
 cough during a meal
 a routine health check
 lost weight since his last check up
 not been eating properly
 no problems talking/chewing
 no abnormalities (extra-oral exam)
 pull faces and stick out his tongue
 intra oral exam
 denture that was loose and badly fitting
 evidence of stomatitis
 auscultation of chest
 No abnormal chest sound
 (?)
 oral miconazole gel
 denture care
 refer him for further investigation
 Questions:
Body in health:
What are the muscles and structure involved in swallowing?
What is the process of swallowing?
What muscles are involved in coughing?
Normal Respiratory Muscles
The normal respiratory muscles used in coughing include the abdominal muscles, intercostal
muscles -- running between adjacent ribs, and diaphragm. The abdominal and intercostal
muscles tighten and the diaphragm relaxes causing increase in chest pressure, as this decreases
the volume of your chest cavity.
Accessory Repiratory Muscles
Because coughing is a very forceful action and often is prolonged, the accessory respiratory
muscles are normally involved in coughing. These muscles are primarily responsible for other
actions of the body but assist in the the process of breathing under stress, coughing or other
large air movements.
Other accessory respiratory muscles include the scalenes, sternoclidomastoid, upper trapezius,
levator costorum, paraspinals and subclavius for inhalation; and, the pectorals, serratus
anterior, latissimus dorsi, serratus posterior muscles.
The primary function of these muscles is to move your shoulders and your neck, however they
assist with breathing by expanding your chest cavity when your diaphragm is weak.
Muscles of the Throat
In addition to inhalation and exhalation, the throat closes initially in coughing and there can be
pain or soreness in the muscles involved in this portion of a cough. The muscles of the throat
that control the flow of air through the trachea --windpipe -- are the pharyngeal constrictors,
tongue and other pharynx muscles. These muscles move your larynx to temporarily block your
trachea to build up an explosive release of air when you cough

What are the distributions of facial nerves?

How do they affect facial expression?
What are the muscles involved in facial expression?
Orbital Group:
 Orbicularis oculi
 Corrugator supercilli

Nasal Group:
 Nasalis
 Procerus
 Depressor septi nasi

Oral Group:
 Orbicularis oris
 Buccinator
 Depressor anguli oris
 Depressor labii inferioris
 Mentalis
 Risorius
 Zygomaticus Major
 Zygomaticus Minor
 Levator labii superioris
 Levator labii superioris alaeque nasi
 Levator anguli oris

How is sound produced in the chest cavity?

Body in disease:
How could the migration/race of the patient affect their oral hygiene?
Are some ethnicities more prone to oral diseases?
How does age affect oral health?
How do poor eating habits affect oral health? ‘tins’’butties’
What are the causes of the difficulty in swallowing food?
Neurological Causes:
 A stroke
 Parkinson’s, dementia, motor neurone disease
 Brain tumours
Congenital and developmental conditions
 Learning disabilities
 Cerebal palsy
 Cleft lip and palate
Obstruction:
 Mouth cancer
 Gastro-oesphageal reflux disease
 Anaphalyxis

What triggers coughing?

What structures can coughing damage?
Common causes of weight loss in the elderly?
What is a stroke? What are the effects of a stroke?
Is the denture fitting effected by dry mouth and/or his diet (tinned foods)? (periodontitis?)
What is stomatitis? (causes? Symptoms?)
Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process
affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

Causes:

 dry tissues from breathing through the mouth due to clogged nasal passages
 small injuries due to dental work, accidental cheek bite, or other injuries
 sharp tooth surfaces, dental braces, dentures, or retainers
 celiac disease
 food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts
 allergic response to certain bacteria in the mouth
 inflammatory bowel diseases
 autoimmune diseases that attack cells in the mouth
 HIV/AIDS
 weakened immune system
 deficiency in vitamin B-12, folic acid, iron, or zinc
 certain medications
 stress
 Candida albicans infection

What does an abnormal chest sound sound like?

PTPc:
How often does social support visit?
Is there a link between social support and oral hygiene in the elderly?
What’s involved in a routine health check?
How often Is a routine health check carried out in the elderly?
How do we investigate a swallowing disorder?
How do we investigate swallowing/ chewing? Could it be a Stroke?
Treatments of stomatitis?
What is oral miconazole gel?
How does it work?
By making holes in the membranes, miconazole allows essential constituents of the fungal
cells to leak out, which kills the fungi and clears up the infection. Miconazole also has some
antibacterial action and kills certain bacteria that may also be present in the infection.

What does this gel affect?

What is an auscultation of the chest?

 Auscultation is listening to the internal sounds of the body, usually using a stethoscope.
Auscultation is performed for the purposes of examining the circulatory and respiratory
systems, as well as the gastrointestinal system.

What is the correct denture care?

What would you refer the patient for?
And who would you refer him to? (specifically for difficulty in swallowing)