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SCD > 3rd year key points > Flashcards

3rd year key points Flashcards

1
Q

sensory impairment

A

when one or more of a person’s senses are no longer normal

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2
Q

macular degeneration

A

wet - severe, quick

dry - gradual loss of central vision

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3
Q

glaucoma

A

rise in IO pressure

lose peripheral vision

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4
Q

causes of cataracts

A

senile
traumatic
disease associated

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5
Q

diabetic retinopathy

A

black spots and blurry

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6
Q

hemianopia

A

blindness in one half of the visual field

stroke

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7
Q

causes of hearing impairment

A

build up of cerumen
ototoxic drugs
otosclerosis
perforated eardrums

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8
Q

hearing loop

A

T
magnetic, wireless signal
cuts out unwanted background noise

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9
Q

impairment

A

something doesn’t work

any loss or abnormality of psychological, physiological or anatomical structure or fct

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10
Q

disability

A

functional performance
a restriction/lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being

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11
Q

handicap

A

disadvantage, resulting from impairment/disability that limits/prevents fulfilment of a role that is normal for that individual
- broader social and psychological consequences

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12
Q

activity limitation

A

difficulty encountered by an individual in executing a task/action

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13
Q

participation restriction

A

problem experienced by an individual in involvement in life situations

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14
Q

characteristics of service use

A 
fewer visits, longer intervals
limited access
difficulty communicating pain
financial
emergency care rather than planned
history of extractions
tx with GA
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15
Q

important piece of legislation relating to capacity

A

AWI Act 2000 (2010) part 5

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16
Q

what should you always assume with capacity?

A

that someone has it

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17
Q

what is capacity?

A 
ability to:
 - act
 - make decision (reasoned)
 - communicate
 - understand
 - retain memory
action/decision specific
residual capacity
may fluctuate
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18
Q

principles of AWI Act

A

benefit - without tx benefit not possible
minimum necessary intervention - least restrictive
take account of wishes of adult
consultation with relevant others
encourage adult to exercise residual capacity

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19
Q

2 types of PofA

A

continuing

welfare

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20
Q

how are PofA made?

A

granted by adult while they still have capacity
registered w Public Guardian
ceases on day they die

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21
Q

continuing PofA

A

finances and property

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22
Q

welfare PofA

A

health and personal welfare

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23
Q

WG orders

A

when adult can’t choose a PofA e.g. born with a severe LD
need 2 medical reports
continuous management of welfare and financial matters
usually 3yrs

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24
Q

how long do WG orders usually last?

A

3yrs usually

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25
Q

certificate of incapacity

A

only valid for your area of practice
even if WG/WPofA still need CofI
GMP/consultant, GDP if additional training
detailed - exact
- one for check ups for 3yrs where no capacity likely to be regained
- individual tx course
photocopy it in notes

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26
Q

schizophrenia

A

disorders of thought (delusions) and perception (hallucinations)

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27
Q

schizophrenia aetiological factors

A

cannabis - tachycardia
neurotransmitter imbalance
genetic predisposition
triggers - stress

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28
Q

clozapine and schizophrenia

A

atypical antipsychotic
neutropenia - monitor
don’t do smoking cessation - can lead to severe toxicity - clozapine levels in plasma changed

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29
Q

why is dentist-led sedation contraindicated in pts with active uncontrolled psychiatric disease?

A

may have unpredictable reactions and increased tolerance

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30
Q

russel sign

A

calluses on knuckles due to repeated self-induced vomiting

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31
Q

signs of SS

A

mirror sticks to mucosa
food residues in oral cavity
cracked tongue
ocular symptoms

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32
Q

SS risks

A

oral infections
malignant change
altered taste

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33
Q

reasons for dry mouth

A 
meds
autonomic dysfct (endocrine)
anxiety, stress
dehydration
starvation
chemo and radio
systemic conditions
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34
Q

cancer - pre-tx priorities

A 
OH
reduce tx complications
 - avoid chemo interruption
 - avoid mucositis exacerbation
 - remove potential sources of infection
reduce post-tx complications
 - prevention
 - plan rehab
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35
Q

role of dentist for cancer pt

A 
early detection
pre-tx assessment
 - radiographs
 - necessary tx
 - pre-tx scaling
dentate pts
 - imps for soft splints
 - start F therapy
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36
Q

during cancer tx role of dentist

A

ulceration
infection
emergency tx

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37
Q

pain relief for mucositis

A

opioid analgesia - severe pain

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38
Q

pathogenesis/stages of mucositis

A

inflammatory/vascular - cytokines released
epithelial - atrophy
ulceration/bacterial - full thickness erosion
healing - epithelium renewal

