diseases + special care Flashcards
What are the 5 barriers to care
availability
accessibility
accomodation
affordability
acceptability
how can access to the dental setting be improved?
ground floor access
suitable car parking
elevators
hand rails
wide corridors
disabled toilets
How can mouth access be improved?
head support
open wide mouth rests
mirror
bedi shield
good light
where can special care dentistry be provided?
GDP
community/public dental services
hospital
hospice
care home
patient’s own home
What is an advocate?
a person who offers support and helps a person to express their wishes and views
what are the types of power of attorney?
continuing
welfare
joint
What is a bariatric person?
any person of any age who has limitations in health and social care due to their physical size, health mobility and environmental access
contributing factors to obesity
genetics
SES
hypothyroidism
steroid medications
physical limitations
lifestyle factors
medical conditions associated with bariatric patients
hypertension
diabetes
sleep apnea
GORD
osteoarthritis
depression
liver disease
cellulitis
dental considerations for bariatric patients
loss of anatomical landmarks
ID blocks more difficult
OPT may not accommodate to their size
long appointments
coagulation abnormalities - potentially
excess fat may affect drug absorption
bariatric patients - dental implications
periodontitis
caries
poor wound healing
tooth erosion
why are bariatric patients contraindicated for IV sedation?
risk of sleep apnea
difficulty placing cannula
compromised airway
features of a dementia friendly practice
reception desk visible from front door
ceilings, floors and floor coverings should be acoustically absorbent for audible communication
colour and tone of walls distinctive from flooring
avoid non-essential signs to avoid confusion
signage placed at eye level with simple use of text and colour
ensure good levels of natural light to minimise artificial light
how can a dentist communicate in a dementia-friendly way?
engage attention and eliminate distraction
eye contact
hold hand
verbal cues
- short simple sentences
yes/no questions
provide reassurance
use humour for rapport
call by first name
- (they may forget surname)
what is Parkinson’s disease
chronic and progressive neurological disorder
caused by degeneration of dopaminergic neurones in basal ganglia
parkisnons signs and symptoms
dyskinesia
- involuntary movement
bradykinesia
- slow movement
muscular rigidity
resting tremor
mask like face
What is drug is used to treat Parkinson’s?
levodopa
- increases dopamine that reaches the brain
Parkinson’s dental implications
dry mouth
- root caries
poor OH
movement, drooling and tremor increase his of harm when using sharp/rotating instruments
dysphagia
limited muscular control
may require toothbrush handle modification
dementia is characterised by…
amnesia
inability to concentrate
disorientation in time, place, person
deterioration in emotional control
social behaviour and motivation
Alzheimer’s distinctive features
short term memory loss
aphasia
communication difficulties
muddled one every day activities
mood swings
withdrawn behaviour
loss of confidence
vascular dementia risk factors
smoking
diabetes
atria fibrillation
hypertension
age
vascular dementia distinctive features
memory problem of sudden onset
anxiety
delusions
seizures
visuospatial difficulties
dementia dental implications
lost’ broken dentures
halitosis
xerostomia
- periodontal disease
- caries
dysphagia
loss of taste - high sugar diet
What is downs syndrome?
a neurodevelopmental disorder of genetic origin affecting chromosome 21
Down syndrome physical features
cranial anomalies
- flat back of head
growth failure
increased BMI
short hands
reduced muscle tone
stubby fingers
atlanto-axial instability
medical conditions associated with downs syndrome
congenital heart defects
alzheimer’s
epilepsy
leukaemia
diabetes melitus
intellectual impairment
coeliac disease
GORD
hypothyroidism
Down’s syndrome dental implications
hypodontia
delayed and out of sequence eruption
severe early onset periodontal disease
Microdontia
increased incidence of gag reflex
high arched palate
macroglossia
how may an individual with intellectual impairment communicate pain?
aggression towards themselves or others
altered facial expressions
change in behavhoir
confusion
changes to apetite or vocalisation
restlessness/sleep pattern changes
what communication adjuncts are available?
makaton
picture boards
letter boards
talking mats
drawing
writing
who is involved in the MDT for head and neck cancer?
