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Special Care Dentistry > Older People > Flashcards

Older People Flashcards

1
Q

what are the challenges of the ageing population

A

increased number of people with long term conditions
increasing age with concurrent increase in co-morbidities
polypharmacy

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2
Q

what is the impact of ageing and systemic disease on dental care

A

population at increased risk of oral disease
polypharmacy
impaired ability to co-operate
access - moving and handling
medical conditions complicate provision of dental treatment
medical conditions contraindicate provision of dental treatment

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3
Q

what types of oral disease can older person get

A

caries
periodontal disease
poor OH
oral mucosal disease
lichen planus
head and neck cancer

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4
Q

what are the complications of lichen planus

A

discomfort when eating
risk of malignant transformation

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5
Q

why do older people sometimes present with quite advanced oral cancer

A

delayed diagnosis
symptoms unable to be communicated
lack of attention paid
misdiagnosis

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6
Q

what is the most common cause of death in patients with dysphagia

A

aspiration pneumonia

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7
Q

what is good health according to WHO

A

complete physical, social and mental well-being and not merely absence of disease or infirmity

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8
Q

what does quality of life mean for older people

A

having good social relationships
maintaining social activities and retaining a role in society
having a positive psychological outlook
having good health and mobility
enjoy life and retain ones independence and control over life

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9
Q

what should treatment planning be like in early stage dementia

A

plan for future
identify and attempt to retain key teeth
high quality restorations
are complex restorations going to be cared for properly?
preventative regime

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10
Q

what key teeth should be kept for quality of life

A

occluding pairs of teeth
number of teeth
attempt to retain anterior teeth

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11
Q

what are the reasons against rendering someone edentulous

A

natural teeth have impact on quality of life
chewing and eating
nutrition
independence/pride
social aspects of life

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12
Q

what should treatment planning be like in mid stage dementia

A

maintenance and prevention
consider medical status and implications on care

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13
Q

what should treatment planning be like in late stage dementia

A

comfort
moist, clean, healthy mouth free of pain and infection
non-invasive
emergency management if need be

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14
Q

what do we need to control to secure oral health

A

oral hygiene and biofilm removal
sugar
level and quality of care
teeth
fluoride
operative intervention

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15
Q

how do you communicate with a person with dementia

A

approach from front
break it into steps
non-verbal - smiles, touch
get environment right

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16
Q

what is caring for smiles

A

national programme to promote good oral health for residents in care homes given by the carers

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17
Q

what issues do older people face

A

frailty
polypharmacy
continence
falls
bone health
nutrition and weight loss

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18
Q

what is frailty

A

a state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic, and immune systems

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19
Q

what does frailty present like

A

unintentional weight loss
exhaustion
weakness
slow walking speed
low physical activity

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20
Q

what is rockwood frailty

A

consequence of deficits that are associated with ageing

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21
Q

define oral health

A

multifaceted and includes speaking, smiling, smelling, taste, touch, chewing, swallowing, conveying emotions without pain, discomfort and disease

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22
Q

what are the 2 models of bringing quality of life into practice

A

prevention
delivery of clinical care

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23
Q

how does caring for smiles work

A

adults moving into care home have mouth care needs assessed on admission
adults living in care home follow personal care plan
supported to clean teeth twice a day and undertake daily oral care for dentures

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24
Q

what are the major oral health complaints in the older population

A

dry mouth
ulceration
infection and pain

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25
Q

what is the oral health improvement plan for older population

A

domiciliary care provision
enhanced skills
partnership between health and social care

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26
Q

what is needed to more forward in caring for older people

A

further education and research

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27
Q

what teeth related things has a positive impact on quality of life for older people

A

increased number of teeth,
anterior teeth
occluding pairs of teeth

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28
Q

what is a haemangioma

A

collection of blood vessels which will bleed if traumatised

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29
Q

how do you remove a haemangioma

A

surgery done in hospital

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30
Q

what is a fibroepithelial polyp

A

build up of tissue which occurred after trauma

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31
Q

what is a black hairy tongue

A

overgrowth on surface of tongue which picks up stains
normal

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32
Q

who more commonly has a black hairy tongue

A

smokers

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33
Q

how do you treat a black hairy tongue

A

brush with toothbrush from midline forwards

34
Q

what is a geographic tongue

A

areas of atrophy surrounded by white margins

35
Q

what is atrophic glossitis

A

smooth tongue

36
Q

what is the causes of atrophic glossitis

A

low iron or low vit b12

37
Q

what do you do if you see someone with atrophic glossitis

A

ask GP for haematinics

38
Q

what is frictional keratosis

A

white patch caused by trauma which keratinises

39
Q

what is speckled leukoplakia

A

hyperplastic candidosis
pre-malignant

40
Q

how do you treat speckled leukoplakia

A

biopsy - refer to oral med

41
Q

what denture induced problems can we get

A

traumatic keratosis
hyperplasia
stomatitis

42
Q

how does denture hyperplasia occur

A

denture slips around causing rubbing at sites leading to overgrowth

43
Q

how do you treat denture hyperplasia

A

remove denture and then can surgically remove hyperplastic area if it does not go away itself

