rheumatology Flashcards
what key features should be considered in the design of the practice and it’s facilities to enable those with limited mobility to access your GDP
- Ramp access - temporary or permanent
- Space for wheelchair turning circle/wheelchair in and out (less space)
- Parking nearby - disabled priorty
- Unlikely in high street
- Lowered pavements at junctions - wheelchairs, mobility scooter
- State pavement in - potholes, cracked, wobbly, moss covered (slippery when wet)
- Grab rails - handles to help
- Button to open door (door open in the way), handle at appropriate height if not
- Reception desk at height that is good for wheelchair
- Uncluttered corridors
- Disabled toilet facilities
do you feel you have a responsibility to facilitate access to healthcare facilities for pts?
yes - moral
but sensible - may not be feasible
any legislative framework which exists to enable the access and provision of care for all individuals and groups of people
- equality act 2010 (wider umbrella than previous Disability Discrimination Act (DDA))
- protected characteristics
- AWI act
- Mental health act
9 protected characteristics of equality act 2010
- age
- disability
- gender reassignment
- marriage and civil partnership
- pregnancy and maternity
- race
- religion or belief
- sex
- sexual orientation
reasonable adjustment
is a change to remove or reduce the effect of disability
positive action to help someone with protected characteristics
example reasonable adjustment for GDP
- Ramp is steps into surgery entrance, installing handrails
- Loop system for hard of hearing
- Clearer signage
- Layout of practice so suitable turning for wheelchair
example unreasonable adjustment GDP
If surgery is situated up the stairs in old building installing a lift as be too expensive to justify
what would you do if unable to make any reasonable adjustments to enable someone with disabilites to enter your practice
if not registered
- Apologise
- Refer/suggest other dentists in the area who will be able to facilitate her
if regestered already
- your responsibility to transfer them to new suitable practice
- not just signpost
possible options to aid transfer to chair
- Hoist
- Transfer boards
- Pt turners / turn table
- Wheelchair recliner
- Reclining wheel chair - need temporary head rest
hoist
benefits and cons
Unlikely to get in GDP
- Portable - big and bulky, space
- when not in use - hoist needs to be in docking station for charging
need pt sitting in sling when they arrive in wheelchair
- single use
- different sizes
- comes up to back of head - stiffened there
- ensure right sling for hoist (attachments)
Pt may not feel comfortable/at ease using it
- scary 1st time
need to 2 people to operate (maybe 3 depending on pt size)
transfer boards
Need a break leg facility or knee break
- Not whole seat conventional dental chair
Wheelchair close to chair
- Breaks on
Slide under pt and onto dental chair
- Pt needs t be able to them self - upper body strength - risky
reclining wheelchair
cushions on chair to make pt more comfortable - ease pt pain and discomfort (can be more sensitive)
good as not compromising dentist’s posture
turn table
Need to be able to stand and support their weight
Usually 2 people to support
wheelchair recliner
best
but bulky, expensive
stand aid
like turntable but more supported
need 2 carers to support
considerations for someone with reduced mobility when planning appointment length
How long has it taken to get her into practice, out of wating room into chair
- Probably need to give them longer appointment for mobility
social history importance for someone with restricted mobility/disability
- travel
- support at home
- carers - when (time around) (first thing not ideal as often longer to get going)
- diet
- alcohol
medical history importance for pt with disability/restricted mobility
- past and future hospital stays
- medications,
- is it stable
- prognosis
methotrexate
immunosuppressant
- inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines.