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39
Q

grading of mucositis

A

0-4 WHO

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40
Q

mucositis grade 0

A

none

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41
Q

mucositis grade 1

A

mild

soreness and erythema

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42
Q

mucositis grade 2

A

mod
erythema, ulcers
solid diet tolerated

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43
Q

mucositis grade 3

A

severe
oral ulcers
liquid diet only

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44
Q

mucositis grade 4

A

oral feeding impossible

requires parenteral nutrition

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45
Q

management of mucositis

A

silk brushes
CHX gel (in clean mouth as won’t penetrate biofilm)
avoid smoking, alcohol, tea and coffee, v hot/spicy
topical lignocaine
caphasol - artificial saliva conc CaPO4
tea tree MW - check not allergy to aloe vera
ice during chemo

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46
Q

SEs of chemo

A 
alopecia
nausea and vomiting
anorexia
bone marrow suppression
mucositis
transient dry mouth
coagulation defects
reduced WBCs
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47
Q

how does chemo work?

A

cytotoxic - interact with cancer cell DNA/RNA and affect a phase of life cycle

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48
Q

what % of chemo pts get mucositis?

A

around 75-80%

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49
Q

when does mucositis usually appear with chemo?

A

7-14 days after initiation of chemo

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50
Q

describe the general trajectory of chemo SEs

A

systemic but more transient

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51
Q

describe the general trajectory of radio SEs

A

chronic, progressive and localised

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52
Q

why is radio fractionated?

A

only kills dividing cells

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53
Q

dental SEs of radio

A 
hyposalivation
hypogeuesia
radiation caries
fungal infections
trismus
ORN
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54
Q

why is trismus a SE of radio?

A

replacement fibrosis of MofM following progressive end arteritis of affected tissues with decrease in blood supply
irreversible

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55
Q

ORN as a SE of radio?

A

dead bone shards
avascular necrosis
endarteritis obliterans - progressive fibrosis

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56
Q

what dose is the risk of SEs greater from radio?

A

> 60Gy

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57
Q

cancer - IO reactivation of herpes simplex

A 
so immunocompromised
clinically atypical
painful oral ulceration, sudden onset
extensive, slow healing and aggressive
ulceration on palate and tongue dorsum
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58
Q

xerostomia management

A

palliative
water
SF gum
tooth mousse

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59
Q

cancer post-tx dentist roles

A

rehabilitation
prevention
monitoring

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60
Q

dentist pre-tx for cancer - getting pt dentally fit

A

if no time to restore - ext
can’t RCT - can’t guarantee
ask pt for GP and MDT team details at 1st appt
if pt refuses ext - explain risks, note it down, contact oncologist

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61
Q

MRONJ

A

exposed bone (not healed) at 8wks

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62
Q

incidence of MRONJ

A

overall risk small <1%

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63
Q

what is Parkinsons?

A

progressive neurodegenerative

basal ganglia - degeneration of dopamine receptors

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64
Q

aetiology of Parkinsons

A 
approx 5% genetic
most idiopathic
toxins?
cerebrovascular disease
head trauma
drug induced
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65
Q

how is Parkinsons diagnosed?

A

clinical diagnosis

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66
Q

Parkinsons S+S

A

rest tremor

  • reduced by action
  • increased by emotion/stress
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67
Q

which type of dementia is Parkinsons associated with?

