SC-bariatric

Question 1

Who is a bariatric patient?

Answer 1

A patient who has abnormal or excessive fat accumulation that can affect health.

Question 2

What else contributes to obesity apart from an energy imbalance.

Answer 2

• Medical conditions (Prader willi syndrome-causing excessive apetite)
• Ability to exercise (e.g. bedbound)
• Medicines causing increased apetite.
• Lack of energy
• Lifestyle factors (harder for poor people to eat healthy and access environment for exercise.
• Learning difficulties.

Question 3

Give some medical complications of obesity?

Answer 3

Angina

diabetes

Sleep apnoea

Dyspnoea

GORD (after gastric band)

Question 4

Discuss some dental complications of obesity?

Answer 4

Caries- the unhealthy diet that causes obesity will also cause caries in the mouth.

Tooth- GORD commonly causes gastric reflux which will cause acid erosion of the teeth.

Patients are more likely to have reduced immune function, causing delayed wound healing.

Question 5

how does the obesity of a patient influence treatment.

Answer 5

In the chair

You need to weigh the patient before sitting them on the chair.

People with weight on their chest are at risk of hypoxaemia when lying flat. (treated upright or semi supine)

The appointment

May require a longer appointment time due to reduced mobility

Mouth access can be obstructed by increased soft tissues e.g. large tongue and cheek.

Use of a lax tongue retractor rather than a mirror.

More difficult to find anatomical landmarks (e.g. IAN blocks)

OPT may not accommodate the patient size.

Excess fat affects the Pharmacological drug absorption.

Emergency treatment:

Will you be able to move the patient into the recovery position?

May need specialist equipment (so would need referred)

More difficult to manage the airway and identify resuscitation landmarks.

Question 6

If an obese patient is unsuitable for treatment in your chair how do you treat them?

Answer 6

In their own wheelchair or a bariatric wheelchair.

Question 7

What is the most apropriate form of sedation for an obese patient?

Answer 7

Inhalation sedation.

Question 8

Why do we not use intravenous sedation?

Answer 8

Obese patients are at risk of sleep apnoea.

Placing a canula is also difficult to place.

Question 9

Why do we not use general anaesthetic on an obese patient?

Answer 9

Obese patients are x2 likely to develop serious airway problems during GA.

Question 10

Discuss the impact bariatric surgery has on oral health?

Answer 10

Caries- patients are advised to eat 4-6 small meals a day (causing more sugar hits a day)

Erosion- GORD results in acid reflux which can cause acid erosion of the teeth.

Question 11

What advice is given for bariatric patients?

Answer 11

• To reduce dry mouth
  
  • Increase water ingestion (bring a water bottle & take small sips)
  • Chew gum with no sugar (but only after 2 months)
• To avoid halitosis
  
  • Brush your tongue
• To avoid toothwear
  
  • Don’t brush your teeth after vomiting or reflux
  • Mouth rinse with sodium bicarbonate to alkalinize the oral medium.
  • Wait half an hour before brushing your teeth.