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BDS 3 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 (wet vs dry)

A

wet - severe, quick
dry - gradual loss of central vision

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3
Q

glaucoma

A

rise in intraocular pressure
lead to damage of optic nerve - loss of peripheral vision

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4
Q

causes of cataracts

A

senile
traumatic
disease associated

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5
Q

diabetic retinopathy symptoms

A

black spots and blurry

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6
Q

hemianopia main cause and symptom

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 (earwax)
ototoxic drugs
otosclerosis
perforated eardrums

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8
Q

hearing loop

A

T setting
magnetic, wireless signal
cuts out unwanted background noise

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9
Q

impairment

A

something doesn’t work

any loss or abnormality in fx of psychological, physiological or anatomical structure

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10
Q

disability

A
  • functional performance
  • a restriction/lack (resulting from an impairment) of ability to perform an activity 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 of SCD

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 incapacity

A

Adults with Incapacity (Scotland) Act 2000 part 5

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16
Q

In Scotland law, what age can you make legally binding decision for yourself?

what age is ADULT

A

16 yo

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17
Q

what should you always assume with capacity?

A

that someone has it

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18
Q

what is capacity?

A

ability to( AMCUR ):

  • act
  • make decision (reasoned)
  • communicate
  • understand
  • retain memory
action/decision specific
residual capacity
may fluctuate
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19
Q

examples of communication aids

A
  • British Sign Language
  • spelling boards
  • iPad
  • pen and paper
  • visual aids
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20
Q

5 principles of AWI Act

A
  • benefit - cannot be achieved without the tx
  • minimum necessary intervention
  • take account of wishes of adult - present + past
  • consultation with relevant others
  • encourage adult to exercise residual capacity
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21
Q

2 types of proxy

A
  • power of attorney
  • guardianship orders
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22
Q

3 types of Power of Attourney

A
  • continuing - cant consent dental tx
  • welfare - can consent dental tx
  • combined - can consent dental tx
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23
Q

Power of Attourney

A
  • no expiry date
  • remain dormant until adult incapacity
  • granted while pt still has capacity
  • done through lawyer (no court)
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24
Q

how are Power of Attorney made?

A

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

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25
Q

continuing Power of Attorney

A

finances and property

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26
Q

welfare Power of Attorney

A

health and personal welfare

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27
Q

2 types of guardianship orders

A
  • welfare guardian - can consent dental tx
  • financial guardian - can’t consent dental tx
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28
Q

Welfare Guardian orders

A
  • when adult can’t choose a Power of Attorney e.g. born with a severe learning disability
  • need 2 medical reports
  • continuous management of welfare and financial matters
  • usually 3yrs
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29
Q

how long do Welfare Guardian orders usually last?

A

3yrs usually

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30
Q

certificate of incapacity

A
  • only valid for your area of practice
  • even if WG/WPofA still need CofI
  • 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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31
Q

who can consent for dental tx

A
  • pt with capacity
  • welfare power of attorney
  • welfare guardians
  • medical/ dental practitioners under Section 47 of AWI Act (General Authority to Treat)
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32
Q

General Authority to treat conditions x3

A
  • a valid certificate of incapacity is issued for the tx given
  • principles of the Act are observed
  • emergency
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33
Q

who can issue certificates of incapacity?

A
  • GMP
  • consultant incharge of the patient care
  • dental practitioner / nurse/ optometrist who completed the training course
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34
Q

schizophrenia

A

disorders of thought (delusions) and perception (hallucinations)

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35
Q

schizophrenia aetiological factors

A

cannabis - tachycardia
neurotransmitter imbalance
genetic predisposition
triggers - stress

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36
Q

clozapine and schizophrenia

A
  • atypical antipsychotic (not first line)
  • neutropenia - monitor
  • don’t do smoking cessation - can lead to severe toxicity - clozapine levels in plasma changed
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37
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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38
Q

russell’s sign

A

calluses on knuckles due to repeated self-induced vomiting

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39
Q

signs of Sjogren’s Syndrome

A
  • mirror sticks to mucosa
  • food residues in oral cavity
  • cracked tongue
  • ocular symptoms
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40
Q

SS risks

A

oral infections
malignant change - lymphoma
altered taste

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41
Q

reasons for dry mouth

A
  • Medication
    • antimuscarinic (tricyclic antidepressants, antipsychotics )
    • Antihistamine
    • Diuretics
  • Systematic disease
    • Sjogren’s Syndrome
  • Cancer treatment
    • Radiotherapy in the head and neck region
    • Treatment with radioactive iodine
  • autonomic dysfct (endocrine)
  • anxiety, stress
  • dehydration
  • starvation
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42
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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43
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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44
Q

during cancer tx role of dentist

A

ulceration
infection
emergency tx

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45
Q

pain relief for mucositis

A

opioid analgesia - severe pain

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46
Q

pathogenesis/stages of mucositis

A

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

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47
Q

grading of mucositis

A

0-4 WHO

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48
Q

management of mucositis

A

avoid smoking, alcohol, tea and coffee, v hot/spicy
Intensive OH
Remove sharp edges of teeth/ denture
topical lignocaine
Caphosol - Supersaturated CaPO4 MW
Difflam - Benzydamine Hydrochlorode
Analgesic - Morphine / Opioids (Doctor Prescription)
tea tree / Aleo Vera MW - check not allergy
ice during chemo

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49
Q

SEs of chemo

A 
alopecia - hair loss
nausea and vomiting
anorexia
bone marrow suppression
mucositis
transient dry mouth
coagulation defects
reduced WBCs
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50
Q

how does chemo work?