44
Q

what is denture stomatitis

A

candida infection where it burrows into the surface of the mucosa and plastic of denture

45
Q

how do you treat denture stomatitis

A

remind of denture hygiene and not to wear at night
clean with sodium hypochlorite/chlorhexidine
antifungals

46
Q

what causes angular cheilitis

A

bacteria/fungal infection often due to denture being reservoir and decreased OVD

47
Q

how do we treat angular cheilitis

A

denture hygiene advice
look at denture OVD
haematinics
medications if nothing else works

48
Q

what are the causes of xerostomia

A

polypharmacy, sjogrens, radiotherapy

49
Q

how do we test for dryness

A

use mirror on tongue, if it sticks is suggests poor saliva quality

50
Q

how do we manage xerostomia

A

change medication
salivary replacement
salivary stimulants

51
Q

what can we use as salivary replacements

A

lots of water
saliva orthana
biotene oral balance
bioxtra

52
Q

what salivary stimulants can we use

A

chewing gum
glycerine and lemon

53
Q

what salivary stimulant should never be used for people with natural teeth as it is acidic

A

glandosane

54
Q

what type of drugs can give mucosal burns

A

aspirin and iron

55
Q

if iron tablets are causing burns to the mucosa what should we try and do

A

get patient changed to liquid iron

56
Q

what drugs can give lichen planus and lichenoid tissue reactions

A

NSAIDs
beta blockers
diuretics
oral hypoglycaemics
statins
antimalarials
sulphonamide

57
Q

how does lichen planus present in the mouth

A

reticular, erosive, plaque, atrophic

58
Q

if a patient presents with erosive oral lichen planus what should you do

A

refer to oral med

59
Q

what do bisphosphonates do

A

inhibit osteoclast formation and osteolytic activity - inhibit bone turnover

60
Q

what are some non-malignant uses of bisphosphonates

A

osteoporosis
pagets disease
osteopenia

61
Q

what are some malignant uses of bisphosphonates

A

multiple myeloma
breast cancer
prostate cancer

62
Q

what are the risk factors for MRONJ

A

extremes of age
concurrent use of corticosteroids
systemic conditions affecting bone turnover
malignancy
coagulopathies, chemotherapy, radiotherapy
duration of therapy
previous diagnosis of BRONJ
potency of drug
invasive dental procedures
denture trauma
poor OH
periodontal disease
alcohol or tobacco use
thin mucosal coverage

63
Q

what are the methods of delivery of bisphosphonates

A

IV or oral

64
Q

in what jaw is MRONJ more common in

A

mandible

65
Q

what does MRONJ present as

A

sequestrae of bone
open area in the mouth as gum does not heal

66
Q

what do we inform people of MRONJ before treatment

A

advise of risk
informed consent
emphasise rarity of condition
dont discourage from taking medication

67
Q

what patient advice should we give to MRONJ patients

A

regular dental checks
maintain good oral hygiene
limit alcohol and stop smoking
report any symptoms

68
Q

what is shingles

A

form of varicella zoster virus

69
Q

what is the presentation of shingles

A

prodromal pain
2-3 days later unilateral rash on face and in mouth
painful

70
Q

what is post herpetic neuralgia

A

constant burning sensation in dermatomal distribution
usually resolves within 2 months
has had previous episode of shingles

71
Q

what is the treatment for post herpetic neuralgia

A

antidepressants
gabapentin
carbamazepine
topical capsaicin
transcutaneous electrical nerve stimulation

72
Q

what is the medical management of trigeminal neuralgia

A

carbamazepine
oxcarbazepine
gabapentin
pregablin
lamotrigine
sodium valproate

73
Q

what is the surgical management of trigeminal neuralgia

A

cryotherapy
injection of alcohol or glycerol
neurectomy
avulsion of nerve
balloon compression

74
Q

if a younger person has trigeminal neuralgia what else should be considered

A

multiple sclerosis
space occupying lesion

75
Q

what can burning mouth syndrome be caused by

A

drugs
dry mouth
candidosis
haematinic deficiencies
diabetes
parafunctional activity
denture factors
hypothyroidism
allergy

76
Q

what did the francis report reveal

A

abuse, neglect, appalling care of people particularly older dependent adults

77
Q

what reduces chances of aspiration pneumonia

A

improved oral health

78
Q

what does the berwick support say

A

patient safety should be the ever present concern of every person working in or affecting NHS funded care

79
Q

what nutrition problems can loss of teeth lead to

A

impaired masticatory function
avoidance of foods that are hard to chew
not meeting nutritional needs
increased intake of processed, high cholesterol and lipid based foodstuffs

79
Q

what nutrition problems can loss of teeth lead to

A

impaired masticatory function
avoidance of foods that are hard to chew
not meeting nutritional needs
increased intake of processed, high cholesterol and lipid based foodstuffs

80
Q

what are the barriers to oral hygiene in the elderly in care homes

A

oral health is low priority in care plans
carers have limited knowledge of oral health
carers have difficulty gaining access to teeth
high turnover of care staff
poorly paid care staff

Special Care Dentistry (15 decks)

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