Rheumatology

Question 1

what are the barriers to accessing dental practice for a patient with rheumatology issues

Answer 1

disabled parking
kerbs/pavements
ramp access
railings
lift/stairs

Question 2

what are the barriers to accessing the dental surgery for rheumatology patients

Answer 2

height of reception desk
wheelchair space
door width
obstacles
position and design of door handles
accessible toilet

Question 3

what is the legislative framework which exists to enable access and provision of care

Answer 3

equality act 2010

Question 4

give a brief overview of the impact of the equality act 2010 and their impact on healthcare provider and patient

Answer 4

provider needs to make reasonable adjustments
provider cannot ask direct questions about disability
makes it easier for a patient to show they have difficulty carrying out day to day activities
protects patients from indirect discrimination

Question 5

what is a reasonable adjustment

Answer 5

any step which can be reasonably taken to prevent any provision, criterion or practice or any physical feature of its premises from putting a disabled person at a disadvantage in comparison with a non-disabled person

Question 6

what factors must we consider when trying to make a reasonable adjustment

Answer 6

how practical
how effective
cost
potential disruption
time, effort and resources

Question 7

suggest an example of a reasonable adjustment which a dentist might make to dental practice

Answer 7

ramp in addition to stairs

Question 8

give an example of an unreasonable adjustment

Answer 8

placing a lift in an old tenement building

Question 9

what do you do if you cannot make a reasonable adjustment for your patient

Answer 9

facilitate care for them at a place which can

Question 10

what are the options for helping a patient transfer from their own wheelchair onto the dental chair

Answer 10

hoist
banana board
reclining wheelchair
turn table
wheelchair recliner
stand aid

Question 11

what is the safest method of transfer from wheelchair to dental chair

Answer 11

hoist

Question 12

what personalised questions might you ask a rheumatology patient during their history

Answer 12

stability of condition, medications, prognosis
travelling to clinic/timings

Question 13

what are the signs of sjogrens syndrome

Answer 13

mucosa stick to dental mirror or tongue spatula
food residues within oral cavity
saliva frothiness
lobulated tongue
enlarged salivary glands

Question 14

what is rheumatoid arthritis

Answer 14

autoimmune and inflammatory disease attacking joints commonly in hands, wrists and knees

Question 15

what are the signs and symptoms of RA

Answer 15

pain or aching in more than one joint
stiffness in more than one joint
tenderness and swelling in more than one joint
weight loss
same symptoms on both sides of the body
fever
fatigue or tiredness
weakness

Question 16

what are the risk factors for RA

Answer 16

age
sex (women)
genetics (HLA gene)
smoking
early life exposure
obesity

Question 17

how is RA diagnosed

Answer 17

by reviewing symptoms and taking radiographs and lab tests

Question 18

what is RA treatment

Answer 18

disease modifying antirheumatic drugs
biological response modifiers
self management strategies

Question 19

what are the complications of RA

Answer 19

premature heart disease
obesity
employment

Question 20

what is osteoporosis

Answer 20

bone disease when mineral density and bone mass decreases leading to decreased bone strength

Question 21

how can you prevent osteoporosis and fractures

Answer 21

staying physically active
drinking alcohol in moderation
no smoking
taking medication properly
calcium and vit d rich diet

Question 22

who is affected by osteoporosis

Answer 22

more so women before menopause
cancer and steroid medications

Question 23

what are the risk factors for osteoporosis

Answer 23

sex (women)
age
body size
race
family history
hormone changes (low oestrogen)
diet - low calcium and vit d
medical conditions

Question 24

what are the treatment options for osteoporosis

Answer 24

proper nutrition
lifestyle changes
exercise
fall prevention
medications

Question 25

what do you want your diet to be like for osteoporosis

Answer 25

fruits and vegetables
calcium, vitamin D and protein

Question 26

what lifestyle changes might you want to make for osteoporosis

Answer 26

avoid second hand smoke
drink alcohol in moderation
visit doctor regularly

Question 27

what is the major drug used for osteoporosis

Answer 27

bisphosphonates

Question 28

how do bisphosphonates work

Answer 28

slows down bone less to preserve bone density and strength

Question 29

apart from bisphosphonates, what other medications are used for osteoporosis

Answer 29

calcitonin
oestrogen agonist/antagonist
HRT
PTH
RANKL inhibitor

Question 30

what is methotrexate

Answer 30

non-biologic disease modifying anti rheumatic drug

Question 31

how does methotrexate work

Answer 31

anti inflammatory and immunosuppressive

Question 32

how are DMARD’s relevant to dental treatment

Answer 32

not stopped for dental treatment but may consider antibiotic prophylaxis for some patients

Question 33

how are biological DMARD’s relevant to dental treatment

Answer 33

liaise with prescribing clinician as timing of treatment is important to avoid interruptions to drug regimes and maximise immune status

Question 34

what is diclofenac

Answer 34

NSAID

Question 35

what is paracetamol

Answer 35

analgesic and anti-pyrexic

Question 36

what is calichew

Answer 36

calcium and vitamin D tablet

Question 37

give a differential diagnosis for dry mouth

Answer 37

medication related
disease - sjogrens
dehydration

Question 38

short term, what needs to be considered with a rheumatology patients treatment plan

Answer 38

prevention - going to be tricky as poor dexterity
volume and type of treatment - limited mouth opening may be issue if requiring multiple extractions/restorations
consider access to practice…

Question 39

what are the long term considerations for rheumatology patients

Answer 39

stability of medical condition and dental disease rate
complications of sjogrens

Question 40

what are the complications of sjogrens

Answer 40

tooth demineralisation and caries
gingival changes
difficulty chewing
swallowing difficulties
oral malodour
altered taste
oral infections

Question 41

if a person is unable to hold a toothbrush what modifications can you advise them of

Answer 41

electric toothbrush
foam handles
putty handles
ball handles
stick suction brush to the wall to clean dentures