neurology Flashcards
NON VERBAL SIGNS OF PAIN
- Trouble sleeping
- Tugging at lip
- Unable to ear
- Agitated
- Sleep disturbance
- Changes in behaviour
- Changes in diet - off, avoid hot/cold/hard
- Hands on face/mouth - unusual for them
how to take a history and perfom examinatin if challenging? e.g. alzeheimers
Ask other health care professionals, then relatives
- GDPs, care home, family
- GP summary
If in wheelchair - see in chair - more comfortable. Supported
- Hoist with sling to transfer immobile pt into chair
Plastic mirrors- less likely to break
Bite props
- Mouth props - rest their jaw open
- Finger guards - thimbles - bite on plastic not fully closed
what is this and cause
Angular cheilitis
- Fold of skin
- Poorly fitting denture
- Moist
- Staph aureus
- Candida albicans
treatment options for angular cheilitis
Cream can help
- Antifungals
- miconazole (gel - only local, 4x a day)
- Fluconazole (systemic - interactions - not recommend)
- Fucidin - staph aureus anti bac gel
refit and reline denture
- OVD reduced - need propped open again
Barrier creams - Vaseline to prevent getting damp
recommended antifungal for angular cheilitis
miconazole
gel - only local, 4x a day
fluconazole
systemic antifungal
not recommened for angular cheilitis or denture stomatitis
2 signs of v concerning ulcer
- Raised rolled border
- Feel it - if firm - concern
4 causes of ulcer
- Chemical
- Physical Trauma
- Nutritional deficiency - iron, vita B12, folate, FBC
- stress
how to treat ulcer
get rid of cause
e.g.
- trauma - smooth RR, fix denture fit
- hard to swallow iron tablets or aspirin as dry mouth - replace medication
how to measure ulcer during examination
BPE probe
mucosal sign of dry mouth
glazed glassy appearance on mucosa
clincal tests for dry mouth
Look for
- Pools of saliva - curl tongue up
- Mirror against mucosa - sticks - concern
treatments for dry mouth
saliva stimulators
saliva replacements
advice
saliva replacement options
- oral balance,
- salivix,
- Glodosane – acidic only use if edentulous – not recommended
smooth onto mucosa to make more comfortable
- Can be good whilst doing restorative work to make comfortable on extractions
Some have pork or cow mucins - be aware
advice for xerostomia mangement
regular drinks of plain tap water
cutting down on caffeine
chew sugar free gum
possible causes of dry mouth
- Polypharmacy -compound it
- Drug side effect
Contact GP
Can be really uncomfortable
what is this
Erythematous Palate
Denture stomatitis
- Swollen, sore
common cause of denture stomatitis
candida albicans
remedies for denture stomatitis
- Clean dentures - soak
- Remove at night
- Better fit - realign temporarily
- Antifungal - topical
- miconazole, on fitting surface of denture
- tee tree oil is a natural antifungal
Candida can get into resin - so constant reinfects need new denture