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BDS 3 SCD > 3rd year key points > Flashcards

3rd year key points Flashcards

(176 cards)

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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
continuing Power of Attorney
finances and property
26
welfare Power of Attorney
health and personal welfare
27
2 types of guardianship orders
- **welfare** guardian - can consent dental tx - financial guardian - can't consent dental tx
28
Welfare Guardian orders
* 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
29
how long do Welfare Guardian orders usually last?
3yrs usually
30
certificate of incapacity
* 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
31
who can consent for dental tx
- pt with capacity - welfare power of attorney - welfare guardians - medical/ dental practitioners under **Section 47** of AWI Act (**General Authority to Treat**)
32
General Authority to treat conditions x3
- a valid certificate of incapacity is issued for the tx given - principles of the Act are observed - emergency
33
who can issue certificates of incapacity?
- GMP - consultant incharge of the patient care - dental practitioner / nurse/ optometrist who completed the training course
34
schizophrenia
disorders of thought (delusions) and perception (hallucinations)
35
schizophrenia aetiological factors
cannabis - tachycardia neurotransmitter imbalance genetic predisposition triggers - stress
36
clozapine and schizophrenia
* **atypical antipsychotic** (not first line) * **neutropenia** - monitor * don't do **smoking cessation** - can lead to severe toxicity - clozapine levels in plasma changed
37
why is dentist-led sedation contraindicated in pts with active uncontrolled psychiatric disease?
may have unpredictable reactions and increased tolerance
38
russell's sign
calluses on knuckles due to repeated self-induced vomiting
39
signs of Sjogren's Syndrome
* mirror sticks to mucosa * food residues in oral cavity * cracked tongue * ocular symptoms
40
SS risks
oral infections malignant change - lymphoma altered taste
41
reasons for dry mouth
* 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
42
cancer - pre-tx priorities
* OH * reduce tx complications * avoid chemo interruption * avoid mucositis exacerbation * remove potential sources of infection * reduce post-tx complications * prevention * plan rehab *
43
role of dentist for cancer pt
early detection pre-tx assessment - radiographs - necessary tx - pre-tx scaling dentate pts - imps for soft splints - start F therapy
44
during cancer tx role of dentist
ulceration infection emergency tx
45
pain relief for mucositis
opioid analgesia - severe pain
46
pathogenesis/stages of mucositis
inflammatory/vascular - cytokines released epithelial - atrophy ulceration/bacterial - full thickness erosion healing - epithelium renewal
47
grading of mucositis
0-4 WHO
48
management of mucositis
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
49
SEs of chemo
``` alopecia - hair loss nausea and vomiting anorexia bone marrow suppression mucositis transient dry mouth coagulation defects reduced WBCs ```
50
how does chemo work?
cytotoxic - interact with cancer cell DNA/RNA and affect a phase of life cycle
51
what % of chemo pts get mucositis?
around 75-80%
52
when does mucositis usually appear with chemo?
1-2 weeks after initiation of chemo
53
describe the general trajectory of chemo SEs
systemic but more transient
54
describe the general trajectory of radio SEs
chronic, progressive and localised
55
why is radio fractionated?
- only kills dividing cells ( more sensitive) - reducing side effects - allows time for normal cells to repair themselves between treatments
56
dental SEs of radio
``` hyposalivation hypogeuesia radiation caries fungal infections trismus ORN ```
57
why is trismus a SE of radio?
**replacement fibrosis of MofM** following progressive endarteritis of affected tissues with decrease in blood supply irreversible
58
ORN as a SE of radio?
dead bone shards avascular necrosis endarteritis obliterans - progressive fibrosis in the endothelium
59
what dose is the risk of SEs greater from radio?
>60Gy
60
cancer - IO reactivation of herpes simplex
``` so immunocompromised clinically atypical painful oral ulceration, sudden onset extensive, slow healing and aggressive ulceration on palate and tongue dorsum ```
61
xerostomia management
palliative water Sugar free gum tooth mousse
62
cancer post-tx dentist roles
rehabilitation prevention monitoring
63
dentist pre-tx for cancer - getting pt dentally fit
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
64
MRONJ
exposed bone (not healed) at 8wks
65
incidence of MRONJ
overall risk small <1%
66
what is Parkinsons?
progressive neurodegenerative | basal ganglia - degeneration of dopamine receptors
67
aetiology of Parkinsons
``` approx 5% genetic most idiopathic toxins? cerebrovascular disease head trauma drug induced ```
68
how is Parkinsons diagnosed?
clinical diagnosis
69
Parkinsons S+S
rest tremor - reduced by action - increased by emotion/stress
70
which type of dementia is Parkinsons associated with?