A

Lewy body dementia

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68
Q

tx of Parkinsons

A

drug therapy when fct disability
Levidopa - non-ergot dopamine agonist
Carbidopa - prolongs action
late management - reduce motor fluctuation

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69
Q

outcome of Parkinsons

A

approx 10-15yrs death usually due to bronchopneumonia

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70
Q

Parkinsons dental risk

A

risk of postural hypotension

71
Q

type of dementias

A 
Alzheimers
vascular dementia
dementia with Lewy bodies
frontotemporal dementia
Korsakoff's syndrome
early-onset dementia
72
Q

Alzheimer’s

A

lose connections between neurones - protein plaques and tangles
less chemical messengers

73
Q

vascular dementia

A

reduced blood supply to brain

74
Q

dementia with Lewy bodies

A

protein deposits, links with Parkinsons

75
Q

frontotemporal dementia

A

lose filter ability - sexual/inappropriate comments

76
Q

Korsakoffs syndrome

A

alcohol

77
Q

early onset dementia

A

U65s

78
Q

signs of pain

A

behavioural changes
body language
mood changes

79
Q

Huntington’s (chorea)

A 
often mid-life
AD - 50% chance
Chr4 mutation
relentless progressive chorea and dementia
cerebral atrophy
80
Q

chorea

A

a movement disorder that causes involuntary, irregular, unpredictable muscle movements

81
Q

S+S of Huntington’s

A

involuntary jerky movements
poor balance
personality changes - moody

82
Q

dental aspects of Huntingtons

A

communication
movements
swallowing

83
Q

stroke S+S

A 
interruption of brain blood supply
one side weakness/numb
dizziness
LOC
altered speech
84
Q

dental aspects of stroke

A

retain prosthesis?
defer tx for 6m post TIA/stroke
protective reflexes?
oropharyngeal dysphagia - swallow ability compromised. Risk of aspiration/pneumonia. Need good suction

85
Q

SE of nicorandil

A

large ulcers

86
Q

VAP

A 
most freq HAI in intubated pts
main risk factor - ETT - impairs natural defence mechanisms
OH essential
diagnosis
 - temp >38
 - WCC >12000/mm3
 - + tracheal cultures
 - resp distress
 - chest xrays
87
Q

Berwick report

A 
pt safety
key principles
 - quality of pt care
 - engage patients and carers
 - growth and development of all staff
 - embrace transparency
88
Q

barriers to change - OH in care homes

A 
OH low priority
assessed often by non-dentist
carers limited knowledge of OH
carers difficulty gaining access to teeth
high turnover of care staff
poorly paid
89
Q

early stage dementia tx planning

A 
oral assessment
plan for future
consider replica models
identify and try to retain key teeth
 - 4 occluding pairs
 - L anteriors
90
Q

mid stage dementia tx planning

A

maintenance and prevention

91
Q

late stage dementia tx planning

A

comfort
free of pain and infection
non-invasive

92
Q

txing pts with dementia

A

communication - approach from front
break it down
non-verbal
right env

93
Q

causes of LD

A

preconception - parental genotype
pre-natal - maternal health, toxics
perinatal - injury
post-natal - infection, trauma, SSD

94
Q

syndromes associated with LD

A 
autism/Aspergers
Down syndrome
CP
Fragile X syndrome
Prader Willi
PKU
95
Q

CP

A 
1 in 400
neurological - affect movement and coordination
muscle stiffness/floppiness (hypotonia)
random and uncontrolled body movements
balance problems
96
Q

Down syndrome

A 
trisomy 21
CHDs
increased risk of haematological malignancy
reduced IQ
risk Alzheimers
PDD
dental anomalies
97
Q

Prader Willi syndrome

A 
15
constantly hungry - obesity
hypotonia
learning difficulties
behavioural problems
98
Q

Autism prep before visit

A 
my health passport
social stories
pre-visit
timing
specific language
take straight to surgery
99
Q

what can be used to aid keeping mouth open?

