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BDS3 Special Care Dentistry > Bariatric Care > Flashcards

Bariatric Care Flashcards

1
Q

What is overweight and obesity defined as?

A
  • Defined as abnormal or excessive fat accumulation that may impair health
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2
Q

What is a bariatric person?

A
  • A bariatric person is an individual of any age (child to adult)who has limitations in health and social care due to physical size, health, mobility and environmental access
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3
Q

What does the WHO define an overweight persons BMI to be?

A

> or equal to 25kg/M2

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4
Q

What does the WHO define an obese persons BMI to be?

A

> or equal to 30kg/M2

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5
Q

What is BMI defined as?

A
  • Defined as weight in kg divided by the square of height in metres
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6
Q

What are the positives about calculating BMI?

A
  • BMI provides the most useful population-level measure as it is inexpensive, easy to use, the same for both sexes and for all ages of adult
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7
Q

What are the limitations of a BMI? (2)

A
  • Does not assess body fat distribution, because it is a measure of excess weight rather than excess body fat
  • Does not account for factors such as age, sex, ethnicity, and muscle mass
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8
Q

What is the fundamental cause of obesity/overweight?

A
  • IS the energy imbalance between calories consumed and calories expended
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9
Q

What is obesity?

A
  • IT is a complex, multifactorial, chronic disease that is strongly associated with multiple comorbidities
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10
Q

What is it common to find obesity co-existing with?

A

Undernutrition

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11
Q

Multiple factors influence obesity. What are these? (4)

A
  • Genetics, socioeconomic status, environment and individual decisions play a significant role
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12
Q

List contributing factors to obesity? (6)

A
  • Underlying health problems e.g. hypothyroidism in down’s syndrome and eating issues such as Prader-willi syndrome
  • A lack of energy
  • Difficulty with chewing or swallowing food or its taste or texture
  • Medications that can contribute to weight gain and changes to appetite e.g. steroid medication
  • Physical limitations that can reduce a person’s ability to exercise without pain on movement e.g. in cerebral palsy, rheumatoid arthritis
  • Lifestyle factors: A lack of healthy food choices; accessible environments that enable exercise; resources and appropriate social support systems
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13
Q

Does the equality act 2010 classify obesity as a disability?

A
  • No
  • However, conditions associated with obesity may lead to disability
  • So failure to provide suitable safe facilities for bariatric patients has the potential to breach the Equality act
  • Those with disabilities should have the same access to health care as anyone else and it is the responsibility of health care professionals to make reasonable adjustments to aid universal access to our services
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14
Q

What are the roles of the dental team in relation to bariatric patients? (6)

A
  • Identify oral health issues associated with the bariatric patient
  • Signpost patients to appropriate services e.g. weight management
  • Be aware of comorbidities or predisposition to dental disease
  • Appropriate referral into secondary and tertiary care
  • May have to provide emergency care prior to onward referral
  • Raise concerns with patient, parents or carers of vulnerable adults or children
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15
Q

Prior to the appointment what should you do for a bariatric patient? (2)

A
  • Ensure your venue has appropriate facilities for patient care
  • This may involve telephoning the patient/referrer/care prior to initial visit querying: patient weight or BMI, mobility e.g. do they use a wheelchair? manual or motorised?
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16
Q

What should you find out about travel in regards to a bariatric patient? (2)

A
  • Is the patient taking private transport e.g. car/taxi? Parking should be available as close to the venue as possible
  • Ambulance transport - will only take patients to hospitals
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17
Q

What should you think about in relation to accessibility in regards to a bariatric patient? (6)

A
  • Waiting room with suitable high weight bearing armless chair
  • Adequate door width
  • Toilet facilities accessible
  • Is the practice accessible via lifts or stairs
  • Emergency evacuation procedures
  • Under no circumstances should staff attempt to break the fall of an obese patient
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18
Q

What should we think about in relation to timing in regards to a bariatric patient? (2)

A
  • May require longer appointment times due to reduced mobility
  • Extra weight around the face can obstruct the access to the mouth
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19
Q

What should we think about in relation to safety in regards to a bariatric patient? (5)

A
  • Specialist equipment may mean patients need referral to specialist clinics or hospitals
  • Wider cuff blood pressure monitors, longer IM needles are needed
  • May be unable to get patient rapidly into supine/recovery position or physically move patient
  • Airway management may be more difficult
  • Resuscitation - identification of landmarks for chest compressions may be difficult
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20
Q

