Old Cunt Symposium Flashcards
What overarching complications arise from the impact of ageing on dental treatment?
Increased risk of oral disease
Polypharmacy
Impairment causing lack of cooperation
Issues with access
Medical conditions complicate or contraindicate treatment
Diagnose and give some signs/symptoms. How might you treat?
Lichen planus
Discomfort on eating, especially hot, acidic of spicy foods
Difficulty performing oral hygiene
Risk of malignancy
What is the leading cause of death in patient with dysphagia associated with neurological impairment?
Aspiration pneumonia - swallowing of food or drink into the airway not the osesophagus
What does qualities of life often mean for older people?
Good mobility
Good social interaction and keeping a role in society
Positive social outlook
Having control of one’s independence
What are some key considerations when planning treatment for a dementia patient?
Retain KEY teeth (anteriors or occluding pairs)
Multi-disciplinary care
High quality restorations to avoid re treatment
Establish preventative regime where consideration is given to deteriorating ability to cooperate and access becomes reduced
Why might rendering the patient edentulous not be the best idea?
Natural teeth have significant impact on QOL
Better chewing and eating
Pt can be proud of teeth
Better motivation to engage in social life
What should treatment focus on in late stage dementia?
Focus on comfort
Moist, clean and healthy mouth
Free of pain
Avoid significant morbidity and challenges associated with GA and sedation
Move away from pharmacological approach
How might one approach communication with a dementia patient?
Approach from the front
Speak in short simple sentences
Limit environmental distraction and sensory overload triggers
What national programmes are on place to aid elderly oral hygiene?
Caring for smiles
- trains carers in care homes on oral hygiene
Mouth care without a battle
- improved familiarity of mouth care procedures in carers and positively affected the provision of oral care
What is dementia?
Characteristics?
Acquired progressive loss of cognitive functions severe enough to interfere with daily functioning
Characterised by
- amnesia
- lack of concentration
- disorientation in time, place or person
- intellectual impairment
- emotional control loss
- social behaviour loss
- motivation loss
Give some forms of dementia
Alzheimer’s
Vascular
Frontotemporal
Dementia with Lewy bodies
Parkinson’s
MS
What is Alzheimer’s disease?
Most common form of dementia caused by a reduction in size of the cortex
- Plaques (beta-amyloid proteins) build up between nerve cells
- Tangles (twisted tau protein fibres) build inside nerve cells
- results in neuroinflamamtion in the brain andf loss of synaptic control
What is vascular dementia? symptoms?
Reduced blood flow to brain damaging or killing Brain cells
Can occur from
- Stroke
- hypertension or diabetes
- small vessel disease in the brain
Seizures, sudden memory issue, anxiety and delusions
What is dementia with Lewy bodies? give some symptoms
Deposits of abnormal protein called lewy bodies in the brain in areas responsible for
- memory
- muscular control
STML, Motor disorders, speech and swallowing issues, cognitive ability fluctuates
What is frontotemporal dementia?
Cause often idiopathic but largely affected by genetics
issues with frontal and temporal lobe
- personality and behavioural changes
- younger age of onset
- repetition of words
Give a few early stage dementia symptoms
STML
Confusion
Anxiety
Decrease in ability or interest in communication
Give some middle stage dementia symptoms
Increasingly forgetful and fail to recognise some people
Mood changes - anger and frustration
Risk of wandering and getting lost
Hallucinations
Give some late stage dementia symptoms
Inability to recognise familiar surroundings or objects
Poor movement - shuffling or even wheelchair or bed bound
Issues with eating and swallowing
Incontinence
How may dementia be delayed?
Counselling can delay residential care by up to a year
Aspirin and reducing cardiac risks can halt vascular dementias
NSAIDS may slow progression
Give some features of a dementia friendly healthcare environment
Visible reception desk
Acoustically absorbent surfaces
Distinctive colour of walls from floor
Eye level signs with simple writing, text and colour
Good natural light
What is the Francis report?
Public enquiry into mid Staffordshire NHS trust
- reports of abuse and neglect
- not an isolated incident
What is a piece of legislation introduced for improving oral health of elderly in care home
What’s their aims?
Caring for smiles
Improving health, nutrition, quality of life, communication and appearance
Through improving and maintaining oral hygiene in the elderly dentition
What are the main oral conditions that affect the elderly?
Lichen planus
Herpes zoster
Malignant lesions, carcinoma
Sore tongue
Candidosis - Candida albicans
Diagnose and explain. How to treat and any complications?
Hemangioma
Collection or malformation of little blood vessels leading to pool of blood under mucosa
Easily traumatised and can bleed lots
Complicated with blood thinner meds
Treat with cryotherapy
Diagnose and explain
Fibroepithelial polyp
Can be peducnulated or cessile
Caused by trauma or irritation e.g, sharp tooth or biting tongue
Removed by excision
Diagnose and explain
Black hairy tongue
Overgrowth of normal tongue tissue, can easily pick up staining
Treat via keeping tongue clean. Clean forward so the bacteria isn’t pushed down throat
Diagnose and explain
Geographic tongue
Abnormal tongue surface
Atrophy depappilated areas surrounded by raised white margins
Diagnose and explain
Atrophic glossitis
Shiny tongue
Caused by low haemotinics so low iron, low folate, low vitamin b12
Send to gp
Diagnose and explain
Frictional keratosis
Caused by trauma so body deposits keratinised tissue
Like guitar players or gym goers having calloused hands
Diagnose and explain
Frictional keratosis
Body deposits keratinised tissue due to trauma
Like gym goers having calloused hands
Identify the trauma and regularly review area, if no obvious sign of trauma may be malignant
Treat by targeting cause
Diagnose and explain
Speckled leukoplakia / hyperplastic candidosis
Found in commissure of mouth often
Speckled appearance
Often in smokers
Typically pre-malignant lesion so can turn into cancer, must be monitored
Take biopsy and also microbial swab to se if infected with candida
Diagnose and explain
Sublingual keratosis
Homogenous white patch beneath tongue in a high risk site
If it crosses midline its also high risk
Be concerned and refer to oral medicine
Diagnose and explain
Traumatic keratosis due to denture
Keratinised tissue being placed due to trauma from denture
Can be overextended flange or trauma to fraternal attachments
Diagnose and explain
Denture induced hyperplasia
Excess mucosa due to rubbing of the denture
Leads to overgrowth in skin
Remove denture or surgically excise or trim denture
Diagnose and explain
Denture stomatitis
Inflammation of palate due to candida infection
Caused by not taking the denture out and leaving it in overnight for example
Diagnose and explain
Angular chelitis
Take a swab of area so you know what is the cause and can prescribe accordingly
Deal with problem first rather than throw meds at it e.g. is denture being removed at night or being cleaned properly
How might one manage xerostomia?