Lewy body dementia
71
tx of Parkinsons
drug therapy when fct disability Levidopa - non-ergot dopamine agonist Carbidopa - prolongs action late management - reduce motor fluctuation
72
outcome of Parkinsons
approx 10-15yrs death usually due to bronchopneumonia
73
Parkinsons dental risk
risk of postural hypotension
74
type of dementias
``` Alzheimers vascular dementia dementia with Lewy bodies frontotemporal dementia Korsakoff's syndrome early-onset dementia ```
75
Alzheimer's
lose connections between neurones - protein plaques and tangles less chemical messengers
76
vascular dementia
reduced blood supply to brain
77
dementia with Lewy bodies
protein deposits, links with Parkinsons
78
frontotemporal dementia
lose filter ability - sexual/inappropriate comments
79
Korsakoffs syndrome
alcohol
80
early onset dementia
U65s
81
signs of pain if pt not able to tell
behavioural changes body language mood changes
82
Huntington's disease
Aetiology: **Chromosome 4 mutation** Symptoms : relentless progressive **chorea** and dementia often mid-life Alzheimer’s Disease- 50% chance cerebral atrophy
83
chorea
a movement disorder that causes involuntary, irregular, unpredictable muscle movements
84
S+S of Huntington's
involuntary jerky movements poor balance personality changes - moody
85
dental aspects of Huntingtons
communication movements swallowing
86
stroke S+S
``` interruption of brain blood supply one side weakness/numb dizziness LOC altered speech ```
87
dental aspects of stroke
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
SE of nicorandil (for angina)
large ulcers
89
VAP - Ventilator-associated pneumonia
``` 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
Berwick report
``` pt safety in NHS key principles - quality of pt care - engage patients and carers - growth and development of all staff - embrace transparency ```
91
barriers to change - OH in care homes
``` 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
early stage dementia tx planning
``` oral assessment plan for future consider replica models identify and try to retain key teeth - 4 occluding pairs - L anteriors ```
93
mid stage dementia tx planning
maintenance and prevention
94
late stage dementia tx planning
comfort free of pain and infection non-invasive
95
txing pts with dementia
communication - approach from front break it down non-verbal right env
96
causes of LD
preconception - parental genotype pre-natal - maternal health, toxics perinatal - injury post-natal - infection, trauma, SSD
97
syndromes associated with LD
``` autism/Aspergers Down syndrome CP Fragile X syndrome Prader Willi PKU ```
98
CP
``` 1 in 400 neurological - affect movement and coordination muscle stiffness/floppiness (hypotonia) random and uncontrolled body movements balance problems ```
99
Down syndrome
``` trisomy 21 CHDs increased risk of haematological malignancy reduced IQ risk Alzheimers PDD dental anomalies ```
100
Prader Willi syndrome
``` 15 constantly hungry - obesity hypotonia learning difficulties behavioural problems ```
101
Autism prep before visit
``` my health passport social stories pre-visit timing specific language take straight to surgery ```
102
what can be used to aid keeping mouth open?
open wide mouth rests
103
LD RFs
poor motor control pouching mouth breathing meds
104
LD toothbrushing advice
sit up behind pt encourage pt to do as much as possible
105
clinical holding
consent no capacity and deemed of benefit - safety risk unplanned emergencies always record and justify
106
thickeners
dysphagia | prevent aspiration
107
self-injurious behaviour management
``` 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
safeguarding
``` 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
dementia definition
syndrome - chronic/progressive deterioration in cognitive fct beyond what might be expected from normal ageing consciousness not affected depression and anxiety often precursors
110
most common type of dementia
Alzheimers 60%
111
dementia risk factors
``` age gender genetics MH lifestyle ```
112
dementia early stage symptoms
often misattributed STML confusion anxiety
113
dementia mid stage symptoms
``` need more support inc reminders distress, aggression wandering inappropriate behaviour hallucinations ```
114
dementia late stage symptoms
physical frailty - shuffle can't recognise people incontinence loss of speech
115
dementia testing
``` MMSE (not sensitive for frontal lobe) Blessed Dementia Scale MINICOG GPCOG dementia screen to eliminate treatable causes - diagnosis of exclusion ```
116
what drug may delay the progression of dementia?
anticholinesterases
117
risk of dementia in Down Syndrome
50%
118
severe haemophilia
<1% factor
119
non-selective B-blockers and LA
heightened sensitivity to effects of vasopressors in LA
120
hypertensive crisis
>180/110
121
what is metformin?
antihyperglycaemic
122
what is the leading cause of renal failure?
diabetes
123
when do neutrophils drop to their lowest point in chemo?
