SNU Flashcards
1
Q
What are the 5 moments of hand hygiene?
A
- Before touching a patient
- Before a procedure
- After a procedure or body fluid exposure
- After touching a patient
- After touching a patient surroundings
2
Q
What is the role of standard precautions?
A
Standard precautions are used to prevent or reduce the likelihood of transmission of infectious agents from one person or place to another, and to render and maintain objects and areas as free as possible from infectious agents. Minimizing the risk of transmission.
3
Q
What are the standard precautions?
A
- Hand hygiene, as consistent with 5 moments for hand hygiene
- The use of appropriate personal protective equipment
- Safe use and disposal of sharps
- Routine environmental cleaning
- Reprocessing of reusable medical equipment and instruments
- Respiratory hygiene and cough etiquette
- Aseptic technique – standard or surgical technique
- Waste management
- Appropriate handling of linen
4
Q
What are the different ways of high transmission?
A
- Contact
- Droplet
- Airborne
5
Q
What is the purpose of transmission-based precautions?
A
To reduce transmission opportunities that may arise due to the specific route of transmission of particular pathogen.
6
Q
What is spaulding classification?
A
It is a classification of instruments depending on their level of causing infection during their use, example is:
- Critical – using a perio-probe for surgical procedures – anything that pierces the mucosa must be sterilized and recorded (ideally)
- Semi-critical – single use items such as micro-brushes or curing light with a sleeve – you need to clean it but you might not need to sterilize it
- Non-critical – example is bib chains – they come in contact with intact ski
7
Q
What are the steps for reprocessing of Reusable medical devises (RMDs)?
A
- Pre-cleaning at the chairside
- Mechanical cleaning using ultrasonic
- Manual cleaning using of professional cleaning machines
- Thermal disinfection
- Thermal disinfection using washer-disinfection
- Inspection
- Choice of packaging material and sealing of packages
- Labelling packages of reuseable medical devices
- Run a Bowie-Dick type tests for air removal and steam
8
Q
What is a gold standard indicator for sterilization?
A
Class 6 – measuring time, steam and temperature.
Class 1 – not great because it only shows temperature.
Class 4 – used in SAD
9
Q
What is Type 1 indicator and what does it do? What is it’s disadvantage?
A
Type 1 is known as process indicators.
It is used on every pack in every load or on a tray of every unpacked load.
It helps to distunguish between processed and unprocessed loads.
Diasdvantage: may react at a point of sterilisation that is below the point of adequate sterilisation.
10
Q
What is Type 2 indicator and what does it do? What is it’s disadvantage?
A
Type 2 are specific test indicators designed to show air removal and rapid or even steam penetration.
Disadvantage: may react at a point of sterilisation that is below the point of adequate sterilisation.
11
Q
What is a Type 4 indicator and what does it do? What is it’s disadvantage?
A
Type 4 are 2 process parasmter indicator. they react to two seperate processes of the sterilisation cycle such as temperature and pressure.
Disadvantage: If one of the processes fail, the indicator will not be able to show it. Thus, either of the two components have failed or both of them have failed. This can create confusion and hinder the resolution of the sterilisation machine problem.
12
Q
What is a Type 5 indicator and what does it do? What is it’s disadvantage?
A
Integrating indicators whouse time, temperature and pressure. Provide the same amount as a biological indicator, mimicking the conditons require to destroy biological organisms.
Disadvantage: If one of the processes fail, the indicator will not be able to show it. Thus, either of the two components have failed or both of them have failed. This can create confusion and hinder the resolution of the sterilisation machine problem.
13
Q
What is a Type 6 indicator and what does it do? What is it’s disadvantage?
A
Indicators that emulates the critical conditions for sterilization. E.g. 134 degrees for 3.5 minutes. GOLD STANDARD.
Disadvantage: If one of the processes fail, the indicator will not be able to show it. Thus, either of the two components have failed or both of them have failed. This can create confusion and hinder the resolution of the sterilisation machine problem.
14
Q
What should we examine/assess our patient fo access?
A
- Perceive the need for oral health care
- Seek oral health care when appropriate
- Reach or access oral health care
- Engage in oral health care process
15
Q
What did NSAOH 17-18 told us in terms of dental health of australians?
