gerodontology Flashcards
unexpected death trajectory
terminal decline
prediction of prognosis
oral self-care function
oral health changes
tx strategies
terminal decline - bried
prediction of prognosis - unpredictable
oral self-care function - no changes
oral health changes - minimal changes
tx strategies - no changes in practice
terminal cancer trajectory
terminal decline
prediction of prognosis
oral self-care function
oral health changes
tx strategies
terminal decline - rapid
prediction of prognosis - relatively reliable
oral self-care function - varied
oral health changes - xerostomia, oral soft tissue patholgy
tx strategies - stage appropriate tx strategies
progressive functional loss trajectory
terminal decline
prediction of prognosis
oral self-care function
oral health changes
tx strategies
terminal decline - slow and progressive
prediction of prognosis - less reliable
oral self-care function - decreased
oral health changes - poor OH, caries, oral pain/infection. tooth loss, denture-related problesm, xerostomia, soft tissue pathology
tx strategies - stage appropriate tx strategies
factors in Oral Health Related Quality of Life
Oral health - pain/infection, bleeding gums, edentulous spaces
social/emotional - anxious, attractive, unhappy
environment - school, job, care home
tx expectations
function - chewing, talking
taks people can struggle with in older age
3 caetgories
Mobility -> stairs, getting to the shops
Dexterity -> making a cup of tea , brushing teeth
Communication -> sight and hearing -> isolation
frailty
defined as ‘a state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic, and immune systems’
Distinct to single organ conditions (such as a stroke) associated with advancing age and multimorbidity, but these can co-exist
frailty phenotype
5
- Unintentional weight loss (4.5 kg in last year)
- Self-reported exhaustion
- Weakness (measured by grip strength in lowest 20% per age)
- Slow walking speed (slowest 20% by gender/height)
- Low physical activity (based on Kcal expended per week in lowest 20%)
Presence of 3 or more of above – Defined as ‘frail’:
Presence of 1 or 2 of above – Defined as ‘pre frail’
Nil present – Defined as ‘fit’
impact of polypharmacy
inc number of medications inc risk of oral side effects
parkinsons disease
2nd most common neurodegenerative condition after Alzheimer’s dementia.
accumulation of alpha-synuclein protein causes the formation of Lewy-bodies in cerebral neurons.
* Lewy-bodies disrupt the production of the neurotransmitter dopamine.
wide range of potential symptoms, divided into those associated with movement (motor) and those that do not affect movement (non-motor)
* early stages of PD, patients present with a tremor, stiffness or slowness of movement.
* non-motor symptoms (drooling, cognitive changes, hallucinations, and constipation) become more prominent with disease progression.
Drooling is a particularly common complaint and can be managed non-pharmacologically with boiled sweets (but with an increased risk of dental disease) that can stimulate swallowing or with topical medications such as anticholinergics or botulinum toxin injections to the salivary glands.
* aspiration v imp
The change in salivary flow substantially impacts the oral microbiome
medication regime - highly personalised and time critical - consider when planning appts
dyskinesias - can make sitting or lying hard (IV sedation for muscle relaxation and reduce movement can help enable safe care)
alzheimer’s dementia
commonest neurodegenerative condition in the UK.
* WHO suggest it accounts for 60–70% of all dementias
associated with a decline in cognitive function across various cognitive domains that progresses over time, and many patients will have problems with memory loss.
* common to have weightloss, co-exist with frailty
Vascular dementia is less common (around 15% of patients with dementia) and classically follows a stepwise pattern of deterioration.
pts may not have dx - signpost to GP
mental health consideration in dental care
pt suffering with mental health issues (depression, anxiety etc) may neglect their physical health inc oral health
so may present later to dental services or only when there is an acute problem
immunse system changes with age
As the immune system ages, it functions less well and the risk of cancer, autoimmune disease, and risk of infections increases.
* Macrophages work slower, T-cells respond less well, and less complement protein is produced.
