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BDS3 - Paediatrics > paeds medical tutorials > Flashcards

paeds medical tutorials Flashcards

1
Q

how can you reassure a parent that your practice is prepared for a child with autism

A
  • reassure that you have experience of treating children with ASD
  • find out about experience of child
  • get parent to complete ASD questionnaire
  • send her a social story for your practice to prepare son
  • detail what will happen on day of examination
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2
Q

what are the 3 main issues for autistic patients

A
  • difficulties with communication and language
  • difficulties in forming relationship with other people
  • a limited pattern of behaviour and obsessive resistance to small changes in familiar surroundings
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3
Q

what can be some difficulties treating autistic patients

A
  • reduced ability to communicate therefore can be difficult to let patient know what you re doing
  • can be difficult to establish rapport
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4
Q

what are some characteristics of patients with ASD

A
  • Poor social relating,
  • poor play skills,
  • gaze aversion,
  • difficulty with open ended language tasks,
  • distractibility,
  • attention deficits,
  • special interest fixation and obsessions (numbers, letters, colours, train timetables etc),
  • heightened sensory input,
  • repetitive behaviours,
  • extreme resistance to invasion of personal space or being hurried,
  • failure to use facial expression and body language to interpret others.
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5
Q

what can be a problem with the dental environment for patients with ASD

A
  • new with lots of strange noises, sounds and smells
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6
Q

how can you modify your behaviour and communication style to help facilitate dental exam for patients with ASD

A
  • use specific language, less general chat, short sentences
  • be aware of how you describe things = take things very literally
  • tell-show-do should be short clear commands
  • use verbal praise and rewards
  • avoid contact where possible
  • be aware of self-injurious behaviour
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7
Q

what are some techniques to help acclimatise and make ASD patients feel more comfortable

A
  • several short visits to familiarise them
  • gradual slow exposure
  • short appointments
  • same designated appointment should be scheduled
  • picture books and cards are useful
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8
Q

why do ASD patients tend to present with worse dental decay

A
  • often have a higher pain tolerance
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9
Q

what is OraNurse

A
  • taste free toothpaste
  • good for ASD patients
  • 1350ppm
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10
Q

what are some methods ASD patients use to communicate

A
  • PECS

- Makaton

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11
Q

how can you establish pain for patients with ASD

A
  • ask if sleeping pattern is different than normal, rather than if they are staying awake
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12
Q

what is tetralogy of fallot

A
  • CHD
  • cyanotic CHD
  • hole in wall between two ventricles
  • narrowing of pulmonary valve
  • enlargement of aorta
  • muscular wall of lower right chamber of heart thicker then normal
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13
Q

what is a CHD

A
  • structural defect or condition affecting the heart, which develops in utero, before baby is born
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14
Q

how are CHD’s categorised

A
  • into cyanotic or non-cyanotic
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15
Q

what are cyanotic cardiac degects

A
  • deoxygenated blood bypasses the lungs and enters the systemic circulation, or a mixture of oxygenated and deoxygenated blood circulates
  • causes low levels of oxygen in the blood
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16
Q

what are non-cyanotic cardiac defects

A
  • occur when blood is shunted from left side of heart to the right through a structural defect in the septum
  • oxygen levels remain normal
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17
Q

what does blood shunting from left to right cause

A
  • creates more pressure on right and can create hypertrophy

- increase blood flow to lungs and can cause damage to the lungs because of increased pressure

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18
Q

what sort of medications can impact dental treatment

A
  • diuretics
  • digoxin
  • vasodilators
  • anticoagulants
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19
Q

who would you consult for patients with CHD if unsure how to treat htem

A
  • consultant cardiologist

- local paediatric dentistry department at the children’s hospital

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20
Q

what is infective endocarditis

A
  • an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect
  • more common on damaged heart valves
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21
Q

what pathogen often causes IE

A
  • streptococcus veridans
22
Q

what is mural endocardium

A
  • any part of the endocardium apart from the heart valves
23
Q

what patients are most at risk of developing IE

A
  • adults and children with structural cardiac defects at risk of developing IE
  • acquired valvular heart disease with stenosis or regurgitation
  • hypertrophic cardiomyopathy
  • previous IE
  • CHD
  • valve replacement
  • cyanotic congenital cardiac defects are most at risk
24
Q

what is the guidelines for antibiotic prophylaxis

A
  • antibiotic prophylaxis is not recommended routinely for people undergoing dental procedures
  • only given for invasive procedures and for this who require special consideration = prosthetic valve, previous IE, CHD
25
Q

