Care of older people and kids dentally relevant questions

Question 1

What are 5 types of child abuse?

Answer 1

Sexual 
Emotional 
Physical 
Neglect
(Fabricated illness)

Question 2

What are intraoral abuse injuries?

Answer 2

Torn frenulum 
Laceration/bruising to lips
Mucosal/gingival injuries 
Dental trauma 
Adult bite on tongue

Question 3

How can you tell the difference between an adult and childs bite?

Answer 3

Intercanine distance is measured
<2.5cm for child
>3cm for adult

Question 4

What are sexual abuse dental signs of a child?

Answer 4

Erythema
Ulceration, vesicles
Petechiae/erythema on palate
Emotional/behavioural disturbances

Question 5

What is a main sign for emotional abuse that may be seen in dental practice?

Answer 5

Frozen watchfulness

Question 6

What is the dental relevance of people ageing?

Answer 6

Increased anaesthetic and sedation risk
Difficult to comply with instructions/meds
Increased bleeding
Difficult lying flat for long appointments

Question 7

What are the 6 geriatric giants (6I’s)?

Answer 7

Instability 
Immobility 
Incontinence
Intellectual impairment 
Isolation 
Iatrogenesis

Question 8

What are medication risks when prescribing to old people?

Answer 8

Altered compliance - consistency and accuracy of tx.
Different pharmacokinetics
Altered drug action 
Drug interactions 
Adverse effects

Question 9

What are the complications of pharmacokinetics and drug action in older people?

Answer 9

Reduced absorption and excretion
Altered protein binding
Increased drug sensitivity

Question 10

What is the general rule when prescribing to older people?

Answer 10

Decrease doses and check the BNF

Question 11

What are the adverse effects of these drugs in older people:

1. Opioids
2. Antibiotics
3. Sedatives
4. NSAIDs
5. Anticholinergic effects of many drugs

Answer 11

1. Confusion and constipation
2. Diarrhoea
3. Confusion and falls
4. Peptic ulceration, fluid retention, renal impairment
5. Confusion, constipation, urine retention and dry mouth

Question 12

Why is saliva important?

Answer 12

Protects against caries and wear 
Denture tolerance 
Mucositis 
Chewing 
Speech/swallow

Question 13

What happens to saliva in physiological ageing?

Answer 13

Reduced flow rate

Modest decrease of concentration of mucins and electrolytes

Question 14

What medical conditions alter salivary flow?

Answer 14

Sjogrens
Diabetes 
Alzheimers 
Dehydration 
Salivary gland disease (surgery and radiotherapy)

Question 15

What drugs alter the flow of saliva?

Answer 15

Anticholinergics
Alpha and beta-adrenergic blockers
Diuretics
Ca channel blockers

Question 16

What happens to enamel with ageing?

Answer 16

Thins 
Darkens 
Loss of features and translucency 
Cracks appear - enamel wall weakens 
Coronal and root caries 
Tooth wear

Question 17

What happens to dentine with ageing?

Answer 17

Dentinal tubules occlude

Question 18

What happens to the pulp with ageing?

Answer 18

Decreased pulp space 
Pulp calcifications 
Degeneration of pulpal neurones 
Widening of major apical foramen 
Vascular and cellular content decreases

Question 19

What happens to the periodontium with ageing?

Answer 19

Fibroblasts decrease cell proliferation and decrease protein and collagen made
Cementum thickens due to increased load
PDL increases fibrosis and decreases cellularity

Question 20

What happens to the oral mucosa with ageing?

Answer 20

Loss of elastic fibres
Thickening and disorganisation of collagen
Decreased microvasculature (impaired wound healing)