What should we think about in relation to the dental chair in regards to a bariatric patient? (4)

A
  • If the patient does not know their weight and is perceived to exceed 22 stone/140kg an accurate weight must be obtained through weighing the patient
  • Unfortunately most standard weighing scaled only weigh up to 22 stone
  • People who carry weight on their chest and upper body are at risk of hypoxaemia when lying flat
  • In extreme circumstances some obese patients may present with obesity hypoventilation syndrome, a result of chronic hypoventilation due to the excess weight preventing full expansion pf the lungs
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21
Q

What are examples of medical complications that people with excess weight are at risk of? (9)

A
  • Hypertension and CVA (do they suffer from angina? at rest or on exertion?)
  • Diabetes
  • Sleep apnoea (may use a CPAP machine)
  • Dyspnoea - are they able to walk comfortably without getting breathless?
  • GORD - especially after bariatric surgery
  • Osteoarthritis
  • Depression/anxiety (often directly related to embarrassment/shame due to their size)
  • Liver and gall bladder disease
  • Skin conditions such as cellulitis and intertrigo (inflammation within excessive body folds)
22
Q

What are possible challenges of providing treatment to a bariatric patient? (5)

A
  • Loss of anatomical landmarks is possible. There are access problems with large cheeks, tongue etc
  • ID blocks may be difficult. Alternative techniques may need to be considered such as the gow-gate or intraligamentary techniques
  • Consider use of a ‘lax’ tongue retractor if a dental mirror is insufficient for soft tissue retraction
  • May have to be treated semi-supine or sitting upright - practitioners need to be careful with their posture
  • Beware operator musculo-skeletal problems when working in a less than ideal position
23
Q

Why might intra-oral radiography be hard to do for a bariatric patient?

A
  • Might be more challenging due to increased soft tissues
24
Q

Why might OPT be difficult to do with a bariatric patient?

A
  • Can be difficult or impossible if the machine is unable to accommodate the patient’s size
25
Q

What can long procedures lead to in bariatric patients? (4)

A
  • Leg oedema
  • Cellulitis
  • Compartment syndrome
  • Pressure sores
26
Q

What is compartment syndrome?

A
  • Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment.
27
Q

Coagulation abnormalities may occur when giving treatment to bariatric patients. What can this be due to?

A
  • Can be due to non-alcoholic fatty liver disease
28
Q

What may excessive fat in the tissues have an effect in in relation to treatment of a bariatric patient?

A
  • It might affect the pharmacological absorption of a drug
29
Q

One dental implication of being a bariatric patient is the increased risk of periodontitis. Discuss this? (4)

A
  • The relationship between obesity and periodontal disease has been acknowledged as associative but there is no evidence of a causal relationship
  • Obesity does not appear to play a negative role in the treatment outcome of non-surgical periodontal therapy
  • Diabetic patients have a high associated risk of periodontal disease
  • Be aware of the complexity of obesity and be able to discuss the importance of maintaining healthy body weight and performing good oral hygiene procedures
30
Q

What other dental implications are bariatric patients more at risk of? (3)

A
  • Caries
  • Wound healing
  • Tooth-wear
31
Q

Explain the relationship between caries and bariatric patients?

A
  • Bariatric patients may have a higher caries rate than the general population as causations are interrelated (diet high in processed sugars)
32
Q

Explain the relationship between would healing and bariatric patients?

A
  • Extractions, surgical periodontal treatment, biopsies

- Bariatric patients are more likely to have reduced immune function leading to delayed wound healing

33
Q

Explain the relationship between tooth-wear and bariatric patients?

A
  • Erosive tooth wear is more likely - increased prevalence of GORD in bariatric patients
  • Increased incidence of oesophageal reflux, in particular in those having gastric banding, causing acid erosion
34
Q

What is domiciliary care?

A
  • Domiciliary care, in short, is for anyone who wants to remain independent within the comfort of their own home rather than move into residential care, but may need some extra help in order for that to happen.
35
Q

When is domiciliary care a useful option?

A
  • When patients are too large and/or too anxious to leave their home
36
Q

When might we use a domiciliary visit for a bariatric patient?

A
  • A domiciliary visit may be useful for initial assessment, then arranging further review in the clinic. Full risk assessment is essential
37
Q

What is dental treatment restricted to in domiciliary visits?

