9.1 Special care dentistry Flashcards
Which groups are managed in special care dentistry?
- Physical, intellectual and sensory disability
- Sensory impairment
- Frail older people
- Mental health conditions
- Medically complex
- Dental anxiety/phobia
- Social impairment e.g. homeless, asylum seekers, drug users
How does WHO define oral health?
A state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal disease, tooth decay, tooth loss and other diseases and disorders; that limit an individual’s capacity in biting, chewing, smiling, speaking and psychosocial wellbeing.
What are the challenges of human disease for oral health?
- Increasing ageing population
- Increasing population living with disabilities
- Limitation in activity in population
- Impact of disease on oral health directly/indirectly
What barries to oral care may exist for those with disabilities?
- Access issues, getting to the practice, into the practice, into the chair
- Communication issues
- Cooperation issues
- Medical risks
- Oral risks
- Legal barriers, capacity to consent affected e.g. dementia
Why are medical history taking skills important?
- Medical status affects dental management
- Must enquire specifically about serious illnesses, hospitalisation, surgeries, allergies, medications and compliance with taking medications
- Appropriate precautions should be taken to avoid medical emergencies
- If conditions are poorly controlled you may need to refer
- Medications may be required prior to dental procedures e.g. steroid/antibiotic cover
- Non-disclosure of medical condition, e.g. substance misuse, infectious disease, mental health
What is mucositis?
A side effect of chemotherapy/radiotherapy causing inflammation of the oral mucosa.
Extremely sore.
Provide pain relief, antibacterial mouthwashes (chlorhexidine), soft and bland food.
What are the implications of an ageing population?
- 80% of over 75s are on medication, come with potential oral side effects, drug interactions, compliance
- 24% of 65-74 year olds are obese, risk of co-morbidities, dental chair limit
- Impact on dental treatment/healing
- Cognitive impairment e.g. dementia
- Sensory impairent, consider written information/surgery signs
How could you accomodate a patient with a condition affecting their seating in a dental chair?
- Pillows
- Head support
What effects can bone marrow conditions have on oral health?
- Gingival bleeding
- Intraoral bruising
- Poor wound healing
- Ulcers
- Opportunistic infections
- Pallor
What effects can endocrine conditions have on oral health?
- Hyperpigmentation (adrenal dysfunction)
- Infection/poor wound healing (diabetes)
- Delayed tooth eruption (hypothyroidism)
What effects can bone GI conditions have on oral health?
- Halitosis
- Tooth erosion (reflux)
- Ulceration (Crohn’s)
What effects can liver conditions have on oral health?
- Gingival bleeding (cirrhosis)
- Yellowing mucosa (jaundice)
What effects can neuromuscular conditions have on oral health?
- Swallowing/speech.chewing problems
- Drooling
- Facial palsy
- Taste changes
What effects can psychological conditions have on oral health?
- Bulimia, erosion
- Trauma (self-injurious behaviour)
- Poor oral hygiene
- TMD
What effects can renal conditions have on oral health?
- Oral odour
- Pallor
- Taste changes
- Uremic stomatitis
What physical issues can affect oral hygiene?
- Arthritis
- Neurological e.g. stroke
- Movement disorders
What cognitive issues can affect oral hygiene?
- Learning disabilities
- Dementia
What sesnsory issues can affect oral hygiene?
- Visual impairment
- Autism spectrum disorder e.g. strong taste of toothpaste, harsh bristles
Name some factors to consider when treating patients with cardiovascular disease.
- Bleeding risk
- Drug interactions
- Infection risk
- Pain/anxiety management
- Medical emergency
Liaise with cardiologist/GP.
Monitor INR if appropriate.
Have emergency drugs in practice.
What dental considerations should be made for patients with cardiovascular conditions?
- Short morning appointments
- Blood pressure measurements
- Check drug compliance
- Avoid elective treatment until 6/12 months post myocardial infarction or stroke
- Care with LA, make sure to aspirate, may need LA without adrenaline
- Poorly controlled conditions, refer to specialist care
- Medical emergency training and equipment accessible
- Check antibiotic cover for high risk infective endocarditis
- Check INR for pts taking Warfarin
Considerations for patients with respiratory disease.
- If taking a steroid inhaler, should use a spcaer and rinse mouth with water after use
- Chair may need to be slightly upright
- Steroid supplementation, if required
- No fluoride varnish if asthmatic (colophony)
- Care with use of sedation, consider supplemental oxygen
- GA may be contraindicated
- COPD, risk of aspiration pneumonia with poor oral health
Considerations for patients with high bleeding risk.
- Pt may have an inherited bleeding disorder e.g. Haemophilia, Von Willebrands, platelet disorder
- Pt may have an acquired bleeding disorder e.g. liver/renal disease, bone marrow disorder, spleen disorder, thrombocytopenia, immune disorder such as HIV or ITP
- Extractions may need sutures and/or haemostatic agents
Considerations for patients with diabetes.
- HbA1c levels (not blood glucose levels)
- Risk of infection and poor wound healing
- Medical emergency: hypoglycaemia
- May experience candida, burning mouth syndrome, xerostomia
