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BDS - Module 9 > 14. Special Care > Flashcards

14. Special Care Flashcards

1
Q

What is the purpose of special care services?

A

To provide oral care to people who are unable to accept routine care due to an impairment.

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2
Q

What patients are seen by special care?

A

Disability
Older
Medically compromised
Mental health issues
Anxious/phobic

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3
Q

What is disability?

A

A physical or mental impairment that has severe and long term effects on a persons ability to perform normal activities.

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4
Q

List the 3 types of disability

A

Physcial
Learning
Sensory

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5
Q

What is dementia?

A

A collection of cognitive symptoms that gradually get worse over time

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6
Q

What are the 5 types of dementia?

A

Alzheimer’s
Vascular
Mixed
Lewy body
Frontotemporal

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7
Q

What are the principles of consent?

A

Informed
Given freely
Pt is capable

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8
Q

What is incapacity?

A

The inability of a person to act, make, communicate, understanding or retain a decision

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9
Q

How is capacity assessed?

A

AMCUR framework
Asking open questions
Chunk and check
Teach back

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10
Q

If someone lacks capacity what legal act applies?

A

AWI Act 2000

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11
Q

Is the AWI Act 2000 applies, what certificate is issued and according to what 5 principles?

A

Section 47 certificate according to 5 key principles of:
Benefit
Least restrictive of freedom
Persons wishes taken into account
Relevant others consulted
Residual capacity encouraged

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12
Q

What is a proxy?

A

A person who has been legally authorised to act on behalf of an adult with incapacity

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13
Q

List the 3 types of proxy:

A

Power of attorney
Guardian
Intervenors

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14
Q

What is power of attorney and what types are there?

A

granted while the person has capacity
Types:
Welfare
Continuing (property and finance)
Combined

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15
Q

What is a guardian and what are the 3 types?

A

Granted when an adult no longer has capacity or has never had capacity
Types:
Welfare
Financial/property
Both

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16
Q

What is an intervenor?

A

Appointed for a one off event by the court

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17
Q

What should you do if a person lacks capacity and there IS a proxy in place?

A

Follow AWI principles
Get consent from proxy
Have AWI section 47 issued

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18
Q

What should you do if person lacks capacity and there is NOT a proxy in place?

A

Follow principles of AWI
have section 47 certificate issued

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19
Q

What legislations are associated with adult protection?

A

Adult support and protection act 2007
Domestic abuse Scotland act 2018
Human trafficking and exploitation act 2015

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20
Q

Who can you report adult protection concerns to?

A

999 - immediate concerns
Local health and social care adult protection team
Social work
OPG

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21
Q

What 5 key medical conditions have effect on dentistry?

A

Cancer
Mronj
Cardiac
Bleeding disorders
Renal

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22
Q

What 3 key dental interventions should be carried out before someone goes through cancer Tx?

A

Screening
XLA of potential sources of infection
Duraphat toothpaste and varnish

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23
Q

What is MRONJ?

A

Medications related osteonecrosis of the jaw
- exposed bone that persists for 8 weeks + in patients taking antiresorptive or antiangiogenic drugs

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24
Q

List 2 antiresorptive mesications associated with MRONJ:

A

Bisphosphonates (e.g alendronic acid)
RANKL inhibitors (e.g denosumab)

