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BDS3 - Special Care Dentistry > PBL 2 - intellectual impairment > Flashcards

PBL 2 - intellectual impairment Flashcards

1
Q

what is Klinefelter’s syndrome

A
  • male is born with an extra X chromosome so has XXY
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2
Q

what can be the problems associate with klinefelter’s

A
  • most individuals there are none
  • in adulthood can have problems with infertility
  • increased risk of type 2 diabetes, osteoporosis, blood clots, CVD, hypothyroidism and anxiety
  • male breast cancer more likely
  • low mood
  • learning difficulties
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3
Q

what do you need to be aware of when doing treatment on those with klinefelters

A
  • if diabetic has poor wound healing
  • plan appointment times in the morning
  • could be anxious
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4
Q

what do those with klinefelters often look like

A
  • tall with narrow shoulders
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5
Q

what is taurodontism

A
  • enlargement of pulp chamber and tooth vertical and the expense of the root = occurs in molar teeth
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6
Q

how can you make dental visits better for those with aSD

A
  • could get health passport before hand
  • give social stories
  • ask how patient communicates = are any adjuncts needed
  • desensitisation can be important
  • distraction can be useful
  • consider reducing light or noise in the surgery
  • consider inhalation sedation = may or may not be effective as needs to be inhaled through nose so they must be cooperative enough
  • GA may be needed
  • for access to the mouth can use bedi shield or an open wide mouth rest
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7
Q

what is a bedi shield

A
  • place on finger and place in mouth to allow patient to bite onto it
  • prone to fracturing
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8
Q

what is an open wide mouth rest

A
  • less likely to fracture

- can be placed in horizontal or vertical depending on access required

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9
Q

wha treatment is given for klinefelters

A
  • testosterone replacement therapy
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10
Q

is testosterone stopped before dental procedures

A
  • recommended to discontinue use 1-2 weeks before undergoing surgical/invasive procedures due to potential increased risk of blood clots and other complications
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11
Q

what makes testosterone dangerous for GA

A
  • it can worsen sleep apnoea which is dangerous for GA
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12
Q

how does smoking cause chest infections

A
  • causes paralysis of the cilia so they are unable to remove mucus, dust or impurities from the lungs
  • makes smokers more likely to develop chest infections, particularly after a GA
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13
Q

what does low levels of testosterone do

A
  • shown to have a negative effect on bone metabolism
  • related to an increased level of pro-inflammatory cytokines and enhanced osteoclastic activity
  • studies show positive link between testosterone levels and periodontitis
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14
Q

what can beta-2 agonists cause with prolonged use

A
  • decrease salivary production which then increases the risk of dental caries
  • also cause smooth muscles relaxation and this will effect lower oesophageal sphincter which leads to acid reflux and teeth erosion eventually
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15
Q

what can repeated contact of corticosteroids with mucous membrane of the mouth cause

A
  • depresses the immune system, leading to overgrowth of thrush-causing yeast
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16
Q

what is important to tell patient when giving OHI to asthmatics

A
  • rinse mouth with neutral or high pH mouth rinse immediately following inhalation of asthma medication
  • wait 30mins before brushing teeth
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17
Q

how does a spacer reduce risk of steroid-related oral candidiasis

A
  • prevents the medication from scattering to the mouth, throat and stomach
18
Q

what 3 main areas do patients with ASD have difficulties in

A
  • social interaciton
  • communication
  • repetitive behaviours or restricted interests
19
Q

what is oranurse

A
  • toothpaste
  • non-foaming, tasteless
  • still has normal fluoride ppm
20
Q

why is oranurse god for ASD patients

A
  • prevents sensory overload

- may be more accepting of it

21
Q

how long does guardianship take to get

A
  • 6 months to a year through the council

- granted by the adult while they still have capacity

22
Q

who do guardians need to be registered with

A
  • office of the public guardian
23
Q

how long are guardianship orders for

A
  • court appointed
  • requires 2 medical reports
  • usually appointed for 3 years
24
Q

what are the 5 As for smoking cessation

A
  • ask
  • advise
  • assess
  • assist
  • arrange
25
Q

how does a patient demonstrate capacity

A

they understand:

  • simple language about treatment
  • risks and benefits
  • consequences of not receiving treatment
  • retain information to use and weigh it in the balance in order to arrive at a decision
26
Q

who can consent for dental treatment

A
  • patients with capacity
  • welfare powers of attorney
  • welfare guardians
  • medical and dental practitioners under section 47 of AWI Act
27
Q

how many ASA classifications are there

A
  • 6
28
Q

what is ASA I

A
  • healthy patient no problems
29
Q

what is ASA II

A

○ Patient with mild systemic disease
○ Current smoker, social alcohol drinker, pregnancy, obesity, well controlled diabetes mellitus,
○ Also patients who demonstrate more extreme anxiety and fear toward density
○ Can be higher risk of complication with sedation
Higher risk of complications with sedation, safe if correct precautions taken

30
Q

what is ASA III

A

○ Patient with severe systemic disease
○ Substantive functional limitations because of the one or more moderate to severe diseases
○ Poorly controlled diabetes mellitus, COPD, morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker
○ Needs to be in hospital for sedation
○ Chronic conditions
Hospital environment only

31
Q

what is ASA IV

A

○ Severe systemic disease

Hospital environment only

32
Q

what is ASA V

A

○ Moribund Patient

○ Not appriate for dental sedation

33
Q

what is ASA VI

A

○ Brain dead patient whose organs are being removed for donor purposes
Not appropriate for dental sedation

34
Q

how many are affected with klinefelters

A
  • 1 in 600
35
Q

how can klinefelters affect dental development

A
  • increased molar size = big pulp with little roots

- prognathism = protruded mandible

36
Q

what do you need to ask if patient is allergic to if asthmatic

A
  • colophony

- in duraphat varnish and toothpaste

37
Q

what is a traumatic erosive ulcer

A
  • adjacent to sharp tooth
  • keratinisation suggests it has been chronic in that area
  • erosion is common from trauma as the tooth wears away the top layers of mucosa
38
Q

what are apthous ulcers

A
  • commonly recurrent and multiple in mouth

- often resolve themselves

39
Q

what are the indications for conscious sedation

A
  • dental phobia and anxiety
  • traumatic and long dental procedures
  • medical conditions aggravated by stress such as angina, asthma or epilepsy
  • children over 1
  • mentally challenged individuals
  • ineffective LA due to any reason
40
Q

what 3 main groups of patients get GA

A
  • simple dental extractions in children aged 4-10 or in those with learning difficulties
  • day care anaesthesia for extraction of permanent molars or minor oral surgery work
  • in-patient anaesthesia for more complex or extensive dental work
41
Q

how can give a AWI section 47 form

A
  • GDP if they have training to do so

- GP

BDS3 - Special Care Dentistry (19 decks)

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