A
- Fewer Australian are now edentate
- More people are retaining some of their natural teeth into old age
- While more older people are retaining natural teeth they report their oral health is only fair/poor
- More people are avoiding or delaying dental treatment due to cost
16
Q
What are some of the other predictions made by NSAOH?
A
- Periodontitis is on the rise due to higher retention of teeht and other factors
- Indigenous population are at very high risk of periodntitis at about 87.5/100 indigenous people have periodontitis
- The socio-economic gap in widening
17
Q
How does tobacco affect periodontal disease?
A
- Negative affect on tissue vasculature
- interfering with normal humoral immune reaction and host inflammatory response
- changes of subgingival microflora thsu facilitating early acquisition and colonisation
- changes in bone turnover
18
Q
What are the links between orla health and general health that are well established?
A
Periodontal leisons are considered to be a renewing reservoir for the systemic sprea of bacteria, antigens, cytokines other pro-inflammatory mediators.
Example:
CV disease, Cereborvascular disease, respiratory disease, adverse pregnancy outcomes, rheumatoid arthritits, osteoporosis, obesity/nutritional status, dementia
19
Q
What is important to let the patient know about peirodontal disease?
A
It is not a one off, it is a continuous process that takes multiple visits and ongoign care. If else, the systemic disease will get worst
20
Q
What is improtannt to understand Rehumatoid Arthritis?
A
- Reduced dexterity resulting in inability to managem daily oral hygiene
- Use of cortical steroids increases the risk of adesonian crisis and MRONJ
21
Q
What do Australians define as age?
A
- Health status
- Appearance
- outlook and attitude to life
- level of fitness
22
Q
What is individual ageing?
A
Refers to the structural, sensory, motor, behavioural and cognitive changes in a person over time, in particular relating to how these factors influence opportunities and lifestyle at various stages of the life of the person.
23
Q
What is biological ageing?
A
Biological ageing takes into account individual differences and mainly reflects the relationship between biological maturationa or deterioration and changes in an individual’s ability to adapt and perform specific physica, cognitive and social tasks.
24
Q
What is considered to be an aged population?
A
Anyone above 65 statistically but geriatric dentistry refers mainly to function rather than age
25
What are functionally independent adults?
They are adults that live in the community unassisted, over 65 that might have two or more medical conditions
26
What are frail older adults?
They are adults over 65 that lost some independence but still live in community with help of family and friends and might use professional support
27
What are functionally dependent older adults?
They are those persons who are no longer able to survive in the community independently and are either homebound or living in institutions.
28
What are the geriatric syndromes?
1. Incontinence
2. Falls
3. Pressure Ulcers
4. Delirium
5. Functional decline
29
What are some of the patient-related factors that we need to consider when treating patient?
Generally, patient centered care (shared decision-making model) and evidence-based dentistry should be utilised.
Culturally safe practices should also be utilised.
Also:
1. Social determinants of health
2. Cultural issues
3. Health literacy
4. Previous life/dental experiences
5. Health issues
30
What are the aspects of shared decision making?
1. Clinicians and patients are equally involved
2. both share information equally
3. Both express treatment preferences
4. An agreement is reached
31
Who is a patient?
It is a person who is receiving healthcare from a registered health practitioner and also including their parent/carer/other family members.
32
What are the steps where patient involvement is essential?
1. Diagnosis - recognition of problems
2. Treatment planning - identification of potential solutions
3. Informed consent
4. Risk management
33
In addition to examination what should you assess in a patient?
1. perception of oral health - health literacy/beliefs/trust
2. Oral health Seeking behaviour -Social/personal/cultural/medical influences
3. Access to oral health care
4. Their engagement in past oral health care processes - e.g. oral hygiene practices
34
What is important to have when you approach patient care?
Not one size fits all.
Make treatment plan specific for the person.
35
What are some of the differences in culture in a dental context?
1. Communication styles
2. Some always agree with a dentla practitioner
3. Approached ot completing tasks
4. Tomorrow will be fine
5. Decision-making styles
6. Attitudes towards disclosure
7. Approaches to knowing
36
What are some of the commonly described variations in communication?
1. Individualism - independent decision making
2. Collectivism - utilising family members or other in making medicla decisions
37
What is patient centred care?
