14. Special Care Flashcards
What is the purpose of special care services?
To provide oral care to people who are unable to accept routine care due to an impairment.
What patients are seen by special care?
Disability
Older
Medically compromised
Mental health issues
Anxious/phobic
What is disability?
A physical or mental impairment that has severe and long term effects on a persons ability to perform normal activities.
List the 3 types of disability
Physcial
Learning
Sensory
What is dementia?
A collection of cognitive symptoms that gradually get worse over time
What are the 5 types of dementia?
Alzheimer’s
Vascular
Mixed
Lewy body
Frontotemporal
What are the principles of consent?
Informed
Given freely
Pt is capable
What is incapacity?
The inability of a person to act, make, communicate, understanding or retain a decision
How is capacity assessed?
AMCUR framework
Asking open questions
Chunk and check
Teach back
If someone lacks capacity what legal act applies?
AWI Act 2000
Is the AWI Act 2000 applies, what certificate is issued and according to what 5 principles?
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
What is a proxy?
A person who has been legally authorised to act on behalf of an adult with incapacity
List the 3 types of proxy:
Power of attorney
Guardian
Intervenors
What is power of attorney and what types are there?
granted while the person has capacity
Types:
Welfare
Continuing (property and finance)
Combined
What is a guardian and what are the 3 types?
Granted when an adult no longer has capacity or has never had capacity
Types:
Welfare
Financial/property
Both
What is an intervenor?
Appointed for a one off event by the court
What should you do if a person lacks capacity and there IS a proxy in place?
Follow AWI principles
Get consent from proxy
Have AWI section 47 issued
What should you do if person lacks capacity and there is NOT a proxy in place?
Follow principles of AWI
have section 47 certificate issued
What legislations are associated with adult protection?
Adult support and protection act 2007
Domestic abuse Scotland act 2018
Human trafficking and exploitation act 2015
Who can you report adult protection concerns to?
999 - immediate concerns
Local health and social care adult protection team
Social work
OPG
What 5 key medical conditions have effect on dentistry?
Cancer
Mronj
Cardiac
Bleeding disorders
Renal
What 3 key dental interventions should be carried out before someone goes through cancer Tx?
Screening
XLA of potential sources of infection
Duraphat toothpaste and varnish
What is MRONJ?
Medications related osteonecrosis of the jaw
- exposed bone that persists for 8 weeks + in patients taking antiresorptive or antiangiogenic drugs
List 2 antiresorptive mesications associated with MRONJ:
Bisphosphonates (e.g alendronic acid)
RANKL inhibitors (e.g denosumab)
List an anti-angiogenic medication:
Cancer medications
What are the symptoms of MRONJ:
Delayed healing
Pain
Soft tissue infection and swelling
Numbness
Exposed bone
What guidelines are available with relation to MRONJ?
SDCEP
How should you manage someone at risk of MRONJ?
- Assess risk
- Advise pt of risk
- Carry out XLA
- Review healing after 8 weeks
- refer to oral surgery or special care if Mronj suspected
What is a congenital cardiac condition?
Condition present from birth
What are the oral findings of congenial cardiac conditions?
Delayed eruption
Abnormalities
Enamel hyperplasia
Increased dental disease
What is an Ischemic cardiac condition?
Progressive restriction of blood supply to the heart
What are the oral findings in Ischemic cardiac conditions?
Serve dental disease
Lichenoid reactions
Gingival swelling
Angioedema
Ulcers
What is hypertension?
High blood pressure (over 140/90mmHg)
What are the oral findings of hypertension?
Xerostomia
Salivary gland pain/swelling
Lichnoid reactions
Angiooedema
Gingival hyperplasia
Sore mouth
Paraesthesia
What is cardiomyopathy?
Conditions that effect the structure of the heart
What are the implications for patients who have had transplants?
Medications
Higher infection risk
Impaired drug metabolism
What 3 drugs are associated with gingival enlargement?
Anticonvulsants
Calcium channel blockers
Immunosuppressants
What is the 4 step process of normal Haemostasis?
- Vasoconstriction
- Platelet formation
- Activation of coagulation
- Activation of fibrinolysis