10-14 days after chemo delivery
124
how long should you allow for healing after ext prior to oncology tx?
10-14 days
125
dose which gives risk of ORN
50 or more Gy
126
how many WGs do you need consent from?
1
127
UKELD
UK model end stage liver disease
128
biotene oralbalance
lactoperoxidase
129
saliva orthana
porcine mucin
130
tooth mousse
recaldent CPP-ACP
131
glandosane
carboxymethylcellulose | artificial saliva spray
132
caphosol
supersaturated Ca and PO4
133
where can chemo induced mucositis affect?
the whole GIT
134
why are bisphosphonates used in cancer?
to reduce the risk of metastatic spread
135
where do radiation caries typically appear?
cervical/smooth surface
136
what can cannabis do to the CV system?
cause tachycardia
137
for end stage liver disease, before operative dental tx what should you request?
FBC, coagulation screen, LFTs, U and Es
138
when should you tx a pt on haemodialysis?
day after haemodialysis
139
do you need an AWI certificate to tx a spreading dental infection?
no
140
max AWI
3yrs
141
WG
a person who is legally appointed by the courts to make the decision on behalf of a person who lacks capacity
142
PofA
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
who should you contact to confirm welfare PofA?
Office of Public Guardian
144
purpose of AWI
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
residual capacity
ensure everything possible is done to provide the individual with the opportunity to decide about the medical tx they receive
146
least restrictive option
any action/decision taken should be the min to achieve the purpose should be the option that restricts freedom as little as possible
147
benefit
any action or decision must benefit the pt and only be taken when that benefit cannot reasonably be achieved without it
148
consultation with relevant others
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
which part of the AWI Act is relevant to dentistry?
part 5
150
if a pt needs ABP for invasive procedures, what does this cover?
"manipulation of mucosa and mucoperiosteum" | - not LA
151
Down Syndrome and immune system
neutrophil chemotaxis impaired
152
Dalteparin (fragmin)
low molecular weight heparin
153
where is thrombopoietin made?
liver
154
where are platelets made?
bone marrow
155
if platelets <100 what should you do before ext?
speak to someone
156
causes of inability to achieve haemostasis
``` inherited/congenital bleeding disorders medication induced other drugs e.g. chemo SE haematological disease infections liver disease ```
157
platelet level for a single uncomplicated tooth extraction
>50 x10 ^9/L should be a safe level to achieve haemostasis
158
S+S of liver disease
``` jaundice palmar erythema, spider naevi bleeding and oesophageal varices ascites encephalopathy if alcohol related: tremors, cognitive impairment ```
159
causes of liver disease
``` infective - hepatitis virus autoimmune - primary biliary cirrhosis alcohol related non-alcoholic fatty liver disease hemochromatosis drug induced hepatocellular carcinoma ```
160
stages of liver disease
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
UKELD score
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
liver disease and LAs
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
liver disease and post-op analgesia
``` 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
liver disease and antibiotics
may need to alter dose amoxicillin safe may need to alter dose of metronidazole erythromycin can affect liver
165
liver disease and IV sedation
dentist led IV sedation with midazolam not appropriate | if need sedation - anaesthetist led propofol sedation or GA
166
if pt needs medical transfusion product for tx
do as much tx as possible as transfusion comes with associated risks
167
is diazepam dialysable?
no
168
cannabis and dentistry
``` 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
bulimia presentations
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
post-vom methods of increasing pH
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
cancer GDP pre-tx
``` radiographs and assessment any necessary tx pre-tx scaling imps for soft splints if dentate F therapy if dentate ```
172
cardinal features of Parkinsons
``` bradykinesia rigidity resting tremor postural instability gradual symptom progression sustained response to therapy with levodopa (precursor to dopamine) ```
173
features of Parkinsons
``` head forward micrographia mask like face drooling rigidity resting tremor akinesia ```
174
vascular dementia
reduced blood flow to brain
175
mod haemophilia
2-5% factor
176
mild haemophilia
6-40% factor

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