It is providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Remember, moderating factors for patients are different, thus your treatment should be different.
38
What are 4 parts of patient centered care?
1. Explore illness and disease and their context
2. Seeing the patient as a whole person - aka holistic care
3. Showing compassion and empathy
4. Reaching a shared sense of patient-doctor responsibility
39
What are the levels of patient-centered decision making?
From most basic to complex:
Level 1-Patient provided information only
Level 2-Patient provided information & choices
Level 3-Patient is provided infomation, choices and tools
Level 4-Patient is in full control of their treatment
40
What is Special Needs Dentistry?
nAustralia, Special Needs Dentistry (SND) is a specialized field of dentistry focused on providing oral healthcare to individuals with physical, medical, developmental, or cognitive conditions that make it difficult for them to receive standard dental care. These individuals may include:
1. People with disabilities (e.g., intellectual disabilities, physical disabilities).
2. Medically compromised patients (e.g., those with cancer, heart conditions, diabetes).
3. Older adults who may have age-related health issues like dementia, Parkinson's disease, or frailty.
4. Patients with mental health conditions (e.g., anxiety, depression, schizophrenia).
5. Individuals with complex social or psychological circumstances that affect their ability to access or undergo routine dental care.
The goal of Special Needs Dentistry is to provide appropriate dental care that considers the individual's unique health challenges and may involve specialized techniques, equipment, and environments. This might include working closely with a multidisciplinary healthcare team to manage underlying health conditions and ensure that dental treatments are safe and effective.
Australia recognizes Special Needs Dentistry as a registered specialty. Dentists who specialize in this field undergo additional training and certification to address the specific needs of these populations. They often work in hospitals, community clinics, or private practices that are equipped to handle complex cases, providing tailored care plans that address both oral health and broader health concerns.
41
According to the Australian Dental Council, what are professional competencies of the newly qualified dental practitioner?
1. Social responsibilities and professionalism
2. Communication and leadership
3. Critical thinking
4. Health promotion
5. Scientific and clinical knowledge
6. Person-centred care
42
What is the purpose of AHPRA's code of condutct?
To set expectation about professional behaviour and conduct for registered health practitioners based on the concept that maintaining a high level of professional competence and conduct is essential for good care.
43
What embodies professionalism?
1. Patient centered practice
2. Effective communciation
3. Ethical and trustworthy professionals
4. Professionals that protect and promote health
5. Regular reflections on practice
6. Constant learning and improvement of skills
7. Practicing within the scope of skills
8. Commitment to safeety and quality in healthcare
44
What are the 4 ethical principle of healthcare?
1. Beneficence
2. Non-maleficence
3. Patient autonomy
4. Justice (this is an essential principle of SND (social justice))
45
What are the international frameworks that support the provision of care in the context of special needs dentistry?
1. Universal declaration of human rights
2. UN Convention on the Rights of Persons with Disabilities
46
What are the national frameworks that support the provision of care in the context of special needs dentistry?
Australian Human Rights Commision Act
Age Discrimintation Act 2004
Disability Discrimination Act 1992
47
What are the state frameworks that support provision of care in the context of special needs dentistry?
South Australian Equal Opportunity Act 1984
48
What is the hierarchy of consent in South Australia?
1. Patient themselves
2. Advance care directive - 'Substitute Decision maker' - a person who can reflect the decision that the person would have made in the circumstances if they had the capacity to consent
3. A guardian
4. A spouse or domestic partner
5. Adult related by blood
6. Aboriginal or Torres Strait Islander kinship/marriage
7. An Adult Friend
8. An Adult Charged with overseeing the day-to-day care of the person
9. The SA Civil Administrative Tribunal upon application as last resort to appoint a Public Advocate
49
What is informed consent?
A person's voluntary decision about health care is made with knowledge and understanding of the benefits and risks involved.
This communication should ensure the patient has an understanding of all the available options and the expected outcomes such as the success rates and or/side effects for each option.
Objective of the dentist: provide comprehensive, evidence-based relevant information to the patient. Dialogue with patient is essential
50
What is the objective of an Advanced Care Directive?
1. Wishes, instruction and preferences for future health care, residential, accommodation and/or personal matters
2. outcomes or intervention a person wishes to avoid
3.'binding provisions' or refusal of health care
4. Appoint one or more Substitute Decision-Makers
51
What are 5 components of discussion when it comes to informed consent?
