PBL 2 - intellectual impairment Flashcards
what is Klinefelter’s syndrome
- male is born with an extra X chromosome so has XXY
what can be the problems associate with klinefelter’s
- 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
what do you need to be aware of when doing treatment on those with klinefelters
- if diabetic has poor wound healing
- plan appointment times in the morning
- could be anxious
what do those with klinefelters often look like
- tall with narrow shoulders
what is taurodontism
- enlargement of pulp chamber and tooth vertical and the expense of the root = occurs in molar teeth
how can you make dental visits better for those with aSD
- 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
what is a bedi shield
- place on finger and place in mouth to allow patient to bite onto it
- prone to fracturing
what is an open wide mouth rest
- less likely to fracture
- can be placed in horizontal or vertical depending on access required
wha treatment is given for klinefelters
- testosterone replacement therapy
is testosterone stopped before dental procedures
- recommended to discontinue use 1-2 weeks before undergoing surgical/invasive procedures due to potential increased risk of blood clots and other complications
what makes testosterone dangerous for GA
- it can worsen sleep apnoea which is dangerous for GA
how does smoking cause chest infections
- 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
what does low levels of testosterone do
- 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
what can beta-2 agonists cause with prolonged use
- 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
what can repeated contact of corticosteroids with mucous membrane of the mouth cause
- depresses the immune system, leading to overgrowth of thrush-causing yeast
what is important to tell patient when giving OHI to asthmatics
- rinse mouth with neutral or high pH mouth rinse immediately following inhalation of asthma medication
- wait 30mins before brushing teeth
how does a spacer reduce risk of steroid-related oral candidiasis
- prevents the medication from scattering to the mouth, throat and stomach
what 3 main areas do patients with ASD have difficulties in
- social interaciton
- communication
- repetitive behaviours or restricted interests
what is oranurse
- toothpaste
- non-foaming, tasteless
- still has normal fluoride ppm
why is oranurse god for ASD patients
- prevents sensory overload
- may be more accepting of it
how long does guardianship take to get
- 6 months to a year through the council
- granted by the adult while they still have capacity
who do guardians need to be registered with
- office of the public guardian
how long are guardianship orders for
- court appointed
- requires 2 medical reports
- usually appointed for 3 years
what are the 5 As for smoking cessation
- ask
- advise
- assess
- assist
- arrange
how does a patient demonstrate capacity
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
who can consent for dental treatment
- patients with capacity
- welfare powers of attorney
- welfare guardians
- medical and dental practitioners under section 47 of AWI Act
how many ASA classifications are there
- 6
what is ASA I
- healthy patient no problems
what is ASA II
○ 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
what is ASA III
○ 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
what is ASA IV
○ Severe systemic disease
Hospital environment only
what is ASA V
○ Moribund Patient
○ Not appriate for dental sedation
what is ASA VI
○ Brain dead patient whose organs are being removed for donor purposes
Not appropriate for dental sedation
how many are affected with klinefelters
- 1 in 600
how can klinefelters affect dental development
- increased molar size = big pulp with little roots
- prognathism = protruded mandible
what do you need to ask if patient is allergic to if asthmatic
- colophony
- in duraphat varnish and toothpaste
what is a traumatic erosive ulcer
- 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
what are apthous ulcers
- commonly recurrent and multiple in mouth
- often resolve themselves
what are the indications for conscious sedation
- 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
what 3 main groups of patients get GA
- 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
how can give a AWI section 47 form
- GDP if they have training to do so
- GP