- Reduces function of cells which are causing inflammation and should help relieve pain from joint damage (RA)
link between sjorgens and RA
RA - autoimmune disease, so is sjorgen
get one likely to get the other
predisnolone
corticosteroid
systemic
dampen down inflammation (RA)
risk of corticosteroid and dental tx
need to know even if long time ago (months) - ask dose as can still be concern
- dampen down inflammation
need body to be able to make cortisole - but will stop if on corticosteroid dose for long time (lose fight/flight response - may need to top up for tx)
primary sjorgen
dry eyes and mouth
secondary sjorgens
dry eyes and mouth with assoicated disease
if pt says they have dry mouth
want info do we want
- Wan to know how long experience symptoms
- Has she got eye symptoms
- referral –> risk loss sight
- Does she have sensation of sand/gravel in eyes
- How severe oral symptoms
- impacts everday life
- swollen glands - recurrent or persistantly
- Drink liquid to aid swallowing
- Salivary flow rate - normal, stim and unstim
- Blood test
blood test
for sjorgens and RA
autoantibodies SS-A/Ro and SS-B/La and rheumatoid factors (if RA)
indicates CT disease (RA, SLE, sjorgen)
hands of RA pt
twisted
claw like
grip issue - toothbrush
impact of dry mouth on tooth hard tissue
demineralise
acidic environment
differential dx for dry mouth (10)
- Medication
- Polypharmacy
- Endocrine disease - diabetes
- Anxiety stress
- Dehydration - starvation
- Cancer therapy
- transient dry mouth in chemo,
- radiotherapy - glands irritated - profound chronic and progressive dry mouth (fibrosis of tissues)
- Heridiatry causes
- Cystic fibrosis
- Inflammatory - lupus, sarcoid, sjorgen
- Infections - HIV, hep C, epstein barr
ramfjords teeth
16, 21, 24, 36, 41, 44
BPE2
supra or sub gingival plaque/calculus
no probing depths >3.5mm
BPE3
supra or sub gingival plaque/calculus
probing depths between 3.5-5.5mm
BPE4
supra or sub gingival plaque/calculus
probing depth 6mm or more (black band entirely in pocket)
BPE *
furcation involvement
tx BPE2
plaque and gingivitis chart
OHI
remove supra- gingival calculus and plaque and sub gingival if present
tx BPE3
6PPC if more than one sextant
plaque and gingivitis chart
OHI
remove supra- gingival calculus and plaque and sub gingival if present
RSD
tx BPE4
6PPC
plaque and gingivitis chart
OHI
remove supra- gingival calculus and plaque and sub gingival if present
RSD
assess need for complex tx referral
tx BPE *
assess need for complex tx referral
which radiograph to take for RA pt
OPT maybe more comfortable if reduced opening
not ideal when pt in wheelchair (better if standing and supported)
maybe size1 PA of anterior teeth id OPT not adequate
consideration for tx planning for someone with restricted access
how can we minimise appointments
- quadrant or arch approach possible ?
endo for restricted access pts
demanding, several tx so not ideal options for access
why may a pt have a particular area of worse perio health if have RA
may find that area particularly hard to clean e.g. right handed lower if right handed
questions to ask about access
How easy to get
How regularly will she be able to come
Would she need accompanied
Best time for her for appt
autoimmune disorders and maligancy
possibility of malignant change in autoimmune disorders
b cell lymphoma and sjorgens
xerostoma and infections
more likely with sore mouth
- Fungal - acidic dry mouth
- Staph aureus - sialitis - red swollen shiny hot cheek if parotid (antibiotics) less common in submandibular
when tx planning for restricted access pt consider
how to carry out tx
- pt level fatigue
- prop needed
- sedation - muscles relax better - possible better access?
long term tx planning for pt with RA
- Stability of disease
- Rate of dental disease - are we getting control of her dental disease
- Frequency of check ups post tx plan
- 3 months (idea getting on top of disaese - managing prevention)
- Complications of sjorgens
- chronic progession condision
- Caries - demin teeth
- Gingiva sore inflammed
- Denure - can she use - saliva, putting it in and out
- chronic progession condision
aids for toothbrush dexterity
- electric?
- adapt handle
- foam
- putty handle
- acrylic lab made handle
- curve toothbrush
- multiple sided
denture cleaning aid for reduced dexterity
denture hold to aid cleaning
made so denture face sits
one for fitting surface, other for outer surface
immunosuppressant risk
infection
depend on dosage
likely drug interactions
