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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
Q

List an anti-angiogenic medication:

A

Cancer medications

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26
Q

What are the symptoms of MRONJ:

A

Delayed healing
Pain
Soft tissue infection and swelling
Numbness
Exposed bone

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27
Q

What guidelines are available with relation to MRONJ?

A

SDCEP

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28
Q

How should you manage someone at risk of MRONJ?

A
  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
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29
Q

What is a congenital cardiac condition?

A

Condition present from birth

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30
Q

What are the oral findings of congenial cardiac conditions?

A

Delayed eruption
Abnormalities
Enamel hyperplasia
Increased dental disease

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31
Q

What is an Ischemic cardiac condition?

A

Progressive restriction of blood supply to the heart

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32
Q

What are the oral findings in Ischemic cardiac conditions?

A

Serve dental disease
Lichenoid reactions
Gingival swelling
Angioedema
Ulcers

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33
Q

What is hypertension?

A

High blood pressure (over 140/90mmHg)

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34
Q

What are the oral findings of hypertension?

A

Xerostomia
Salivary gland pain/swelling
Lichnoid reactions
Angiooedema
Gingival hyperplasia
Sore mouth
Paraesthesia

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35
Q

What is cardiomyopathy?

A

Conditions that effect the structure of the heart

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36
Q

What are the implications for patients who have had transplants?

A

Medications
Higher infection risk
Impaired drug metabolism

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37
Q

What 3 drugs are associated with gingival enlargement?

A

Anticonvulsants
Calcium channel blockers
Immunosuppressants

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38
Q

What is the 4 step process of normal Haemostasis?

A
  1. Vasoconstriction
  2. Platelet formation
  3. Activation of coagulation
  4. Activation of fibrinolysis
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39
Q

What are the 2 types of bleeding disorders?

A

Platelet disorders
Clotting disorders

40
Q

Give an example of a platelet disorder:

A

Thrombocytopenia

41
Q

Give an example of a clotting disorder:

A

Vonwiliebrands or heamophillia

42
Q

What 2 types of medications affect bleeding?

A

Antiplatelets
Anticoagulants

43
Q

List 2 examples of an Antiplatelet medication:

A

Aspirin
Clopidagrel

44
Q

List 2 examples of anticoagulants:

A

Warfarin
Heparin

45
Q

What is a renal condition?

A

Condition that effects renal system: kidneys, ureters, bladder, urethra

46
Q

What is the function of the renal system?

A

Excretes waste
Maintains fluid balance
Secretes hormones
Excretes drugs

47
Q

Give 3 examples of renal conditions that effect dentistry:

A

Chronic kidney disease
Renal failure
Renal transplants

48
Q

Oral findings in chronic kidney disease:

A

Xerostomia
Metallic taste
Halitosis
Accelerated calculus production
Pale mucosa
Oral ulceration
Paraesthesia

49
Q

Oral findings in renal failure:

A

More prone to bleeding
Infection

50
Q

Dental management of renal failure:

A

Consult with renal physician
FBC and coagulation screen for Xla

51
Q

Oral findings in renal transplant pts:

A

Gingival hyperplasia
Increases chance of tumours
Candidiasis
Herpes simplex
Immunosuppresion

52
Q

Anxiety:

A

Physiological reaction to perceived threat/danger

53
Q

Fear:

A

Physiological reaction to actual threat/danger

54
Q

Phobia:

A

A persistent and excessive fear of something that is not dangerous

55
Q

What are the 4 steps to managing anxious pts?

A
  1. Assess the pt
  2. Provide psycho education and identify causes of anxiety
  3. Provide coping strategies
  4. Expose pt to fears gradually
56
Q

List 3 coping strategies for anxiety:

A

Deep breathing
Progressive muscle relaxation
Grounding

57
Q

How can dental anxiety be measured?

58
Q

What is conscious sedation?

A

The use of drugs to produce a state of depression in the CNS but maintaining verbal communication.

59
Q

What are the 6 effects of conscious sedation?

A

Anxiolytic
Anticonvulsant
Sedation
Reduced attention
Amnesia
Muscle relaxation

60
Q

List the 3 main types of conscious sedation:

A

Inhalation
Intra venous
Oral

61
Q

What 9 things are asssed at a sedation assessment?