A

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

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51
Q

what % of chemo pts get mucositis?

A

around 75-80%

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52
Q

when does mucositis usually appear with chemo?

A

1-2 weeks after initiation of chemo

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53
Q

describe the general trajectory of chemo SEs

A

systemic but more transient

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54
Q

describe the general trajectory of radio SEs

A

chronic, progressive and localised

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55
Q

why is radio fractionated?

A
  • only kills dividing cells ( more sensitive)
  • reducing side effects
    • allows time for normal cells to repair themselves between treatments
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56
Q

dental SEs of radio

A 
hyposalivation
hypogeuesia
radiation caries
fungal infections
trismus
ORN
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57
Q

why is trismus a SE of radio?

A

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

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58
Q

ORN as a SE of radio?

A

dead bone shards
avascular necrosis
endarteritis obliterans - progressive fibrosis in the endothelium

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59
Q

what dose is the risk of SEs greater from radio?

A

> 60Gy

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60
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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61
Q

xerostomia management

A

palliative
water
Sugar free gum
tooth mousse

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62
Q

cancer post-tx dentist roles

A

rehabilitation
prevention
monitoring

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63
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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64
Q

MRONJ

A

exposed bone (not healed) at 8wks

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65
Q

incidence of MRONJ

A

overall risk small <1%

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66
Q

what is Parkinsons?

A

progressive neurodegenerative

basal ganglia - degeneration of dopamine receptors

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67
Q

aetiology of Parkinsons

A 
approx 5% genetic
most idiopathic
toxins?
cerebrovascular disease
head trauma
drug induced
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68
Q

how is Parkinsons diagnosed?

A

clinical diagnosis

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69
Q

Parkinsons S+S

A

rest tremor

  • reduced by action
  • increased by emotion/stress
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70
Q

which type of dementia is Parkinsons associated with?

A

Lewy body dementia

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71
Q

tx of Parkinsons

A

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

72
Q

outcome of Parkinsons

A

approx 10-15yrs death usually due to bronchopneumonia

73
Q

Parkinsons dental risk

A

risk of postural hypotension

74
Q

type of dementias

A 
Alzheimers
vascular dementia
dementia with Lewy bodies
frontotemporal dementia
Korsakoff's syndrome
early-onset dementia
75
Q

Alzheimer’s

A

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

76
Q

vascular dementia

A

reduced blood supply to brain

77
Q

dementia with Lewy bodies

A

protein deposits, links with Parkinsons

78
Q

frontotemporal dementia

A

lose filter ability - sexual/inappropriate comments

79
Q

Korsakoffs syndrome

A

alcohol

80
Q

early onset dementia

A

U65s

81
Q

signs of pain if pt not able to tell

A

behavioural changes
body language
mood changes

82
Q

Huntington’s disease

A

Aetiology: Chromosome 4 mutation
Symptoms : relentless progressive chorea and dementia

often mid-life
Alzheimer’s Disease- 50% chance

cerebral atrophy

83
Q

chorea

A

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

84
Q

S+S of Huntington’s

A

involuntary jerky movements
poor balance
personality changes - moody

85
Q

dental aspects of Huntingtons

A

communication
movements
swallowing

86
Q

stroke S+S

A 
interruption of brain blood supply
one side weakness/numb
dizziness
LOC
altered speech
87
Q

dental aspects of stroke

A

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

88
Q

SE of nicorandil (for angina)

A

large ulcers

89
Q

VAP - Ventilator-associated pneumonia

A 
most freq healthcare associated infection in intubated pts
main risk factor - endotracheal tube - impairs natural defence mechanisms
OH essential
diagnosis
 - temp >38
 - WCC >12000/mm3
 - + tracheal cultures
 - resp distress
 - chest xrays
90
Q

Berwick report

A 
pt safety in NHS
key principles
 - quality of pt care
 - engage patients and carers
 - growth and development of all staff
 - embrace transparency
91
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
92
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
93
Q

mid stage dementia tx planning

A

maintenance and prevention

94
Q

late stage dementia tx planning

A

comfort
free of pain and infection
non-invasive

95
Q

txing pts with dementia

A

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

96
Q

causes of LD

A

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

97
Q

syndromes associated with LD

A 
autism/Aspergers
Down syndrome
CP
Fragile X syndrome
Prader Willi
PKU
98
Q

CP

A 
1 in 400
neurological - affect movement and coordination
muscle stiffness/floppiness (hypotonia)
random and uncontrolled body movements
balance problems
99
Q

Down syndrome

A 
trisomy 21
CHDs
increased risk of haematological malignancy
reduced IQ
risk Alzheimers
PDD
dental anomalies
100
Q

Prader Willi syndrome

A 
15
constantly hungry - obesity
hypotonia
learning difficulties
behavioural problems
101
Q

Autism prep before visit

A 
my health passport
social stories
pre-visit
timing
specific language
take straight to surgery
102
Q

what can be used to aid keeping mouth open?

