9.1 Special care dentistry

Question 1

Which groups are managed in special care dentistry?

Answer 1

• 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

Question 2

How does WHO define oral health?

Answer 2

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.

Question 3

What are the challenges of human disease for oral health?

Answer 3

• Increasing ageing population
• Increasing population living with disabilities
• Limitation in activity in population
• Impact of disease on oral health directly/indirectly

Question 4

What barries to oral care may exist for those with disabilities?

Answer 4

• 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

Question 5

Why are medical history taking skills important?

Answer 5

• 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

Question 6

What is mucositis?

Answer 6

A side effect of chemotherapy/radiotherapy causing inflammation of the oral mucosa.
Extremely sore.
Provide pain relief, antibacterial mouthwashes (chlorhexidine), soft and bland food.

Question 7

What are the implications of an ageing population?

Answer 7

• 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

Question 8

How could you accomodate a patient with a condition affecting their seating in a dental chair?

Answer 8

• Pillows
• Head support

Question 9

What effects can bone marrow conditions have on oral health?

Answer 9

• Gingival bleeding
• Intraoral bruising
• Poor wound healing
• Ulcers
• Opportunistic infections
• Pallor

Question 10

What effects can endocrine conditions have on oral health?

Answer 10

• Hyperpigmentation (adrenal dysfunction)
• Infection/poor wound healing (diabetes)
• Delayed tooth eruption (hypothyroidism)

Question 11

What effects can bone GI conditions have on oral health?

Answer 11

• Halitosis
• Tooth erosion (reflux)
• Ulceration (Crohn’s)

Question 12

What effects can liver conditions have on oral health?

Answer 12

• Gingival bleeding (cirrhosis)
• Yellowing mucosa (jaundice)

Question 13

What effects can neuromuscular conditions have on oral health?

Answer 13

• Swallowing/speech.chewing problems
• Drooling
• Facial palsy
• Taste changes

Question 14

What effects can psychological conditions have on oral health?

Answer 14

• Bulimia, erosion
• Trauma (self-injurious behaviour)
• Poor oral hygiene
• TMD

Question 15

What effects can renal conditions have on oral health?

Answer 15

• Oral odour
• Pallor
• Taste changes
• Uremic stomatitis

Question 16

What physical issues can affect oral hygiene?

Answer 16

• Arthritis
• Neurological e.g. stroke
• Movement disorders

Question 17

What cognitive issues can affect oral hygiene?

Answer 17

• Learning disabilities
• Dementia

Question 18

What sesnsory issues can affect oral hygiene?

Answer 18

• Visual impairment
• Autism spectrum disorder e.g. strong taste of toothpaste, harsh bristles

Question 19

Name some factors to consider when treating patients with cardiovascular disease.

Answer 19

• Bleeding risk
• Drug interactions
• Infection risk
• Pain/anxiety management
• Medical emergency

Liaise with cardiologist/GP.
Monitor INR if appropriate.
Have emergency drugs in practice.

Question 20

What dental considerations should be made for patients with cardiovascular conditions?

Answer 20

• 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

Question 21

Considerations for patients with respiratory disease.

Answer 21

• 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

Question 22

Considerations for patients with high bleeding risk.

Answer 22

• 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

Question 23

Considerations for patients with diabetes.

Answer 23

• HbA1c levels (not blood glucose levels)
• Risk of infection and poor wound healing
• Medical emergency: hypoglycaemia
• May experience candida, burning mouth syndrome, xerostomia