surgeons
radiologists
clinical oncologists
SALT
dieticians
restorative dentists
clinical support nurses
pathologist
what is the role of the GDP in head and neck cancer?
early detection through soft tissue examination
take clinical photographs
onward referral
pre-treatment assessment
prevention and management of oral mucositis
caphosol
gelclair
muguard
soluble aspirin
benzydamine
aloe vera
cryotherapy
Manuka honey
What is osteoradionecrosis?
an area of exposed bone for at least 3 months duration in an irradiated site and not sue to tumour resistance
ORN prevention
Remove teeth of doubtful prognosis in pre-assessment phase
OHI
extractions completed at least 10 days prior to radiotherapy
lease with oncologist
What can be used in ORN patients to encourage blood vessel growth and healing of the area?
vitamin E
Pentxyfyline
radiographic features of head and neck cancer?
moth eaten bone
pathological fractures
non healing sockets
spiking root resorption
floating teeth
unusual periodontal loss
generalised widening of PDL space and loss of lamina dura
loss of bony outlines for anatomical features
What is tardive dyskinesia?
involuntary movements of the tongue, lips, face, trunk and extremities
associated with antipsychotics
what is psychosis?
when an individual loses contact with reality
common causes of psychosis?
schizophrenia
bipolar disorder
severe depression
traumatic experience
stress
drug or alcohol misuse
side effects of prescribed medication
physical condition e.g. brain tumour
features of bipolar disorder
mania
- happy, energetic
- impulsive
depression
- sadness
- little energy
- trouble concentrating
common casuses of depression
stress events
personality traits
family history
giving birth
alcohol and drugs
illness
what is Schizophrenia?
a disorder of the mind that affects how you think, feel and behave
anorexia nervosa features
self starvation and weight loss
- results in a low weight for height and age
types of anorexia nervosa
restrictive eating
binge eating/purging
anorexia nervosa signs and symptoms
dizziness
no period/irregular periods
brittle hair and nails
cold intolerance
GORD
muscle wasting
constipation
osteoporosis
depression/anxiety
poor concentration
anorexia nervosa complications
hypokalaemia
hypotension
arrythmia
cardiac atrophy
sudden cardiac death
hypothermia
what is bulimia nervosa?
alternative diet with binging on forbidden foods
binges occur at least weekly for 3 months followed by compensatory behaviours each as
- fasting
- laxative misuse
- exercise
- vomitting
bulimia nervosa signs and symptoms
frequent bathroom trips after meals
large amounts of food disappearing
chronic sore throat
sialosis
caries/erosion
GORD
dizziness
recurrent and unexplained diarrhoea
mouth ulcers
mallory-weiss Syndrome
dental implications of eating disorders
dental erosion
- dental sensitivity
angular chelitis
candidiasis
oral ulceration
glossitis
sialosis
xerostomia
- dehydration/antidepressants
poor OH
caries
- periodontal disease
consider weight in LA dosage
What is Rheumatoid arthritis?
an autoimmune inflammatory disease where the immune system attacks the joints
Rheumatoid arthritis typically affects…
hands, wrists and knees
Rheumatoid arthritis risk factors
age
sex
- females > male
genetics
- HLA class II
history of live births
- never giving birth
early life exposures
- smoking
obesity
Rheumatoid arthritis signs and symptoms
pain or aching in more than one joint
stiffness in more than one joint
tenderness and swelling in more than one joint
weight loss
fever
fatigue
weakness
Rheumatoid arthritis treatment
disease modifying anti-rheumatic drugs (DMARDs)
biologics
self management techniques to reduce pain and disability
Rheumatoid arthritis complications
premature heart disease
increased diabetes risk
obesity
unemployment
What is osteoporosis?
a bone disease that develops when bone mineral density and bone mass decreases
results to a decrease in bone strength
how can osteoporosis be prevented?
staying physically active
participating in weight bearing exercises such as walking
drinking in moderation
no smoking
medication
nutritious diet high in calcium and vitamin D
osteoporosis risk factors
gender
- females > males
race
- non-hispanic white
- asian
age
- increases with age
body size
- more slender
hormonal changes
- menopause
- low testosterone in men
low level of physical activity
osteoporosis treatment
proper nutrition
- calcium and vitamin D
lifestyle changes
- no smoking
- low alcohol
- exercise
medication
- bisphosphonates
- osterogen agonist
- osterogen and hormone therapy
- parathyroid hormone
- RANKL inhibitors
Options of aids that can be used to transfer a patient into a dental chair?
