Bariatric Care

Question 1

What is obesity?

Answer 1

An abnormal or excessive fat accumulation that may impair health

Question 2

Who is considered a bariatric patient?

Answer 2

An individual of any age who has limitations in health and social care due to physical size and mobility

Question 3

What is the BMI value for an overweight individual?

Answer 3

25kg/m or more

Question 4

What is the BMI value for an obese individual?

Answer 4

30kg/m or more

Question 5

How do you calculate BMI?

Answer 5

Weight (Kg) divided by the height (m) squared

Question 6

Advantages of using BMI?

Answer 6

• useful for population measure
• inexpensive
• easy to use
• universal for both sexes and all ages

Question 7

Limitations of BMI?

Answer 7

• doesn’t assess body fat distribution
• doesn’t account for muscle mass

Question 8

What are the factors affecting obesity?

Answer 8

• underlying health problems (e.g. Down’s syndrome or Prader-Willi syndrome)
• Genetics
• socioeconomic status
• medications
• physical limitations (mobility issues reducing exercise)
• lifestyle factors (e.g. lack of healthy food, unable to exercise)

Question 9

What legislation protects bariatric patients?

Answer 9

The Equality Act 2010

Question 10

List considerations for treating a bariatric patient before they even attend an appointment?

Answer 10

Travel - may require transport by ambulance or vehicle able to facilitate wheelchairs

Accessibility - suitable chairs in the waiting room (armless chairs)

Timing - reduced mobility may affect length of appointment

Safety - airway management and resuscitation more difficult
- may not be able to put patient into recovery position

Equipment - may need higher weight dental chair or mobility aids if patient uses a wheelchair

Question 11

What are common co-morbidities associated with obesity?

Answer 11

• Diabetes
• Hypertension
• Cardiovascular disease
• Non-alcoholic fatty liver disease
• Gastro-Oesophageal Reflux disease
• Sleep apnoea
• Osteoarthritis
• skin conditions (cellulitis in excessive body folds)

Question 12

What are affects to dental treatment due to obesity?

Answer 12

• loss of anatomical landmarks
• clotting issues due to non-alcoholic fatty liver disease
• long procedures can lead to acute leg oedema, cellulitis and pressure sores
• IDB may be more difficult and different techniques may need to be used
• may need a LAX tongue retractor if dental mirror insufficient at retracting soft tissue
• may need to treat semi-upright or supine due to being unable to lie down
• Intra-oral Radiographs can be more difficult due to increased soft tissues

Question 13

What are dental implications of bariatric patients?

Answer 13

• more likely to have diabetes which is highly associated with periodontal disease
• higher caries rate linked to high sugar diet
• delayed wound healing due to reduced immune function
• More likely to have erosive tooth wear due to GORD, Gastric band treatment causing acid erosion from reflux and high sugar diet

Question 14

What is the aim of emergency appointments?

Answer 14

To provide treatment that will receive pain only

Question 15

What is the main concern when using inhaled sedation on bariatric patients

Answer 15

To ensure good safe airway management

Question 16

What are contraindications for intravenous sedation in bariatric patients

Answer 16

• risk of sleep apnoea
• placing a cannula required to be done in hospital setting
• compromised airways require specialist management

Question 17

What is the most appropriate form of sedation for bariatric patients?

Answer 17

Inhaled sedation

Question 18

What is the effect of bariatric surgery on dental health?

Answer 18

• Patients are advised to eat 4-6 smaller meals throughout the day, this increases the acid attacks on teeth

causes increased risk of dental caries, halitosis, periodontal disease