A

open wide mouth rests

103
Q

LD RFs

A

poor motor control
pouching
mouth breathing
meds

104
Q

LD toothbrushing advice

A

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

105
Q

clinical holding

A

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

106
Q

thickeners

A

dysphagia

prevent aspiration

107
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
108
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

109
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

110
Q

most common type of dementia

A

Alzheimers 60%

111
Q

dementia risk factors

A 
age
gender
genetics
MH
lifestyle
112
Q

dementia early stage symptoms

A

often misattributed
STML
confusion
anxiety

113
Q

dementia mid stage symptoms

A 
need more support inc reminders
distress, aggression
wandering
inappropriate behaviour
hallucinations
114
Q

dementia late stage symptoms

A

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

115
Q

dementia testing

A 
MMSE (not sensitive for frontal lobe)
Blessed Dementia Scale
MINICOG
GPCOG
dementia screen to eliminate treatable causes - diagnosis of exclusion
116
Q

what drug may delay the progression of dementia?

A

anticholinesterases

117
Q

risk of dementia in Down Syndrome

A

50%

118
Q

severe haemophilia

A

<1% factor

119
Q

non-selective B-blockers and LA

A

heightened sensitivity to effects of vasopressors in LA

120
Q

hypertensive crisis

A

> 180/110

121
Q

what is metformin?

A

antihyperglycaemic

122
Q

what is the leading cause of renal failure?

A

diabetes

123
Q

when do neutrophils drop to their lowest point in chemo?

A

10-14 days after chemo delivery

124
Q

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

A

10-14 days

125
Q

dose which gives risk of ORN

A

50 or more Gy

126
Q

how many WGs do you need consent from?

A

1

127
Q

UKELD

A

UK model end stage liver disease

128
Q

biotene oralbalance

A

lactoperoxidase

129
Q

saliva orthana

A

porcine mucin

130
Q

tooth mousse

A

recaldent CPP-ACP

131
Q

glandosane

A

carboxymethylcellulose

artificial saliva spray

132
Q

caphosol

A

supersaturated Ca and PO4

133
Q

where can chemo induced mucositis affect?

A

the whole GIT

134
Q

why are bisphosphonates used in cancer?

A

to reduce the risk of metastatic spread

135
Q

where do radiation caries typically appear?

A

cervical/smooth surface

136
Q

what can cannabis do to the CV system?

A

cause tachycardia

137
Q

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

A

FBC, coagulation screen, LFTs, U and Es

138
Q

when should you tx a pt on haemodialysis?

A

day after haemodialysis

139
Q

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

A

no

140
Q

max AWI

A

3yrs

141
Q

WG

A

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

142
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

143
Q

who should you contact to confirm welfare PofA?

A

Office of Public Guardian

144
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

145
Q

residual capacity

A

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

146
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

147
Q

benefit

A

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

148
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

149
Q

which part of the AWI Act is relevant to dentistry?

A

part 5

150
Q

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

A

“manipulation of mucosa and mucoperiosteum”

- not LA

151
Q

Down Syndrome and immune system

A

neutrophil chemotaxis impaired

152
Q

Dalteparin (fragmin)

A

low molecular weight heparin

153
Q

where is thrombopoietin made?

A

liver

154
Q

where are platelets made?

A

bone marrow

155
Q

if platelets <100 what should you do before ext?

A

speak to someone

156
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
157
Q

platelet level for a single uncomplicated tooth extraction

A

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

158
Q

S+S of liver disease

A 
jaundice
palmar erythema, spider naevi
bleeding and oesophageal varices
ascites
encephalopathy
if alcohol related: tremors, cognitive impairment
159
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
160
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

161
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

162
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

163
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
164
Q

liver disease and antibiotics

A

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

165
Q

liver disease and IV sedation

A

dentist led IV sedation with midazolam not appropriate

if need sedation - anaesthetist led propofol sedation or GA

166
Q

if pt needs medical transfusion product for tx

A

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

167
Q

is diazepam dialysable?

A

no

168
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
169
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

170
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

171
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
172
Q

cardinal features of Parkinsons

A 
bradykinesia
rigidity
resting tremor
postural instability
gradual symptom progression
sustained response to therapy with levodopa (precursor to dopamine)
173
Q

features of Parkinsons

A 
head forward
micrographia
mask like face
drooling
rigidity
resting tremor
akinesia
174
Q

vascular dementia

A

reduced blood flow to brain

175
Q

mod haemophilia

A

2-5% factor

176
Q

mild haemophilia

A

6-40% factor

BDS 3 SCD (1 decks)

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