A

open wide mouth rests

100
Q

LD RFs

A

poor motor control
pouching
mouth breathing
meds

101
Q

LD toothbrushing advice

A

sit up
behind pt
encourage pt to do as much as possible

102
Q

clinical holding

A

consent
no capacity and deemed of benefit - safety risk
unplanned emergencies
always record and justify

103
Q

thickeners

A

dysphagia

prevent aspiration

104
Q

self-injurious behaviour management

A 
self-biting
tx strategies
 - symptomatic relief
 - reassurance
 - distraction when SIB
 - pharmacological
 - behaviour psychology - positive reinforcement
 - extract specific anterior teeth
 - orthognathic surgery to create open bite
105
Q

safeguarding

A 
recognise
respond
record
 - non-urgent - contact SS within 24hrs
 - 999 immediate risk of harm

Removal (7days)
Assessment
Banning (up to 6m) - where adult at risk likely to be seriously harmed

106
Q

dementia definition

A

syndrome - chronic/progressive
deterioration in cognitive fct beyond what might be expected from normal ageing
consciousness not affected
depression and anxiety often precursors

107
Q

most common type of dementia

A

Alzheimers 60%

108
Q

dementia risk factors

A 
age
gender
genetics
MH
lifestyle
109
Q

dementia early stage symptoms

A

often misattributed
STML
confusion
anxiety

110
Q

dementia mid stage symptoms

A 
need more support inc reminders
distress, aggression
wandering
inappropriate behaviour
hallucinations
111
Q

dementia late stage symptoms

A

physical frailty - shuffle
can’t recognise people
incontinence
loss of speech

112
Q

dementia testing

A 
MMSE (not sensitive for frontal lobe)
Blessed Dementia Scale
MINICOG
GPCOG
dementia screen to eliminate treatable causes - diagnosis of exclusion
113
Q

what drug may delay the progression of dementia?

A

anticholinesterases

114
Q

risk of dementia in Down Syndrome

A

50%

115
Q

severe haemophilia

A

<1% factor

116
Q

non-selective B-blockers and LA

A

heightened sensitivity to effects of vasopressors in LA

117
Q

hypertensive crisis

A

> 180/110

118
Q

what is metformin?

A

antihyperglycaemic

119
Q

what is the leading cause of renal failure?

A

diabetes

120
Q

when do neutrophils drop to their lowest point in chemo?

A

10-14 days after chemo delivery

121
Q

how long should you allow for healing after ext prior to oncology tx?

A

10-14 days

122
Q

dose which gives risk of ORN

A

50 or more Gy

123
Q

how many WGs do you need consent from?

A

1

124
Q

UKELD

A

UK model end stage liver disease

125
Q

biotene oralbalance

A

lactoperoxidase

126
Q

saliva orthana

A

porcine mucin

127
Q

tooth mousse

A

recaldent CPP-ACP

128
Q

glandosane

A

carboxymethylcellulose

artificial saliva spray

129
Q

caphosol

A

supersaturated Ca and PO4

130
Q

where can chemo induced mucositis affect?

A

the whole GIT

131
Q

why are bisphosphonates used in cancer?

A

to reduce the risk of metastatic spread

132
Q

where do radiation caries typically appear?

A

cervical/smooth surface

133
Q

what can cannabis do to the CV system?

A

cause tachycardia

134
Q

for end stage liver disease, before operative dental tx what should you request?

A

FBC, coagulation screen, LFTs, U and Es

135
Q

when should you tx a pt on haemodialysis?

A

day after haemodialysis

136
Q

do you need an AWI certificate to tx a spreading dental infection?

A

no

137
Q

max AWI

A

3yrs

138
Q

WG

A

a person who is legally appointed by the courts to make the decision on behalf of a person who lacks capacity

139
Q

PofA

A

person who is nominated whilst an individual still has capacity who is subsequently legally appt by a court to make decisions on behalf of that individual when they lose capacity

140
Q

who should you contact to confirm welfare PofA?

A

Office of Public Guardian

141
Q

purpose of AWI

A

provides a framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental disorder or inability to communicate

142
Q

residual capacity

A

ensure everything possible is done to provide the individual with the opportunity to decide about the medical tx they receive

143
Q

least restrictive option

A

any action/decision taken should be the min to achieve the purpose
should be the option that restricts freedom as little as possible

144
Q

benefit

A

any action or decision must benefit the pt and only be taken when that benefit cannot reasonably be achieved without it

145
Q

consultation with relevant others

A

take account of the views of others with an interest in the person’s welfare
Act lists who should be consulted whenever practicable and reasonable

146
Q

which part of the AWI Act is relevant to dentistry?

A

part 5

147
Q

if a pt needs ABP for invasive procedures, what does this cover?