1. Diagnosis of condition
2. Recommended treatment plan
3. Alternate treartment plan
4.Potential risks of all treatemnt alternatives
5. Potential risks of no treatment
52
What are the conditions for consent to be valid?
1. Capacity - to understamt and appreciate the consequences of the decision
53
How do you assess capacity to consent?
Step 1 - consider the following questions "Do they know what the procedure involves?" " Do they know what treatment they getting?"
Step 2 - Do they understand the consequences of treatment proposed? Have the decision made freely and independently?"
Step 3 - directly ask the patient "How would this treatment help you?". Remeber to ask open-ended questions and ensure it is the person being assessed who answers the questions"
54
Why did we need Special Needs Dentistry?
The following factors were considered:
1. Increasing life expectancy for people with disabilities and chronic disease
2. Increasing disability or chronic disease progression into middle and older age
3. Increasing size of ageing population, with increased functional dependence
4. Increasing cancer survival
5. increasing complexity of medical treatment provided and medication prescribed
6. Increasing population expectation to retain teeth
7. De-instutionalisation of people who are intellectually and or physically impaired
55
How can we define disability?
Disability is the result of environmental, attitudinal or organisation barriers.
This social model of disability is the current widely accepted model.
An impairment may not necessarily lead to disability, if the individual functions in an inclusive and accessible environment.
56
What are the main barriers for people with special needs that prevent them from accessing primary care?
1. Training of professionals
2. Knowledge and awareness of the rpoviders
3. Communication
4. Fear and embarrassment
5. Lack of involvement in healthcare decision-making
6. Time constratins
57
What should we look out for when examining a patient with special needs when it comes to barriers?
Their capactiy to:
1. Perceive the need for oral health care
2. Seek oral health care when appropriate
3. Reach or access oral health care
4.Engage in the oral health care process
58
What are the barriers faced by people with special needs in Australia?
1. Govemental, organisation or syste, barriers
2. Physical barriers
3. Professional or workforce barriers
4. Patient or carer barriers
5. Financial barriers
59
How do we deal with barries faced by people with special needs?
1. We identify all the barries
2. We adress barries we can adress throuh legislative changes, chaning our environemnt, trainign progress, population approaches and public funding
60
How can we overcome barries related to government, organisation or the way our system is set up?
1. Through legislative changes that protect people with special needs and support them through policy change. E.g. Disability Discrimination Act or Australia's Disability Strategy
2. Highlightin groups that are less represented in healthcare and improving their access to health services e.g. Putting people with special needs in a priority population in National Oral Health Plan as there is large overlap between their complex medical/social situationa nd complex oral health conditions
61
What is an example of overcoming physical barriers for people with special needs?
Example of this is Australasian Health Facility Guidlines which set minimal requirement for resources to be allocated to provide facilties for people with special needs to make facilities more inclusive.
Example is the Residential Aged Care Emergency (RACE) Dental Service
62
What is important to understand about communication in a dental environment?
Communication is key and should not be considered as simply an act of giving and receiving information.
Communication is about establishing "connection" on a human level.
63
How to communicate appropriately?
1. Communicate courteousley, respectfully, compassionatley and honestly
2. COnsider the ahre, amturity and intellectual capacity
3. Be aware of health literacy issues
4. Meet the specific language, cultural and communicaiton needs
5. Endeavour to confirm a patient understading of the information
6. Encourage the patient to engage in conversation
7. Only relevant infromation
8. Be non-judmental
64
What are the steps to effective communication?
1. Appropriate eye contact
2. Questioning and summarising
3. opena dn relaxed language
4. Nodding or shaking the head
5. Some silence
6. Checking for understanding
7. Smiling or serious facial expression
8. Encouraging to continue
65
What is the most appropriate type of empathy that can be used in a healthcare setting?
Compassionate empathy is the type of empathy that is usually most. Nobody wants to understand them or feel what they feel, they just want support.
66
What are 5 components of emotional inteligence?
1. Self-awareness - recognising your triggers
2. Self-management - managing your own emotions
3. Motivation - what moves us to action
4. Empathy - ability to connect emotionally
5. Relationship management - building rapport
67
What are some social determinants of health?
