3 - Bariatric Dental Care

Question 1

Define a bariatric person.

Answer 1

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

Question 2

Define obesity.

Answer 2

Abnormal or excessive fat accumulation that may impair health

Question 3

What BMI is defined as overweight?

Answer 3

≥ 25

Question 4

What BMI is defined as obesity?

Answer 4

≥ 30

Question 5

What are the limitations of BMI?

Answer 5

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

Question 6

What are some contributing factors to obesity?

Answer 6

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

Question 7

What diseases are commonly associated with causing obesity?

Answer 7

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

Question 8

Does the Equality Act protect those with obesity?

Answer 8

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

Question 9

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

Answer 9

22 stone

Question 10

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

Answer 10

• 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)

Question 11

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

Answer 11

• 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)

Question 12

How does obesity affect dental treatment?

Answer 12

• 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

Question 13

How are periodontitis and obesity linked?

Answer 13

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

Question 14

How is caries and obesity linked?

Answer 14

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

Question 15

How are extractions or surgical dentistry impacted by obesity?

Answer 15

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

Question 16

How are tooth wear and obesity linked?

Answer 16

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

Question 17

Describe the domiciliary care of bariatric patients.

Answer 17

• 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

Question 18

How are emergency appointments handled with bariatric patients?

Answer 18

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

Question 19

How should you communicate with bariatric patients?

Answer 19

• 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’

Question 20

How does bariatric surgery affect dentistry?

Answer 20

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