A
  • Usually restricted to inexpensive, short procedures which carry little risk such as examinations
38
Q

What is the most common type of dental treatment given in domiciliary care?

A
  • Prosthetics
39
Q

When bariatric patients require emergency care what should you do? (4)

A
  • Provide emergency relief of pain treatment only, weighing up risks and benefits
  • Patient and staff health and safety should not be compromised
  • ID a patient is unsuitable for your dental chair consider treating them in their own wheelchair or in a bariatric wheelchair
  • Future appointments should be arranged in a clinic with suitable facilities
40
Q

Why is obesity and people with learning disabilities increasingly interlinked?

A
  • Thought to be multifactorial, with people with learning disabilities often having poorly balanced diets, more sedentary lifestyles and possible genetic predisposition to weight gain, such is the case in prader-Willi syndrome or in down’s syndrome
  • Anti-psychotic medications, such as clozapine and olanzapine, predispose patients to weight gain
41
Q

Are there any risks in giving bariatric patients inhalation sedation?

A
  • No specific contraindications however special care must be taken to ensure good safe airway management.
  • This may be the most appropriate form of sedation for these patients
42
Q

Are there any risks in giving bariatric patients intravenous sedation?

A
  • Obese adults are at risk of sleep apnoea - a contraindication to dental sedation in a primary care setting
  • Bariatric adults are not suitable for conscious sedation in a standard dental clinic due to difficulty placing cannula
  • Bariatric adults may have compromised airways which require specialist teams to manage in an emergency with the appropriate resuscitation equipment
43
Q

Are there any risks in giving bariatric patients general anaesthetic?

A
  • Obese patients are twice as likely to develop serious airway problems during a GA than non-obese
44
Q

When communicating with our bariatric patients we need to explain any changes to treatment plan/venue as a result of their weight sensitively but honestly. What will this include? (5)

A
  • Patients may be quite resistant to being referred elsewhere - they may feel ashamed or upset
  • They may have experiences discrimination in many services because of their size
  • Highlight the importance of you and your patient’s safety and also the need for the best possible care in the best possible setting. Keep reasons technical and not personal
  • Making too much of an issue regarding a patients weight may only serve to make them more embarrassed and anxious when attending the dentist. This may make them less likely to re-attend
  • Arrange onward referral as required and keep the patient informed
45
Q

What are the positives of bariatric surgery?

A
  • Results in greater improvement in weight loss outcomes, improved control of comorbidities and significant improvement in self-esteem
46
Q

What are the negatives of bariatric surgery?

A
  • Negative consequences e.g. nutritional deficiencies, ‘dumping’ syndrome and eating disorders, such as anorexia, bulimia and compulsive eating
47
Q

Bariatric surgery has a correlation with oral problems. Give examples of these problems? (6)

A
  • Periodontal disease
  • Increase in dental caries
  • Hyposalivation
  • Ulcers
  • Dentine sensitivity
  • Halitosis
48
Q

Why are patients who have had bariatric surgery are at a higher risk of dental erosion?

A
  • Due to the common side effect of reflux and vomiting
49
Q

Following bariatric surgery patients are advised to divide food into 4-6 meals throughout the day, chewing slowly. Why is this not so good for dental health?

A
  • higher frequency and prolonged meal times = increase risk of caries as sugary items are ingested
50
Q

Once a patient has had bariatric surgery GDP’s can provide simple and clear messages to patients. What are these? (10)

A
  • Ingestion of a health, balanced diet
  • Adequate oral hygiene
  • Simulate salivary flow to avoid dry mouth +/- artificial saliva
  • Increase the consumption of foods rich in fibre
  • Chew gum without sugar, but only two months after surgery
  • To avoid halitosis or coated tongue, brush the tongue or use a tongue scraper
  • Take care to avoid tooth wear
  • Drink soft drinks or fruit juices through a straw to minimize contact with teeth; in case of ingesting soft drinks, never brush right afterwards but perform mouth rinsing with water
  • Never brush teeth after episodes of vomiting or reflux, if you are not at home, perform mouth rinsing with water or chew gum without sugar; if you are at home; perform mouth rinsing with sodium bicarbonate
  • Provide topical fluoride varnish and OHI ad required

BDS3 Special Care Dentistry (9 decks)

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