1. economic stability
2. Physical environment
3. Education
4. Food
68
What are the categories of communication disorders?
1. Language disorders: Speech Disorders (Autism or aphasia after stroke) or Auditory Processing (hearing impairment, vision impariment or ADD) - these disorders make speaking difficult
2. Physical disorders: Oral Muscular - physical oro-motor disorders like mutism or dysphonia
3. Intellectual delay and disability
69
What can be used for alternative methods of communication?
1. Alternative and augmentive communication devices
2. Speech generative devices
3. Prosthetic devices (OBTURATORS!!!)
70
What is trauma informed care?
Trauma-informed care is an approach to engaging people with histories of trauma that recognises the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. It involves the awareness and avoidance of practices that lead to re-traumatisation.
71
Within the context of special needs dentist, what are some of the other factors/barriers shoudl you consider when treating a patient?
1. Medical conditions and treatments
2. Medications
3. patient ability to co-operate
4. Patient's expectations and wishes
72
What is the most common reason for delay of dental treatment in Australia?
Cost related to treatment
73
In general, whata did different surveys of Oral Health in Australia conclude?
They have concluded that in general, oral health deteriorates with age
74
What is classified as moderate periodontitis by CDC/AAP?
1. At least two proximal sites not on the same tooth with attachment loss of 4mm or more
2. At least two such sites have pockets of 5mm or more
75
What is classified as sever periodontitis by CDC/AAP?
1. At least two proximal sites not on the same tooth with attachment loss of 6mm or more
2. At least one such sites have pockets of 5mm or more
76
How does smoking affect periodontitis rate?
Negatively.
In general, smoking does:
1. Affect tissue vasculature by reducing oxygenation
2. Interferce with immune function
3. Causes changes in subgingivalal fluora
4. Increase the number of periodontal pathogens
77
What is the association between diabetes and periodontal disease?
In general, the relationship is considered to be bi-directional.
Poor glycemic control = periodontal disease
78
What is the relationship between periodontal disease and respiratory disease?
Oral cavity can act as the reservoir for pulmonary pathogens thus adequate debridement, use of chlorhexidine and at-home care can help with lung diseases
79
What is the similarity between rheumatoid arthritis and periodontal disease?
Both are:
1. Chronic inflammations
2. Involve imbalance of immune regulation
3. Release inflammatory cytokines
4. Have environmental and genetic factors
80
What is ageing? What are we consider as aged?
Ageing in humans is a multidimensional process of physical, psychological and social change.
In terms of oral disease, ageing commonly impact chemo-sensory function.
In healthcare, those above the age of 65 is considered to be aged.
81
What are different categories of aged adults?
1. Functionally independent adults - two or more medical conditions but they can access dental care independently - treatment planning can be normal
2. Frail older adults - some loss of independence with impairments and comorbidities - usually still living in a community but rely on support services - treatment needs to consider their polypharmacy and difficulty accessing treatment
3. Functionally dependent older adults - have their activities of daily living fully supported with carers and are homebound or live in institutions. transportation is difficult if not impossible. Treatment planning: palative care essentially
82
What are different types of anti-thrombotics?
1. Anticoagulants - warfarin
2. Antiplatelet - clopidogrel
3. Target-specific oral anticoagulatns - apixaban
83
What are some if the risk factors for prologned bleeding that a patient might have?
1. High BP
2. Abnormal kidney and lvier function
3. prior stroke
4. history of bleeding or bleeding disorders
5. Drugs predisposing to bleeding
6. Poor anticoagulatn control
7. Alchohol consumption
84
What should you do if a patient takes anti-platelet therapy?
Use local haemostatis measures like pressures, coagulation assiting material like surgicel and suturing of the wound
85
How do we read INR? What are the impacts on treatment?
If using warfarin:
<2.0 - use local measures AND NOTIFY GP BECAUSE IT IS IN THE SUB-THERAPEUTIC RANGE
2.0-3.5 - use local measures
>3.5 - NO SURGERIES TO PERFORM UNTIL INR DROPS - INFORM GP IMMEDIATLEY
86
How do NOACs impact treatment?