sling and hoist
banana board
reclining wheelchair
turn table
wheelchair recliner
stand aid
advantages of a hoist
can be used for non weight bearing individuals
safest
allows transfer to dental chair
disadvantages of a hoist
requires additional training
advantage of a banana board
allows for self transfer
disadvantages of a banana board
requires a leg break chair
what is atrial fibrillation
when the electrical impulses of the atria fire irregular and chaotically, leading to fibrillation/quivering
atrial fibrillation presents with…
an irregular and fast heart rate
hypertension risk factors
high alcohol intake
smoking
overweight/obesity
high sodium intake
lack of exercise
causes of secondary hypertension
kidney disease
diabetes
medications
- oral contraceptives
hypertension complications
heart attack
stroke
kidney failure
heart failure
sight problems
vascular dementia
types of stroke
ischaemic
haemorrhagic
carotid artery dissection
cerebral venous thrombosis
stroke risk factors
medical
- hypertension
- diabetes
- atrial fibrelation
- high cholesterol
- sickle cell disease
gender
- male>female
age
genetics
lifestyle factors
- smoking
- alcohol
- lack of exercise
- poor diet
signs and symptoms of a stroke
facial weakness
arm weakness
slurred speech
gait disturbance
urinary incontinece
loss of taste
impaired pain
headache
confusion
loss of consciousness
facial/neck pain
Horner’s syndrome
Stroke - dental considerations
communication
patients may have aphasia
short mid-morning appointments
take care with adrenaline
avoid benzodiazepines
- respiratory depression
denture wearing issues
- muscular control loss
poor OH
root caries - xerostomia
Dental advice to stroke survivors with dysphagia
brush teeth upright with suction or aspirating toothpaste
low foaming toothpaste
remove excess water on toothbrush
rub toothpaste into toothbrush before placing in mouth
what is haemophilia A ?
Factor VIII deficiency
What is haemophilia B?
factor IX deficiency
what can be given to patients with mild haemophilia or von willebrands prior to dental treatments with an increased bleeding risk?
DDAVP
What can be given to patients with moderate or severe haemophilia before dental treatments that carry and increased bleeding risk?
factor replacement
What is warfarin?
an oral anticoagulant which antagonises vitamin K antagonists
Dabigatran mechanism of action
reversibly inhibit thrombin-induced platelet aggregation
how do Apixaban, Edoxaban and rivaroxaban work?
reversibly inhibit activated factor Xa which prevents thrombin generation
What is simvastatin?
A HMG CoA reductase inhibitor used to treat hyperchloesterolaemia
What is furosemide?
a loop diuretic used to treat resistance hypertension
diabetes dental and medical implications
risk of hypoglycaemic episode
increased prevalence, progression and severity of periodontal disease
xerostomia
increased risk of infections
poor wound healing
oral dyseastheisa
parotid gland enlargement
What is metformin
an anti hyperglycaemic medication
metformin side effects
can reduce B12 levels
associated with B12 deficient anaemia
Where is lidocaine metabolised?
in the liver
where is articaine metabolised?
5-10% liver
rest = plasma
What additional procedures can be carried out under GA?
investigation by other medical specialties
blood sampling
eye examination
ECG
nail cutting
hair cuts
alcohol abuse dental implications
advanced caries
periodontal disease
NCTSL
increased oral cancer risk
glossitis
angular stomatitis
tooth erosin
nocturnal bruxism
dry mouth
- secondary to dehydration and vomiting
dental advice for methadone users
use a straw
drink water after consumption
don’t brush teeth immediacy after
engage with dental services
prevention
sugar free available
dental implications of opioids
suboptimal oral hygiene and self care
xerostomia
taste impairment
rampant decay and periodontitis
Patient you are treating is an alcoholic - what considerations should you make?
LA
- take care with LA metabolised in the liver
- consider articaine - metabolised in plasma
avoid aspirin and NSAID’s
avoid metronidazole
