gerodontology Flashcards
What can be used for caries management in older people?
ART
Atraumatic restorative technique
Name 4 things affected by dry mouth
Speech
Nutritional function and intake
Impairs social interaction
Protective features of saliva are lost
Name 6 common medical concerns in older people
Any from:
- frailty
- polypharmacy
- incontinence
- falls
- bone health
- nutrition and weight loss
- dementia
- Parkinson’s
- diabetes
- stroke
What is the incidence of falls in older people?
1 in 3 >65 year olds fall every year
1 in 2 >80 year olds fall every year
What are the 2 different causes of falls?
Intrinsic eg - postural hypotension
Extrinsic eg - trip hazards
Name 4 dental implications of falls?
Dental trauma
Sitting patients up slowly after treatment
Manual handling
May need domiciliary visits from fears of falling
What is the incidence of osteoporosis in older people?
25% chance at 80 years old
Why is bone more common in older women?
Oestrogen withdrawal during menopause impacts bone density
Name 4 medication types that affect the immune system
Oral corticosteroids - treats inflammatory conditions
Disease modifying meds for autoimmune conditions eg mycophenolate for SLE
Chemotherapy agents for cancer treatment
Immunomodulatory treatment for cancer eg biologics
What are the different HbA1c levels to carry out tx?
If 9% only emergency tx can be carried out
If >12%, no tx can be carried out
Should be <7%
Name 5 risks of uncontrolled diabetes
Hyperglycaemia
Hypoglycaemia
Poor wound healing
Increased risk of periodontal disease
Increased risk of infection
What are the signs and symptoms of stroke?
Facial weakness
Arm weakness
Slurred speech
Gait disturbance
Urinary incontenance
FAST - face, arms, speech, time
Name 4 dental implications of strokes?
Any from:
- access and mobility is difficult
- confusion and memory loss can influence capacity
- dysphagia common
- root caries due to drug induced xerostomia
- denture wearing issues due to loss of muscle control or loss of sensation on one side of the mouth
Name 4 risk factors of stoke?
Hypertension
Diabetes
Ischaemic heart disease
Obesity
What dental advice should be given to pts with dysphagia?
Brush teeth upright with suction or an aspirating toothbrush
Use low foaming toothpaste
Remove excess water on toothbrush
Rub toothpaste into toothbrush before placing in mouth
What is Parkinson’s disease?
A chronic, progressive neurological disorder characterised by the loss of dopamine producing cells in the brain
Give 4 non motor Parkinson’s signs and symptoms
Any from:
- emotional changes
- dysphagia
- urinary problems
- sleep disturbance
- loss of blink reflex
Give 4 motor signs and symptoms of Parkinson’s
Dyskinesia - tremor
Bradykinesia - slow movement
Akinesia - stiffening
Resting tremor
Name 4 dental implications of Parkinson’s
Any from:
- access can be challenging
- xerostomia and root caries
- anxiety increases tremor
- dysphagia
- denture success is related to neuromuscular control
- avoid mouthwash due to aspiration risk
- often rely on others for oral hygiene
- can’t recline more than 45º for airway protection
What is dementia?
An acquired progressive loss of cognitive functions, intellectual and social abilities characterised by amnesia, inability to concentrate and disorientation
What are the different types of dementia?
Alzheimer’s
Vascular
Lewy body
Frontotemporal
Other
Mixed
Describe Alzheimer’s
60% of dementia cases
Involves parts of the brain that control thought, memory and language
Deposits of beta-amyloid protein fragments build up in spaces between nerve cells
Twisted tau protein fibres build up inside cells creating tangles
Associated with Down’s syndrome
Describe vascular dementia
15% of dementia cases
Disturbances in blood supply to brain cause ischaemic and neuronal death
Risk factors include smoking, diabetes and atrial fibrillation
Describe Lewy body dementia
10% of cases
Shrinking of frontal and temporal lobes
Symptoms can either be changes in behaviour or problems with language
Describe frontotemporal dementia
Caused by TDP 43 and tau protein
Can be a behavioural variant, semantic (language and logic) variant or non-fluent variant
List 4 ways you can create a dementia friendly environment
Reception visible from entrance
Colour and tone of walls distinctive from flooring
Avoid non-essential signs
Any signage at eye level with simple clear text
How should you tx plan when a patient has dementia?
- Comprehensive full routine care with aesthetics and prosthodontics
- Prevention
- Emergency care only - prevention if possible
- No treatment due to cooperation or poor general health
Find key teeth to retain quality of life
List 4 dental implications of dementia
Prevention
Halitosis
Xerostomia
Root caries
What is domiciliary care?
A service that reaches out to care for those who cannot reach a service themselves
Includes residential units and nursing homes
Should be offered as a routine option and not last resort
Give 5 examples of patients who should be seen via domiciliary visits
Pt confined to bed
Pt on oxygen therapy
Pt in hospital
Pt with agoraphobia
End of life care
Name 4 items essential for domiciliary visits
Any from:
- portable suction
- oral airways and bag-valve mask
- portable oxygen cylinder
- emergency drugs
- mobile phone
- sharp box
How can a GDP get an AWI (adults with incapacity)?
Further training and complete an assessment and paperwork - Section 47
Name 4 common dental issues found in older patients
Any from:
- poor denture hygiene
- admitted with poor oral health
- xerostomia
- fungal infections
- viral infections
- ulceration