1. No patient risk factors or dentla procedure with no/low risk - jsut consider liver/renal health and use local measures
2. Patient risk factors and dental procedure low risk - contact GP and try to postpone the drug for 24-48 hours
3. Patient risk factors and high risk dentla procedure - no surgicla treatment
87
What are local haemostatic measures?
1, Pressure
2. Minimal trauma
3. Cellulose or collagen
4. Sutures
5. 4.8% tranexamic acid for blood clot stability (warfarin only). Before surgery + 10ml for 2 minutes 4 times a day for 2 days
88
What do you do if the patient takes triple antitrhombotic therapy?
Refer to specialist
89
What do you do if the patient takes injectable anti-thrombotic therapy?
Wait until they stop the therapy, it is usually given after hospital visit
90
How do you manage patients with bleeding disorders?
Haemophilic patients or patient with von Willebrand disease require additional care depending of sverity of the conditon and the procedure that will be performed + peri operative and post operative care.
Consider case selection carefully and consider referring to up-to-date guidelines and discuss with ahetologist.
91
Why do liver disease increase bleeding risks?
1. Impaired vitamin K metabolism
2. XS fibrinolysis
3. Failure to synthesis or over consumption of normal clotting factors
4. poorly synthesised clotting factors
5. Thrombocytopenia (low platelet count)
92
How do you manage bleeding risk in aptients with liver disease?
1. Fresh frozen plasma
2. Vitamin K
3. Cryoprecipitate
93
What is importatn to consider when treating patients with immunodeficiency/immunopcompromise/immunosupression?
1. Review of serology
2. Antibiotic prophylaxis
3. Supportive blood products during surgery
4. Assessment for opportunistic infection of the oral cavity
5. Management of herpes simplex and zostra virus with acyclovir
6. CHx rinse pre and psot operativley
7. AIDS defining illnesses like Necrotising periodontits
94
What is important to understand about multiple myeloma?
It can result in renal insufficiency and painful lytic lesions in the mandible as a result it may lead to pathological fractures
95
What are the oral manifestations of chemo-therapy?
1. oral mucostitis
2. Increased risk of bacterial infections
3. Increase risk of viral infections
4. Increased risk of fungal infections
5. Malnutrition
6. Painful oral hygiene
7. Oral haemorhage
8. Increased risk of trismus
96
When treating a patient with solid organ transplant what should you consider?
1. Corticosteroid supplementation
2. Any increased risk of bleeding
3. Any infection risk
97
What are the steps of management of MRONJ when doing bone invasive procedures?
1. Inform patient about the risk
2. Drug holidays are essential
3. No antibiotic prophylaxis
4. Ensure optimal oral hygiene with use of mechanical debridment
5. Reduce trauma to periosteum
6. Monitor oral wound for 8 weeks, if does not heal than refer
7. DO NOT DEBRIDE NONHEALING WOUNDS
98
What are the oral side effects during radiotherapy?
1. Mucositits
2. Taste changes
3. Dry mouth
4. Increased mucous
5. Tooth hypersensitivity
6. Dysphagia
7. Weight loss
99
What are the oral side effects after radiotherapy?
1. Impaired quality and quantity of saliva
2. Radiation caries
3. Trismus
4. Xerostomia
5. Dysphagia
100
When should you give AB prophylaxis for a person undergoing dyalisis?
When they have an AV graft which is a graft that is sticking out of the arm
101
What is a normal platalet count?
150-450 billion cells/L or 150,000 to 450,000/mcL
102
What is a normal GFR?
Above 60 if it is below 15 they are in kidney failure
103
What is a normal fasted plasma glucose level?
4-6 mmol/L
104
What is a normal oral glucose tolerance test?
2 hours after 75 grams should be below 11 mmol/L
105
What is an intelectual disability?
It starts at the time before child turns 18 and is characterised by difficulties in communication, memory, udnerstanding and can also include physical skills
106
What is a developmental disability?
It applies to children aged 0-5 where conditions have appeared in the early developmental period, but no specific diagnosis has been made and the specific disability group has not yet been diagnosed. E.g. Autism or cerebral palsy
107
What is important to understand as a dentist when treating people with developmental disabilities?
You need to be aware of the different needs - behavioural, physical,e motional and cognitive.
You need to expand and update your skill set and techniques to meet the unique oral needs of people with developmental disabilities by creating a person-centered environment and identifying a person's intellectual capability and level of cooperation.
