BDS4 - Special Care Flashcards
Outline the main principles of the biosychosocial model to care?
Acceptance that illness and health are the result of an interaction between biological, psychological and social factors.
Patient centered care is key
Collaberation and sharing of care and resource
Successful and sustainable health system
Social determinants of health.
What are the active barriers to dental care for older people?
Cost and fear of cost
Dental anxiety
Accessibility
Availability
Characteristics of dentist
Outline the financial barriers for patients to dental care?
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Direct - cost of treatment
Indirect - travel cost, carers
Give four barriers to domicilary care.
Orginisational barriers
Physical barriers for patients with reduced mobility
Lack of motivation from care staff for oral health training
Lack of flexible opening times
What barriers are there for oral hygiene in older people?
Lack of knowledge
Refusing care
Facilitators
Training/education
Presence of a dental professional
What barriers are there for treatment of older people?
Lack of facilities
Transportation of patients
Lack of routine and awareness of care home staff
What steps can be taken to promote oral health for older people with limited access to dental care?
Oral health promotion and education
Prevention in primary and secondary care (SDF. FV)
What are the limits to sedation for patients with DFA?
Limited in general dental services
Case complexity
Techniques available
What are some individual-level barriers to mental health?
Feelings of shame, guilt, stigma, helplessness and low self-esteem
Confusion and lack of recall of conversations
Public services perceived as inadequate
What are some orginisational-level barriers to mental health?
Lack of protocols
Lack of staff time
General dentists not willing to treat these patients
Limited specialised expertise in managing individuals with high treatment needs
Discrimination regarding the use of limited resources
What are some policy-level barriers to mental health?
Service organisation with move from institutional to community living
What is oral health literacy?
The degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions.
What are the key barriers to effective communication in dental practice?
Limited time
Financial incentives promoting treatment over prevention
Lack of OHL training
Limited plain-language patient education materials
Patients with low OHL knowledge
What are some individual-level barriers to learning disability?
Lack of consent
Complicating medical histories
Inability to cooperate with treatment
Inability to communicate dental pain
What are some orginisational-level barriers to learning disability?
General dentists not willing to treat these patients
Shortage of specially trained or experienced dental professionals in treating individuals with learning disabilities
What are some policy-level barriers to learning disability?
Service organisation as people with learning disabilities move from institutional to community living
Why should clinical special care dentistry teaching be prioritised?
To reduce inequalities
To provide opportunities to learn, gain confidence, and collaborate
Because upskilling undergraduates means they are more likely to deliver care on graduation
Because confidence and competence enhances patient acceptance
What are some of the factors determining ageing progression?
Accumulation of cellular damage
Internal/external factors
Genetic
Social determinants of health
What is frailty?
A biological syndrome of increased vulnerability resulting from age related decline.
To the extent where the ability to come with every day or acute stressors is compromised.
What issues may frailty present?
Exhaustion
Reduced grip strength
Weight loss
Low activity
Slow gait
What are the main consequences of frailty?
Falls
Immobility
Delirium
Incontinence
Susceptibility to side effects
What is the WHO definition of good mental health?
A state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community.
What are the impacts of poor mental health on oral healthcare?
Less likely to seek treatment
Poorer overall health outcomes
More susceptible to oral disease
Social withdrawal, isolation and low self-esteem
Outline the protective factors to mental health.
Genetic background and upbringing
Personality traits
Social support networks
Reduced inequality
Employment and other purposeful activity
Community factors
Self-esteem, autonomy, and values
Emotional and social literacy
Physical health
What is generalised anxiety disorder?
Regular or uncontrollable worries about everyday life. Varying presentations.
What is a panic disorder?
Regular frequent panic attacks without clear cause or trigger. Experiencing panic disorder may mean you are constantly afraid of having a panic attack - which may trigger an attack itself.
What is a phobia?
An extreme fear or anxiety triggered by a particular situation or object.
What is social anxiety disorder?
Fear or anxiety in social situations.
What is PTSD?
Anxiety problems after going through something traumatic. Flashbacks, nightmares, reliving events.
What is OCD?
Anxiety related to compelled repetitive thoughts, behaviours, urges.