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25
List an anti-angiogenic medication:
Cancer medications
26
What are the symptoms of MRONJ:
Delayed healing Pain Soft tissue infection and swelling Numbness Exposed bone
27
What guidelines are available with relation to MRONJ?
SDCEP
28
How should you manage someone at risk of MRONJ?
1. Assess risk 2. Advise pt of risk 3. Carry out XLA 4. Review healing after 8 weeks - refer to oral surgery or special care if Mronj suspected
29
What is a congenital cardiac condition?
Condition present from birth
30
What are the oral findings of congenial cardiac conditions?
Delayed eruption Abnormalities Enamel hyperplasia Increased dental disease
31
What is an Ischemic cardiac condition?
Progressive restriction of blood supply to the heart
32
What are the oral findings in Ischemic cardiac conditions?
Serve dental disease Lichenoid reactions Gingival swelling Angioedema Ulcers
33
What is hypertension?
High blood pressure (over 140/90mmHg)
34
What are the oral findings of hypertension?
Xerostomia Salivary gland pain/swelling Lichnoid reactions Angiooedema Gingival hyperplasia Sore mouth Paraesthesia
35
What is cardiomyopathy?
Conditions that effect the structure of the heart
36
What are the implications for patients who have had transplants?
Medications Higher infection risk Impaired drug metabolism
37
What 3 drugs are associated with gingival enlargement?
Anticonvulsants Calcium channel blockers Immunosuppressants
38
What is the 4 step process of normal Haemostasis?
1. Vasoconstriction 2. Platelet formation 3. Activation of coagulation 4. Activation of fibrinolysis
39
What are the 2 types of bleeding disorders?
Platelet disorders Clotting disorders
40
Give an example of a platelet disorder:
Thrombocytopenia
41
Give an example of a clotting disorder:
Vonwiliebrands or heamophillia
42
What 2 types of medications affect bleeding?
Antiplatelets Anticoagulants
43
List 2 examples of an Antiplatelet medication:
Aspirin Clopidagrel
44
List 2 examples of anticoagulants:
Warfarin Heparin
45
What is a renal condition?
Condition that effects renal system: kidneys, ureters, bladder, urethra
46
What is the function of the renal system?
Excretes waste Maintains fluid balance Secretes hormones Excretes drugs
47
Give 3 examples of renal conditions that effect dentistry:
Chronic kidney disease Renal failure Renal transplants
48
Oral findings in chronic kidney disease:
Xerostomia Metallic taste Halitosis Accelerated calculus production Pale mucosa Oral ulceration Paraesthesia
49
Oral findings in renal failure:
More prone to bleeding Infection
50
Dental management of renal failure:
Consult with renal physician FBC and coagulation screen for Xla
51
Oral findings in renal transplant pts:
Gingival hyperplasia Increases chance of tumours Candidiasis Herpes simplex Immunosuppresion
52
Anxiety:
Physiological reaction to perceived threat/danger
53
Fear:
Physiological reaction to actual threat/danger
54
Phobia:
A persistent and excessive fear of something that is not dangerous
55
What are the 4 steps to managing anxious pts?
1. Assess the pt 2. Provide psycho education and identify causes of anxiety 3. Provide coping strategies 4. Expose pt to fears gradually
56
List 3 coping strategies for anxiety:
Deep breathing Progressive muscle relaxation Grounding
57
How can dental anxiety be measured?
MDAS
58
What is conscious sedation?
The use of drugs to produce a state of depression in the CNS but maintaining verbal communication.
59
What are the 6 effects of conscious sedation?
Anxiolytic Anticonvulsant Sedation Reduced attention Amnesia Muscle relaxation
60
List the 3 main types of conscious sedation:
Inhalation Intra venous Oral
61
What 9 things are asssed at a sedation assessment?
MH, SH, Airway, height, weight, bmi, heart rate, bp, oxygen sats
62
What is inhalation sedation?
Nitrous oxide and oxygen Delivered via a nose mask Provides mild sedative effect
63
What are the 7 contraindications for inhalation sedation?
COPD recent eye or ear surgery Mask tolerance Pregnancy Vitamin B12 deficiency Methotrexate Chemotherapy
64
What are the 4 signs of overdose of inhalation sedation and how would you manage this?
Headache Naesea Vomiting Diffusion hypoxia - reduce dose and flush with pure oxygen
65
What is intravenous sedation?
Injection of sedative agent midazolam via an cannula that causes sedation and amnesia
66
What are the requirements to be allowed IV sedation?
Just have escort
67
What is the reversal drug for midazolam?
Flumazenil
68
What are the 5 contraindications for IV sedation?
Needle phobias Medical conditions such as liver, kidney or cardiac disease No escort Pregnancy Poor venous access
69
What are the signs of IV sedation overdose?
Loss of protective reflexes Loss of consciousness Decreased resp rate Decreased heart rate
70
List 3 guidelines sources for sedation:
SDCEP IACSP IACSDS
71
What is oral sedation?
Sedation given via drink form Midazolam used
72
Give examples of the 2 medications used as a pre-med for anxious patients: What type of medication are they?
Diazepam Temazepam - both examples of benzodiazepines
73
What are contraindications of pre-meds?
Hepatic impairment Renal impairment Pregnancy Breast feeding
74
What 3 things do pre medications interact with?
Antibacterials Antivirals Proton pump inhibitors
75
What is general anaesthesia?
A state of controlled consciousness that affects the whole body Pt does not move or feel pain All protective reflexes are lost
76
List the possible options for dental Tx:
1. LA 2. Inhalation sedation 3. IV sedation 4. GA
77
What are the 4 levels of sedation?
Minimal - anxiolysis Moderate - conscious sedation Deep - nearly unconscious General anaesthesia - unconscious
78
What are benzodiazepines used for in dentistry?
IV SEDATION - midazolam PRE-MED - diazepam
79
What are the precaution groups for benzodiazepines?
Elderly pts Alcohol or drug dependent pts Personality disorders Resp disease Cardiac disease
80
List the 5 contraindications for benzodiazepine use?
Pulmonary insufficiency Respiratory weakness Sleep apnoea CNS depression Compromised airways
81
List 4 types of mental health conditions:
Psychosis Neurosis Personality disorders Eating disorders
82
Neurosis
Contact with reality maintained
83
Psychosis
Contact with reality lost
84
What is trauma?
An event or circumstance that is physically or emotionally harmful to a person.
85
List 3 signs of trauma:
Fight/flight/ freeze Shame/guilt Dissociation
86
How would you manage fight/flight/freeze?
Deep breathing
87
How would you manage shame/guilt?
Normalise
88
How would you manage disociation?
Grounding
89
List 3 drugs classed as stimulants:
Caffeine Nicotine Cocaine, amphetamines, ecstasy
90
List 3 examples of downer drugs:
Alcohol Heroin Morphine Benzodiazepines
91
List 3 causes of poor oral health in drug users:
Dry mouth Parafunctional habits Sugar cravings
92
Oral findings in amphetamine users:
Xerostomia Bruxism Attrition/erosion
93
Oral findings in ecstasy users:
Bruxism Xerostomia Attrition/erosion Mucosal burns
94
Oral findings in cocaine users:
Xerostomia Caries on unusual surfaces
95
Oral findings in heroin users:
General oral neglect Advanced dental disease
96
Oral findings in canabis users:
Decreased resp rate Memory impairment Soft tissue disease

BDS - Module 9 (16 decks)

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