Target cause - certain drugs causing it
Artificial saliva
Salivary stimulants e.g. chewing gum
Diagnose and explain
Lichen planus
Caused by drugs (lichen planus)
or autoimmune reactions (lichenoid reaction)
NSAIDS, beta blockers, statins can all cause this
Give some risk factors for MRONJ
Age extremes
Corticosteroids
Systemic issue affecting bone
Chemo/radiotherapy
MRONJ previous diagnosis
Bisphosphonates !!
Diagnose and explain
Herpes zoster virus / shingles
Can affect any branch of the trigeminal nerve, mostly V1
- Often unilateral
Typically prodromal pain followed by rash a few days later
- low grade fever
- malaise
-paraesthesia
- shooting pain / herpetic neuralgia
- drop like vesicles
What is trigeminal neuralgia? How can it be treated?
It is 10/10 electrical shock pain along trigeminal branches
Can be cryotherapy to freeze nerve, inject nerve with alcohol or glycerol to damage it, neurectomy to remove or avulsion of nerve
Ask for an MRI
What is burning mouth syndrome?
Feels like mouth is burning
Often associated with anxiety and depression, but idiopathic in 50% cases
Its a signalling problem between mouth and brain
How can HbA1c levels affect tx?
<7% = any tx in clinic
<9% = only emergency care and preferably in hospital
> 12% = all procedures halted
How facilitate diabetic patient?
Morning sessions
- higher endogenous cortisol levels increase blood glucose levels and most stable in morning
- avoid appt at meal times
What is ischaemic stroke?
Occlusion of artery leading to affected cerebral circulation
- cerebral infarction 85%
Thrombotic - atherosclerosis in cerebral artery
Embolic - AF/valve and IE pts, thrombus breaks down and wedges into smaller distal artery
What is haemorrhaging stroke?
Collection of blood from ruptured BV
Cerebral haemorrhage
Subarachinoid haemorrhage
Signs and symptoms of stroke?
Face and arm weakness
Slurred speech
Urinary incontincence
Headache
Confusion
Face / neck pain
Horners syndrome - drooping of upper eyelid - partial ptosis - and miosis - constricted pupil.
Loss of voluntary movement
Risk factors stroke?
Hypertension
Diabetes
A-fib
IE
Atherosclerosis
> 55 age - doubles risk
Smoking and alcohol
Dental implications of stroke?
Aphasia - communication impairment
Denture wearing issues - loss of muscle control of the cheek and tongue, or sensation on one side of mouth
Root caries - drug induced xerostomia
Poor OH - may rely on third party due to loss of dominant hand?
How instruct stroke pt to eat after stroke? Why?
Issue with swallowing after stroke as one side may not function correctly
- most recover after 1 month as control comes bilaterally from brain
- chin to chest when swallowing so epiglottis closes over larynx
Symptoms of Parkinson’s
Stooped posture
Mask like face
Bradykinesia
Muscular rigidity
Resting tremor
Shuffling gait
Non motor symptoms / signs of Parkinson’s?
Sleep disturbances
Increased Lewy body disease!
Psychoses
Depression
Dental implications of Parkinson’s?
Xerostomia
- root caries
- poor denture retention
- poor perio
- poor denture rendition due to tremor
- tremor and drooling can mean sharp instruments = hazardous
Distinctive features of Alzheimer’s
STML
Getting lost
Poor insight into issues
Behavioural changes
Dysphagia
Distinctive features of vascular dementia?
Step-wise progression
Sudden onset memory issues
- stroke symptoms
- seizures
- delusions
- planning and organising impairment
Distinctive features of Lewy body dementia?
Fluctuating cognition
Visual hallucinations
Parkinson’s features
- Parkinson’s increases Lewy bodies
Characteristics of frontal temporal dementia?
Behavioural - personality and behaviour changes
Semantic - difficult finding words, aphasia, impaired comprehension
Non-fluent - more hesitant speech and aphasia
Dementia friendly surgery and environment?
- visible reception
- acoustically absorbent
- walls distinct colour from floor / ceiling
- avoid non-essential signs
- eye level signage
- natural light
- staff only / locked doors same colour as walls
How communicate to someone with dementia?
Engage attention and avoid distraction
Eye contact
Hold hand or arm
Short sentences
Yes/no questions
Humour for rapport
Reassure constantly
Call by first name if happy, they will remember this much longer than first name
Early stage dementia care?
MDT
- assessment and consider type and progression
- retain key teeth!!!
- high quality restorations
- establish prevention
Dental implications of dementia
Future decline in OH
Prevention!!!
Dentures often lost / broken - spares
Xerostomia
- drugs
- caries and perio
- halitosis
Dysphagia
Find time of day cooperation is best