What is health anxiety?
Obsessions and compulsions relating to illness, such as researching symptoms and diseases.
What is body dysmorphic disorder?
Experience obsessions and compulsions relating to physical appearence.
What is depression?
Characterised by sad mood, diminished interest in activities that used to be pleasurable, inappropriate guilt, difficulty concentrating, recurrent thoughts of death.
What are some of the causes of depression?
Stressful events
Predisposed risk (personality traits, low self esteem)
Family history
Giving birth
Loneliness
Alcohol and drugs
Illness
What is psychosis?
A loss of contact with reality, which may involve hallucinations or delusions.
What is bipolar disorder?
Severe mood swings which last several weeks or months. Periods of mania and periods of depression.
How can depression manifest orally?
Poor care of OHI
Caries, gingivitis
How can mania present orally?
Overbrushing
NCTSL
Overzealous hygiene aids
Outline the main types of eating disorder?
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant restrictive foot intake disorder
Pica / rumination disorder
What is the difference between anorexia nervosa and bulimia nervosa?
Anorexia - Restricting what you eat, self starvation
Bulimia - Induced vomiting/laxative use.
What are the dental implications of an eating disorder?
Dental erosion
Angular cheilitis
Glossitis
Candidiasis
Oral ulceration
Sialosis
Xerostomia
What is the SCOFF question method?
Screening tool for eating disorder.
Sick from overeating
Control loss in eating
One stone loss in 3/12
Fat when others say thin
Food dominates life
What is the role of the pathologist in H+N cancer?
Part of MDT
Establish subtype and grade/stage of cancer.
Identify prognostic factors
What is the role of the GDP in terms of patients with H+N cancer?
Early detection and screening
Referral for biopsy
Managing patient through treatment
Rendering dentally fit
Reconstructive after treatment
What are the criteria for H+N cancer referral?
Persistent unexplained head and neck lumps >3 weeks
Ulceration unexplained for >3 weeks
Red or mixed persisting for >3 weeks
Persistent horsiness >3 weeks
Persistent pain in throat >3 weeks
What investigations may be involved in H+N cancer diagnosis?
Biopsy
CT scan
Radiograph
Lymph node biopsy
Baseline medical testing
PET scan
What is involved in dental pre-assessment for H+N cancer treatment?
Detailed OHI
FL
GC tooth mousse
Dietary advice
PMPR
CHX
Restore carious teeth
Remove trauma
XLA teeth of poor prognosis
Outline the typical timeline for oral mucositis during cancer treatment.
Begins 1-2 weeks after treatment
Lasts until 6 weeks after treatment
Severe pain produced by mucositis - difficulty eating
What pharmacological options may be useful for mucositis whilst undergoing cancer treatment?
Caphosol
Gelclair
Oral rinse
Soluble aspirin
Zinc suppliments
Aloe vera
Cryotherapy
Makuna honey
Lidocaine mouthwash
What oral manifestations of cancer treatment can present?
Herpes simplex
Mucositis
Candida
Traumatic ulceration
What is the contraindication for glandosane in patients with teeth remaining?
Avoid, as it is acidic
What are some dental issues following cancer treatment?
Trismus (MoM fibrosis)
Erosion (xerostomia)
Caries (OHI difficult and xerostomia)
Periodontal disease (xerostomia, depression poor self care)
ORN
Immunocompromised
What is ORN?
Osteoradionecrosis
Area of exposed bone for at least three months of duration in an irradiated site - not due to tumour recurrence.
What is the management of ORN?
Remove teeth of questionable prognosis prior to treatment.
Prevention.
XLA 10 days before radiotherapy.
Encourage healing by primary intention.
Hyperbaric oxygen
Anti-biotic prophylaxis
What puts a radiotherapy patient at a higher risk of ORN?
Radiation dose exceeded 60Gy
Large fraction of dose with large number of fractions
Immunodeficient
Malnourished
Outline the grading of ORN.
0 - Mucosal defects, bone exposed
1 - Radiographic evidence of dentoalveolar necrotic bone
2 - ID canal involved
3 - Skin fistulas, potential/acute fracture, clear radio necrotic bone
