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Old Cunt Symposium Flashcards

1
Q

What overarching complications arise from the impact of ageing on dental treatment?

A

Increased risk of oral disease

Polypharmacy

Impairment causing lack of cooperation

Issues with access

Medical conditions complicate or contraindicate treatment

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2
Q

Diagnose and give some signs/symptoms. How might you treat?

A

Lichen planus

Discomfort on eating, especially hot, acidic of spicy foods

Difficulty performing oral hygiene

Risk of malignancy

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3
Q

What is the leading cause of death in patient with dysphagia associated with neurological impairment?

A

Aspiration pneumonia - swallowing of food or drink into the airway not the osesophagus

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4
Q

What does qualities of life often mean for older people?

A

Good mobility

Good social interaction and keeping a role in society

Positive social outlook

Having control of one’s independence

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5
Q

What are some key considerations when planning treatment for a dementia patient?

A

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

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6
Q

Why might rendering the patient edentulous not be the best idea?

A

Natural teeth have significant impact on QOL

Better chewing and eating

Pt can be proud of teeth

Better motivation to engage in social life

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7
Q

What should treatment focus on in late stage dementia?

A

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

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8
Q

How might one approach communication with a dementia patient?

A

Approach from the front

Speak in short simple sentences

Limit environmental distraction and sensory overload triggers

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9
Q

What national programmes are on place to aid elderly oral hygiene?

A

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

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10
Q

What is dementia?

Characteristics?

A

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
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11
Q

Give some forms of dementia

A

Alzheimer’s

Vascular

Frontotemporal

Dementia with Lewy bodies

Parkinson’s

MS

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12
Q

What is Alzheimer’s disease?

A

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
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13
Q

What is vascular dementia? symptoms?

A

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

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14
Q

What is dementia with Lewy bodies? give some symptoms

A

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

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15
Q

What is frontotemporal dementia?

A

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

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16
Q

Give a few early stage dementia symptoms

A

STML

Confusion

Anxiety

Decrease in ability or interest in communication

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17
Q

Give some middle stage dementia symptoms

A

Increasingly forgetful and fail to recognise some people

Mood changes - anger and frustration

Risk of wandering and getting lost

Hallucinations

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18
Q

Give some late stage dementia symptoms

A

Inability to recognise familiar surroundings or objects

Poor movement - shuffling or even wheelchair or bed bound

Issues with eating and swallowing

Incontinence

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19
Q

How may dementia be delayed?

A

Counselling can delay residential care by up to a year

Aspirin and reducing cardiac risks can halt vascular dementias

NSAIDS may slow progression

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20
Q

Give some features of a dementia friendly healthcare environment

A

Visible reception desk

Acoustically absorbent surfaces

Distinctive colour of walls from floor

Eye level signs with simple writing, text and colour

Good natural light

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21
Q

What is the Francis report?

A

Public enquiry into mid Staffordshire NHS trust

  • reports of abuse and neglect
  • not an isolated incident
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22
Q

What is a piece of legislation introduced for improving oral health of elderly in care home

What’s their aims?

A

Caring for smiles

Improving health, nutrition, quality of life, communication and appearance

Through improving and maintaining oral hygiene in the elderly dentition

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23
Q

What are the main oral conditions that affect the elderly?

A

Lichen planus

Herpes zoster

Malignant lesions, carcinoma

Sore tongue

Candidosis - Candida albicans

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24
Q

Diagnose and explain. How to treat and any complications?

A

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

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25
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
26
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
27
Diagnose and explain
Geographic tongue Abnormal tongue surface Atrophy depappilated areas surrounded by raised white margins
28
Diagnose and explain
Atrophic glossitis Shiny tongue Caused by low haemotinics so low iron, low folate, low vitamin b12 Send to gp
29
Diagnose and explain
Frictional keratosis Caused by trauma so body deposits keratinised tissue Like guitar players or gym goers having calloused hands
30
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
31
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
32
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
33
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
34
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
35
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
36
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
37
How might one manage xerostomia?
Target cause - certain drugs causing it Artificial saliva Salivary stimulants e.g. chewing gum
38
Diagnose and explain
Lichen planus Caused by drugs (lichen planus) or autoimmune reactions (lichenoid reaction) NSAIDS, beta blockers, statins can all cause this
39
Give some risk factors for MRONJ
Age extremes Corticosteroids Systemic issue affecting bone Chemo/radiotherapy MRONJ previous diagnosis Bisphosphonates !!
40
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
41
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
42
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
43
How can HbA1c levels affect tx?
<7% = any tx in clinic <9% = only emergency care and preferably in hospital >12% = all procedures halted
44
How facilitate diabetic patient?
Morning sessions - higher endogenous cortisol levels increase blood glucose levels and most stable in morning - avoid appt at meal times
45
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
46
What is haemorrhaging stroke?
Collection of blood from ruptured BV Cerebral haemorrhage Subarachinoid haemorrhage
47
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
48
Risk factors stroke?
Hypertension Diabetes A-fib IE Atherosclerosis >55 age - doubles risk Smoking and alcohol
49
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?
50
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
51
Symptoms of Parkinson’s
Stooped posture Mask like face Bradykinesia Muscular rigidity Resting tremor Shuffling gait
52
Non motor symptoms / signs of Parkinson’s?
Sleep disturbances Increased Lewy body disease! Psychoses Depression
53
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
54
Distinctive features of Alzheimer’s
STML Getting lost Poor insight into issues Behavioural changes Dysphagia
55
Distinctive features of vascular dementia?
Step-wise progression Sudden onset memory issues - stroke symptoms - seizures - delusions - planning and organising impairment
56
Distinctive features of Lewy body dementia?
Fluctuating cognition Visual hallucinations Parkinson’s features - Parkinson’s increases Lewy bodies
57
Characteristics of frontal temporal dementia?
Behavioural - personality and behaviour changes Semantic - difficult finding words, aphasia, impaired comprehension Non-fluent - more hesitant speech and aphasia
58
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
59
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
60
Early stage dementia care?
MDT - assessment and consider type and progression - retain key teeth!!! - high quality restorations - establish prevention
61
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

F - SCD (12 decks)

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