3 - Bariatric Dental Care Flashcards
Define a bariatric person.
- any age
- limitations in health and care due to physical size, health, mobility and environmental access
Define obesity.
Abnormal or excessive fat accumulation that may impair health
What BMI is defined as overweight?
≥ 25
What BMI is defined as obesity?
≥ 30
What are the limitations of BMI?
- does not assess fat distribution
- measure of excess weight not excess body fat
- does not account for sex, ethnicity, age and muscle mass
What are some contributing factors to obesity?
- energy imbalance between caloric intake and caloric expenditure
- associated with comorbidities
- undernutrition
- genetics
- socioeconomic status
- environment
- individual choice
What diseases are commonly associated with causing obesity?
- hypothyroidism in Down’s
- Prader-Willi syndrome (always hungry)
- Autism
- steroidal medication
- diseases cause physical limitation (cerebral palsy, RA)
Does the Equality Act protect those with obesity?
- no
- conditions associated with obesity may lead to disability (then protected)
What is the typical weight bearing limit of a dental chair?
22 stone
What are alternatives if the patient’s weight is greater than a standard dental chair’s limit?
- higher weight dental chair (up to 32 stone)
- wheelchair recliner (up to 32 stone)
- higher SWL operating table (up to 40 stone)
- bariatric wheel chair (up to 50 stone)
What are some common conditions that obesity puts patients at risk of?
- HTN
- CVA (stroke)
- diabetes
- sleep apnea
- dyspnea (unable to walk comfortably without getting breathless)
- GORD
- osteoarthritis
- depression/anxiety
- liver/gall bladder disease
- skin conditions (cellulitis/intertrigo)
How does obesity affect dental treatment?
- loss of anatomical landmarks
- access issues due to large cheeks
- IDB difficult
- tongue retractor may be required if mirror insufficient
- may need treated sat more upright
- may not fit inside extra-oral radiograph machines
- long procedures may lead to compartment syndrome or pressure sores
- excessive fat may affect absorption of drugs
How are periodontitis and obesity linked?
- associative relationship, not causative
- diabetes (often caused by obesity) has a high risk of periodontitis
How is caries and obesity linked?
- causative relationship
- obese patients often have a much higher intake of sugar
How are extractions or surgical dentistry impacted by obesity?
Bariatric patients are likely to have reduced immune function = delayed wound healing