A

“manipulation of mucosa and mucoperiosteum”

- not LA

148
Q

Down Syndrome and immune system

A

neutrophil chemotaxis impaired

149
Q

Dalteparin (fragmin)

A

low molecular weight heparin

150
Q

where is thrombopoietin made?

A

liver

151
Q

where are platelets made?

A

bone marrow

152
Q

if platelets <100 what should you do before ext?

A

speak to someone

153
Q

causes of inability to achieve haemostasis

A 
inherited/congenital bleeding disorders
medication induced
other drugs e.g. chemo SE
haematological disease
infections
liver disease
154
Q

platelet level for a single uncomplicated tooth extraction

A

> 50 x10 ^9/L should be a safe level to achieve haemostasis

155
Q

S+S of liver disease

A 
jaundice
palmar erythema, spider naevi
bleeding and oesophageal varices
ascites
encephalopathy
if alcohol related: tremors, cognitive impairment
156
Q

causes of liver disease

A 
infective - hepatitis virus
autoimmune - primary biliary cirrhosis
alcohol related
non-alcoholic fatty liver disease
hemochromatosis
drug induced
hepatocellular carcinoma
157
Q

stages of liver disease

A

hepatitis: inflammation of liver, may/may not be reversible depending on the disease
liver cirrhosis: irreversible liver necrosis and fibrosis
liver failure: failure of normal liver fct

158
Q

UKELD score

A

UK model for end stage liver disease
predicts a person’s prognosis in chronic liver disease, used as a guide to determine the need for a liver transplant
49 minimum for pt to be assessed for a liver transplant
- >9% mortality within 12m

159
Q

liver disease and LAs

A

lignocaine fully metabolised in liver
only 5-10% of articaine processed in liver, most is metabolised in plasma
- decreases metabolic demand on liver
could use articaine infiltrations to avoid IAN blocks? - reduces risk of haematoma formation

160
Q

liver disease and post-op analgesia

A 
NSAIDs
 - bleeding risk
 - hepatorenal syndrome - inhibition of prostaglandins leads to reduction in renal perfusion, reduction in GFR and sodium retention
paracetamol
 - risk of hepatotoxicity
 - safer than NSAIDs
161
Q

liver disease and antibiotics

A

may need to alter dose
amoxicillin safe
may need to alter dose of metronidazole
erythromycin can affect liver

162
Q

liver disease and IV sedation

A

dentist led IV sedation with midazolam not appropriate

if need sedation - anaesthetist led propofol sedation or GA

163
Q

if pt needs medical transfusion product for tx

A

do as much tx as possible as transfusion comes with associated risks

164
Q

is diazepam dialysable?

A

no

165
Q

cannabis and dentistry

A 
attend less regularly
associated with schizophrenia
increased caries rare
 - xerostomia
 - hunger - acts on hormone leptin
 - more PDD and gingival enlargement
 - oral leukoplakia and cancer
acts on CV system - tachycardia with widespread vasodilation
 - can become acute medical issue if LA containing adrenaline given during tachycardia period
166
Q

bulimia presentations

A

palatal NCTSL erosion
dry mouth
nutritional deficiency related - ulceration and infections
increased keratin in oral STs in response to trauma from purging/acidic vomit
sialadenosis
damage to nails or fingers if used to purge

167
Q

post-vom methods of increasing pH

A

chew gum, rinse mouth with water/milk
rinse with antacid prep
avoid abrasive toothpastes
gentle brushing with desensitising toothpaste and a soft brush may be ok

168
Q

cancer GDP pre-tx

A 
radiographs and assessment
any necessary tx
pre-tx scaling
imps for soft splints if dentate
F therapy if dentate
169
Q

cardinal features of Parkinsons

A 
bradykinesia
rigidity
resting tremor
postural instability
gradual symptom progression
sustained response to therapy with levodopa (precursor to dopamine)
170
Q

features of Parkinsons

A 
head forward
micrographia
mask like face
drooling
rigidity
resting tremor
akinesia
171
Q

vascular dementia

A

reduced blood flow to brain

172
Q

mod haemophilia

A

2-5% factor

173
Q

mild haemophilia

A

6-40% factor

SCD (1 decks)

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