As a result, bacterial infections are more common in older people (particularly respiratory, urinary and skin infections). Viral infections, such as fu and COVID-19, also have a more significant effect due to this immunosenescence.
* Vaccination helps to mitigate against these effects for some viral illnesses.
additionally may be on medications which can alter function of immune system
medications that can alter immune system function
4
Oral corticosteroids for treating a range of inflammatory autoimmune conditions (e.g., prednisolone for asthma or temporal arteritis).
Disease modifying medications for more severe autoimmune diseases (e.g., methotrexate for rheumatoid arthritis or mycophenolate for systemic lupus erythematosus).
Chemotherapy agents for cancer treatment [e.g. 5-fuorouracil (5-FU) capecitabine for bowel cancer].
Immunomodulatory treatment for cancer treatment (e.g., rituximab to treat non-Hodgkin lymphoma or chronic lymphocytic leukaemia).
what is diabetes
condition where the regulation of blood sugar is affected.
* Insulin usually is produced by the body to move sugar from the blood into the cells.
* When the blood sugar level is raised, sugar is excreted into the urine, which pulls water with it, leading to polyuria and polydipsia—the hallmark symptoms of diabetes.
Two main types:
* Type 1 diabetes, the pancreas does not produce insulin and is often a condition that older people have lived with for many years and would be treated with insulin injections.
* Type 2 diabetes is the most common form (around 90% of cases) and is where the body becomes less responsive to insulin.
type 2 diabetes
tx
complications
develops over time and is associated with obesity.
Treatment can be via insulin injections but is often initially managed with tablets to modulate the response to endogenous insulin.
longer patients live, the longer people live with diabetes and its potential complications.
* Complications mostly related to its effect on small blood vessels e.g. damage to Renal, retinal, and peripheral small blood - Leading to, chronic kidney disease, visual loss, and peripheral neuropathies
diabiabetic complications impact on tx
- Written information in larger font size
- Transfer from wheelchairs when the peripheral vascular disease has significant impacts on mobility or has led to amputation.
- Wound healing can be compromised with diabetes, and infections can progress rapidly in uncontrolled diabetes, requiring aggressive management.
- Type 1 diabetic patients or those needing insulin for type 2 diabetes undergoing general anaesthesia for dental procedures may need modifications to their insulin regime in the pre-operative and peri-operative period, especially as fasting is required before anaesthesia. Medical teams should support the planning of care in such situations.
HbA1c levels and diabetes
HbA1c levels are <7%, any type of dental treatment can generally be performed within the dental clinic
If HbA1c levels are 9%, only emergency treatments should be conducted and surgical procedures should preferably be undertaken in a hospital setting
with HbA1c readings >12%, all procedures should be postponed until the glycaemic control has improved
diabetes pt risk
7
- Hyperglycaemia
- Hypoglycaemia
- Fatigue/reduced tolerance for long treatment
- increased risk of infection
- Poor wound healing
- Increased risk of periodontal disease
- Complications related to comorbidities/secondary vascular complications
dental appt timing for tx
- The sessions should preferably be scheduled for the morning (higher endogenous cortisol levels increase blood glucose and decrease the risk of hypoglycaemia)
- Avoid scheduling an appointment time that coincides with the maximum insulin activity peak or when it may lead to a meal being missed
stroke
definition
sudden onset of focal ischaemic changes in the brain.
* Ischaemia is most commonly caused by a blood clot occluding an artery (85% of all strokes).
* or ischaemic area can be result from a rupture in the blood vessel wall leading to haemorrhage (around 15% of all strokes).
Risk factors include atrial fibrillation, hypertension, diabetes, and smoking.
In both situations, whatever function the affected area of the brain is responsible for will be affected
* E.g. a stroke affecting the left hemisphere would give rise to a right-sided weakness
impact of stroke on person
a wide range of neurological problems, from complete one-sided paralysis with higher cognitive dysfunction, loss of speech, poor swallowing function, and one-sided visual loss (a total anterior circulation stroke) to a relatively minor weakness.
For some people, the sequencing of tasks may be affected