what are the two ways in which IE can present

A
  • acute = takes place over days

- subacute = occurs more gradually, over weeks or months

26
Q

what are the clinical symptoms of IE

A
  • temp >38
  • shortness of breath on exertion
  • fatigue
  • muscle and joint pains
  • unexplained weight loss
  • flu-like symptoms
  • pale skin
  • heart murmur
27
Q

what is finger clubbing

A
  • enlargement of ends of digits
28
Q

what age can you prescribe 2800ppm toothpaste

A
  • from age of 10
29
Q

at what age can you give 5000ppm

A
  • from age 16
30
Q

why do cardiac patients need to be treatment planned more radically

A
  • need to treatment plan differently because of the risk that infection can cause
  • won’t do any hall crowns or pulp treatment of primary teeth
31
Q

why are children with CCD a priority group for prevention of dental disease

A
  • increased risk of IE
  • risk of bacteraemia from dental infections and treatment
  • dental decay may delay cardiac surgery
32
Q

what type of CHD are more commonly seen in adults

A
  • acquired
33
Q

what are blue babies

A
  • right to left shunt
  • de-oxygenated blood mixes with oxygenated then goes to systemic circulation
  • most commonly seen in lips and oral mucosa = because it is so thin
34
Q

why do those with cyanotic CHD have tachycardia

A
  • to compensate for less oxygen in the body

- needs of tissues not being met so brain makes heart beat faster to compensate

35
Q

what is polycythaemia

A
  • increased RBC

- can damage liver which is involved in haemostasis

36
Q

what are the 3 layers of the heart

A
  • pericardium = outer
  • myocardium = middle
  • endocardium = inner
37
Q

what are the 4 valves of the heart

A
  • tricuspid valve = between right atria and ventricle
  • bicuspid valve - between left atria and ventricle
  • pulmonary valve = right
  • aortic valve = left
38
Q

when id CHD often picked up

A

20 week scan so parents are aware before baby is born

39
Q

what are some cyanotic CHD

A
  • tetralogy of fallot
  • transposition of great arteries
  • complete atrioventricular septal defect
  • tricuspid atresia
  • pulmonary atresia
40
Q

what are some acyanotic CHD

A
  • ventricular septal defect
  • atrial septal defect
  • patent ductus arteriosus
  • pulmonary stenosis
  • aortic stenosis
  • coartication of aorta
41
Q

what are dental considerations for CHD

A
  • risk of bleeding
  • risk of IE
  • risk of GA
  • active dental disease may delay cardiac surgery
42
Q

what is leukaemia

A
  • cancer of the white blood cells
  • normally WBC are made in bone marrow and develop, repair and reproduce themselves in an orderly and controlled way
  • in leukaemia, process gets out of control and cells do not mature so don’t work well
43
Q

what are the 4 types of leukaemia

A
  • acute myeloid leukaemia = AML
  • acute lymphoblastic leukaemia = ALL
  • chronic myeloid leukaemia = CML
  • chronic lymphocytic leukaemia = CLL
44
Q

how is ALL treated

A
  • chemotherapy is the main treatment

- 3 stages = induction, consolidation and maintenance

45
Q

what is the induction stage of ALL treatment

A
  • involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed
  • lasts 4 to 6 weeks
  • bone marrow sample is taken at the end of induction treatment to confirm whether or not child still has leukaemia
46
Q

what is the consolidation and CNS treatment of ALL treatment

A
  • aimed at maintaining remission and preventing spread of leukaemia cells into the brain and spinal cord
  • CNS treatment involves performing lumbar puncture and injecting methotrexate into spinal fluid
47
Q

what stage is between consolidation and maintenance

A
  • interim maintenance

- more drugs given to try to keep leukaemia in remission

48
Q

what is the maintenance treatment of ALL

A
  • lasts for 2 years from start of interim maintenance
  • 3 years for girls and 2 for boys
  • child takes daily and weekly tablets
49
Q

what is bone marrow transplantation used for in ALL

A
  • needed by a minority of patients and is used for children with ALL that is likely to come back
50
Q

what are the short term affects of chemotherapy

A
  • cytotoxic = mucositis and deceased salivary gland function
  • haemorrhagic = due to bone marrow suppression, can result in petechiae and gingival bleeding
  • infectious = due to bone marrow suppression, viral, bacterial and fungal
  • neurological = trismus and jaw pain
51
Q

what are the long term effects of chemotherapy

A
  • tooth agenesis
  • microdontia
  • crown hypoplasia
  • disturbed root formation
  • effect will be on teeth mineralising during chemotherapy
52
Q

if a child with ALL has dental caries what treatment would you need to do

A
  • radical treatment

- need to remove any potential sources of infection

BDS3 - Paediatrics (20 decks)

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