GERO Flashcards
5 principles of mental capacity act 2005
1-Presume capacity unless proven otherwise
2-Give people help before saying not able to make own decisions
3-Patients have the right to make the wrong decision
4-If deciding for them, in their best interest- consult other people, consider past and present wishes/feeling/beliefs
5-Least restrictive option with least interference
-Mental capacity may FLUCTUATE
-Consent is specific to each person, at that time, for that procedure
-Not likely to have capacity if cannot weight up pros /cons/ info, cannot express their own wishes
Options if a patient lacks capacity
- Lasting power of attorney- appointed by patient prior to their loss of capacity to make decisions (usually family)
- Deputies - Appointed by Court of Protection
- IMCA - advocates for those with no friends or family
- Health professional Make a best interests decision on behalf of the patient
- Can the decision wait until the patient gains capacity
Role of an IMCA
Independent Mental Capacity Advocates -make a best interest decision for those that lack capacity and they do not have family or friends appropriate to consult about the decision. Instructed when a patient is over 16. For serious treatment.
Things to consider when providing treatment to old patients
-know their expectations and wishes. What is important to them
-consider SDA (aesthetics, function, self-esteem)
-access to dental clinic- mobility
-medical history- risks of treatment
-consider long-term viability of prostheses. Plan tx outcomes for easy maintenance
-soemtimes risks outweigh beenfits of treatment so no tx may be valid
-assess mental capacity
-best interest
What is the atraumatic restorative technique (ART)
-Considered for older patients.
-Minimally invasive approach to prevent pain and preserve teeth in individuals who do not have access to regular and conventional oral health care
-Eg:
-Sealing caries-prone fissures
-Use excavator for Incomplete excavation of soft dentinal carie. Etch, then GIC with finger pressure application. Coat with vaseline. Moisture control with cotton wool. No LA and no rotary instruments
Why periodontal disease increases with age- risk factors
-Change to biofilm
-Increased biofilm
-Saliva naturally decreases with age. And due to polypharmacy, radiotherapy etc.
-Reduced Immune response
-Type 2 Diabetes
-Irregular attendance- physical barriers, cost issues
-Smoking
Why demineralisation is faster during root caries than in coronal tissue
-Demineralisation and collagen degradation involved. Cementum is highly organic and dissolves easily.
-lesions are broad and flat. Spread laterally so are quite shallow
Critical pH of enamel and dentine
-Enamel - 5.5
-Dentine -6. Demineralisation occurs sooner in dentine
Managing root caries. How to tell if it does not need cons
-Active decay if soft, wet, friable= Caries debridement. Only restore if cannot clean well, large cavity, lost surface contour or close to pulp
- If hard then no treatment needed. Made need to recontour if lost surface contour and a plaque trap
-Fluoride varnish or SDF for older patients
Managing TSL
-diagnose (BEWE/ Smith and Knight)
-assess aetiology
-prevention- diet, OHI, FV, FS
-Monitor- study models, photos
If concern for patient/ clinician and once things are stable then restore with composite build-ups or crowns
-splint if attrition
Why elderly patients have increased risk of dentine hypersensitivity. How to manage in these patients
-Short duration of sharp dental pain in response to stimuli in absence of pathology
-High prevalence within elderly population – despite tubules decreasing & tertiary dentine formation = patency of tubules maintained
-Adhesives not recommended for long term treatment = lose efficiency over time
-Toothpaste and mouth rinses which contain components which promote tubule occlusion are effective = patency to pulp is diminished
What should be a first choice treatment for the edentulous mandible in elderly patients
evidence that a low-cost mandibular two-implant prosthesis improves their dietary intake and nutritional state. Increases quality of life compared to conventional denture
What is dysarthria, dysphasia, dysphagia, odynophagia
-Dysarthria – poor articulation
-Dysphasia – struggle to produce and understand language
-Dysphagia- difficult swallowing
-Odynophagia- pain swallowing
How stroke and dementia affect ora health and delivery of dental care
-forget to brush
-poor vision, weakness, motor function affecting OH
-poor mobility, accessibility to practices, need to bring carer
-xerostomia
-impaired speech and communication
-finances
-soft cariogenic diet
-consent
-poor gag reflex- risk of aspiration
-altered mastication, salivation, swallowing, fear of choking
-behaviour changes, aggression
-tremors
-recommend electric tooth brush, mouthwash, high fluoride toothpaste
-can find it daunting - good rapport, consistent experience (staff)
-may need longer or shorter appointments
-tell show do techniques
-utilise family/carers
-prevention is a priority
What is special care dentistry. Give examples of patients
-The improvement of oral health of patients who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability.
-eg. Physical disabilities, Learning disabilities, dementia, autism, Dental Anxiety/Phobia, Multiple medical issues and polypharmacy, Palliative care needs, head trauma, Bariatric issues, lack capacity, vulnerable people- homeless, drug and alcohol issues etc