A

MH, SH, Airway, height, weight, bmi, heart rate, bp, oxygen sats

62
Q

What is inhalation sedation?

A

Nitrous oxide and oxygen
Delivered via a nose mask
Provides mild sedative effect

63
Q

What are the 7 contraindications for inhalation sedation?

A

COPD
recent eye or ear surgery
Mask tolerance
Pregnancy
Vitamin B12 deficiency
Methotrexate
Chemotherapy

64
Q

What are the 4 signs of overdose of inhalation sedation and how would you manage this?

A

Headache
Naesea
Vomiting
Diffusion hypoxia
- reduce dose and flush with pure oxygen

65
Q

What is intravenous sedation?

A

Injection of sedative agent midazolam via an cannula that causes sedation and amnesia

66
Q

What are the requirements to be allowed IV sedation?

A

Just have escort

67
Q

What is the reversal drug for midazolam?

A

Flumazenil

68
Q

What are the 5 contraindications for IV sedation?

A

Needle phobias
Medical conditions such as liver, kidney or cardiac disease
No escort
Pregnancy
Poor venous access

69
Q

What are the signs of IV sedation overdose?

A

Loss of protective reflexes
Loss of consciousness
Decreased resp rate
Decreased heart rate

70
Q

List 3 guidelines sources for sedation:

A

SDCEP
IACSP
IACSDS

71
Q

What is oral sedation?

A

Sedation given via drink form
Midazolam used

72
Q

Give examples of the 2 medications used as a pre-med for anxious patients:
What type of medication are they?

A

Diazepam
Temazepam
- both examples of benzodiazepines

73
Q

What are contraindications of pre-meds?

A

Hepatic impairment
Renal impairment
Pregnancy
Breast feeding

74
Q

What 3 things do pre medications interact with?

A

Antibacterials
Antivirals
Proton pump inhibitors

75
Q

What is general anaesthesia?

A

A state of controlled consciousness that affects the whole body
Pt does not move or feel pain
All protective reflexes are lost

76
Q

List the possible options for dental Tx:

A
  1. LA
  2. Inhalation sedation
  3. IV sedation
  4. GA
77
Q

What are the 4 levels of sedation?

A

Minimal - anxiolysis
Moderate - conscious sedation
Deep - nearly unconscious
General anaesthesia - unconscious

78
Q

What are benzodiazepines used for in dentistry?

A

IV SEDATION - midazolam
PRE-MED - diazepam

79
Q

What are the precaution groups for benzodiazepines?

A

Elderly pts
Alcohol or drug dependent pts
Personality disorders
Resp disease
Cardiac disease

80
Q

List the 5 contraindications for benzodiazepine use?

A

Pulmonary insufficiency
Respiratory weakness
Sleep apnoea
CNS depression
Compromised airways

81
Q

List 4 types of mental health conditions:

A

Psychosis
Neurosis
Personality disorders
Eating disorders

82
Q

Neurosis

A

Contact with reality maintained

83
Q

Psychosis

A

Contact with reality lost

84
Q

What is trauma?

A

An event or circumstance that is physically or emotionally harmful to a person.

85
Q

List 3 signs of trauma:

A

Fight/flight/ freeze
Shame/guilt
Dissociation

86
Q

How would you manage fight/flight/freeze?

A

Deep breathing

87
Q

How would you manage shame/guilt?

88
Q

How would you manage disociation?

89
Q

List 3 drugs classed as stimulants:

A

Caffeine
Nicotine
Cocaine, amphetamines, ecstasy

90
Q

List 3 examples of downer drugs:

A

Alcohol
Heroin
Morphine
Benzodiazepines

91
Q

List 3 causes of poor oral health in drug users:

A

Dry mouth
Parafunctional habits
Sugar cravings

92
Q

Oral findings in amphetamine users:

A

Xerostomia
Bruxism
Attrition/erosion

93
Q

Oral findings in ecstasy users:

A

Bruxism
Xerostomia
Attrition/erosion
Mucosal burns

94
Q

Oral findings in cocaine users:

A

Xerostomia
Caries on unusual surfaces

95
Q

Oral findings in heroin users:

A

General oral neglect
Advanced dental disease

96
Q

Oral findings in canabis users:

A

Decreased resp rate
Memory impairment
Soft tissue disease

BDS - Module 9 (16 decks)

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