Bariatric Dental Care Flashcards
1
Q
What is a bariatric person?
A
an individual of any age who has limitations in health and social care due to physical size, health, mobility and environmental access
2
Q
What is BMI defined as and what is the normal range?
A
- the weight in kilograms divided by the square height in meters
- 18.5-24.5
3
Q
What are the limitations of BMI?
A
- does not assess body fat distribution
- measures excess weight rather than body fat
- does not account for several important factors
- sex
- age
- ethnicity
- muscle mass
4
Q
What factors can contribute to obesity?
A
- fundamentally result of an energy imbalance between calories consumed and calories expended
- genetics
- socioeconomic status
- environment
- individual decisions
- lifestyle choices
- lack of healthy food choices
- underlying health problems
- hypothyroidism
- Down’s syndrome
- Prader-Willi syndrome (constant feeling of hunger)
- medications
- steroid medication - physical limitations
- cerebral palsy
- rheumatoid arthritis
- lack of energy
- difficulty with chewing or swallowing food
- difficulty with taste and texture
5
Q
How does the Equality Act 2010 consider obesity?
A
- obesity is not classified as a disability
- conditions associated may lead to disability
- failure to provide suitable and safe facilities for bariatric patients has the potential to breach the act
6
Q
What is the role of the dental team in relation to bariatric patients?
A
- identify and diagnose oral health issues associated with obesity
- signpost patients to appropriate services
- weight management
- GP
- awareness of co-morbidities of obesity
- predisposition to dental disease
- appropriate referral to secondary and tertiary care
- provide emergency care before this if required
- raise concerns with patients, parents or cares of vulnerable adults and children
7
Q
What are the challenges a bariatric patient may face when accessing dental care?
A
- transportation
- bariatric ambulance transport only goes to hospitals
- waiting room
- adequate width of chairs
- adequate door widths (potentially wheelchair)
- accessible toilet facilities
- lift or stairs in practice
- emergency evacuation procedures
- appointment timing
- may require longer due to reduced mobility
- access to mouth more challenging
- patient safety
- wider cuff blood pressure monitors
- longer IM needles needed
- may be unable to get patient in supine/recovery position
- airway management more challenging
- resuscitation landmarks more challenging to find
- dental chair
- patient may have to be weighed
- patients carrying weight on chest are at risk of hypoxaemia when lying flat
- obesity hypoventilation syndrome due to excess weight preventing full expansion of lungs
8
Q
What are the co-morbidities associated with obesity?
A
- cardiovascular
- hypertension
- cerebrovascular accident (CVA)
- stroke
- coronary heart disease
- phlebitis
- diabetes
- respiratory
- sleep apnoea
- dyspnoea
- hypoventilation syndrome
- gastrointestinal
- GORD
- liver and gallbladder disease
- joint problems
- osteoarthritis
- gout
- mental health problems
- depression
- anxiety
- skin conditions
- cellulitis
- intertrigo
9
Q
How is treatment affected by bariatric patients?
A
- loss of anatomical landmarks
- large cheeks and tongue
- Lax tongue retractor can be used for sufficient retraction
- IDB challenging (consider Gow-Gates or intraligamentary)
- semi-supine or upright position
- practitioner must be aware of posture
- intramural radiography
- challenging due to increased soft tissues
- OPT machine unable to accommodate patient size
- long procedures
- acute leg oedema
- cellulitis
- compartment syndrome
- bleeding and swelling enclosed within muscles
- increasing pressure
- restricted blood flow causes damage to nerves/muscles - pressure sores
- coagulation abnormalities
- non-alcoholic fatty liver disease
- absorption of drugs
- excessive fat in tissues can affect pharmacological absorption
10
Q
What are the dental implications of obesity?
A
- periodontitis
- not a causal relationship
- non-surgical treatment can be successful
- diabetes increases periodontitis risk
- caries
- diet may be high in processed. sugars
- wound healing
- extractions, surgical periodontal treatment, biopsies
- more likely to have reduced immune function
- delayed healing
- tooth wear
- erosive tooth wear more likely (GORD)
11
Q
What is the role of domiciliary care for bariatric patients?
A
- useful when patients are too large or anxious to leave home
- good for initial assessment
- risk assessment is essential
12
Q
What do emergency appointments for bariatric patients involve?
A
- emergency relief of pain
- weigh up risks and benefits
- if patient not suitable for chair treat in own wheelchair or bariatric wheelchair
- arrange future appointments in clinics with suitable facilities
13
Q
What considerations are there for sedating bariatric patients?
A
- inhalation sedation
- must maintain good airway management
- likely most appropriate form of sedation
- intravenous sedation
- risk of sleep apnoea
- not suitable in standard dental clinic
- difficulty placing cannula - compromised airways requiring specialist management
- general anaesthetic
- more likely to develop serious airway problems during GA
14
Q
How is communication altered for bariatric patients?
A
- discuss weight sensitively but honestly
- often prefer overweight to obese
- highlight importance of patient safety
- best care in the best setting
15
Q
What is bariatric surgery and what are the dental implications?
A
- surgery to reduce the volume of the stomach
- good weight loss outcomes
- improved control of co-morbidities
- several disadvantages
- nutritional deficiencies
- eating disorders
- dental implications
- periodontal disease
- dental caries (more frequent meals)
- hypo salivation
- ulcers
- dentine sensitivity
- halitosis
