3 - Bariatric Dental Care Flashcards

1
Q

Define a bariatric person.

A
  • any age
  • limitations in health and care due to physical size, health, mobility and environmental access
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2
Q

Define obesity.

A

Abnormal or excessive fat accumulation that may impair health

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3
Q

What BMI is defined as overweight?

A

≥ 25

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4
Q

What BMI is defined as obesity?

A

≥ 30

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5
Q

What are the limitations of BMI?

A
  • does not assess fat distribution
  • measure of excess weight not excess body fat
  • does not account for sex, ethnicity, age and muscle mass
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6
Q

What are some contributing factors to obesity?

A
  • energy imbalance between caloric intake and caloric expenditure
  • associated with comorbidities
  • undernutrition
  • genetics
  • socioeconomic status
  • environment
  • individual choice
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7
Q

What diseases are commonly associated with causing obesity?

A
  • hypothyroidism in Down’s
  • Prader-Willi syndrome (always hungry)
  • Autism
  • steroidal medication
  • diseases cause physical limitation (cerebral palsy, RA)
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8
Q

Does the Equality Act protect those with obesity?

A
  • no
  • conditions associated with obesity may lead to disability (then protected)
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9
Q

What is the typical weight bearing limit of a dental chair?

A

22 stone

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10
Q

What are alternatives if the patient’s weight is greater than a standard dental chair’s limit?

A
  • 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)
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11
Q

What are some common conditions that obesity puts patients at risk of?

A
  • 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)
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12
Q

How does obesity affect dental treatment?

A
  • 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
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13
Q

How are periodontitis and obesity linked?

A
  • associative relationship, not causative
  • diabetes (often caused by obesity) has a high risk of periodontitis
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14
Q

How is caries and obesity linked?

A
  • causative relationship
  • obese patients often have a much higher intake of sugar
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15
Q

How are extractions or surgical dentistry impacted by obesity?

A

Bariatric patients are likely to have reduced immune function = delayed wound healing

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16
Q

How are tooth wear and obesity linked?

A
  • erosive tooth wear from increased prevalence of GORD
  • erosive tooth wear due to reflux caused by gastric banding
17
Q

Describe the domiciliary care of bariatric patients.

A
  • option when patient is too large to leave home
  • for initial assessment but then likely required to be referred to specialist clinic
  • most commonly prosthetics are delivered
18
Q

How are emergency appointments handled with bariatric patients?

A
  • relief of pain only
  • patient often seen in a wheelchair
  • often require referral to clinic with suitable facilities
19
Q

How should you communicate with bariatric patients?

A
  • technical terminology not personal
  • be sensitive but honest
  • highlight safety issues and that this is the priority
  • patients prefer to be referred to as ‘overweight’ rather than ‘obese’
20
Q

How does bariatric surgery affect dentistry?

A
  • reflux
  • prolonged and more frequent meal times may increase caries