108
What are the levels of intellectual disabiltiy?
1. Mild - has basic maths, reading and writtign skills on 3-6 grade level
2. Moderate - rrquries some oversight
3. Severe - can learn skills but can not read and write . Requires daily supervision
4. Profound - requires intensive support
109
What are physical disabilities?
These are conditions that are atrributed to a physical cause or impact on the ability to perform physcial activities such as mobility e.g. deformity of limbs
110
What are neurological disabilities?
These are conditions that are attributable to a neurological cause which may impact on the ability to perform physical activities e.g. cerebral palsy
111
What are psychiatric disabilities?
They are conditions with recognisable symptoms and behaviour patterns, frequently associated with distress, which may impair personal functioning in normal social acitivity e.g. bipolar disorder or substance abuse
112
What are some of the implication of our ageing population on access to oral health care and service delivery?
1. Patient issues - residence, transport barriers, financial barriers, health issues, consent
2. Workforce issures - suitability trained individuals, appropriate skills, equipment and willingness to provide care
113
How can we as dental specialist prepare patient for the impacts of agein?
1. Start having conversations early about the longevity of treatment plans
2. For aged care patients, long term dental fitness is essential
114
What are some of the geriatric syndromes that can be experienced by older adults?
Different dementia related illnesses
115
What are the challenges that occur when providing care for frail older adults?
1. Deteriorating cognitive ability
2. Detiorating physical ability
3. Deteriorating ability for co-operation
116
What are the categories of the Seattle Care Pathway?
1. No dependency - fit, robust adults that exercise regularly
2. Pre-dependency - chronic systemic conditions - treatment plan as normal
3. Low dependency (functionally independent) - some cronic conditions that are affecting oral health - modified treatment planning with for example tooth brushes that are electric
4. Medium dependency (frail elderly) - identified chronic conditions that currently impact on oral health. These patients deman treatment at home or do not have transport to a dental clinic - more invasive prevention might be needed like high fluoride tooth paste
5. High dependency (functionally dependent) - people have complex medical problems preventing them from receiving oral health care at dental clinics. They must be seen at home - emphasisze management of pain and infection
117
For each of the Seatle Care groups, devise a quick treatment plan?
1. Pre-dependency - consider the long-term viability of restorations and prostheses. Plan treatment outcomes for easy maintenance
2. Low dependecy - focus on repair and replacement of strategically important teeth and plan for ongoing maintenance
3. Medium dependency - repair or replace strategically important teeth with conservative treatments like the atraumatic restorative technique (GIC+use of hand instruments for removal of caries) and oral prosthesis to simplify oral hygiene
4. High dependency - offer palliative treatment
118
What is the difference between serous and mucous saliva?
Serous - produced by the parotid gland and a bit by submandibular of protein rich watery fluid.
Mucous - produced by the sublingual and minor salivary glands. It is important for lubrication
119
What are the properties of saliva?
Physical properties:
- lubrication
- coats food bolus
- solvent for flavour
- cohesive effects
Chemcial properties:
- maintains pH
- neutralises acid
- controls bacterial growth
- remin
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What is the difference between salivary gland hypofunction and xerostomia?
Salivary hypofunction: an objective finding of a reduced oral salivary flow that occurs in relation to salivary dysfunction
Xerostomia: a subjective complaint of dry mouth
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What are the signs of salivary gland dysfunction?
1. Frothy mucinous saliva
2. Pooling of saliva in sublingual area
3. Dry mucinous strands coating the tongue
4. Epithelial atrophy
5. Lack of calculus
6. Candida infection
7. Coronial root caries
8. Accelerated tooth wear
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What are some of the impacts of salivary dysfunction?
Quantitative or qualitative
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What are some of the treatment for salivary dysfunction?
1. Stimulation of salivary flow through masticatory sialagogues or medication
2. Use of saliva substitutes in form of carboxycellulose or mucin based
3. Use of mucosal wetting agents like water or GC dry mouth gel
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What are some of the active ingridients for sensitivity management and where can you find it?
1. Arginine - Colgate Pro-Relief - immediate closure of dentinal tubules
2. Potassium nitrate - Sensodyne daily care - takes 2-4 weeks and works for erosion
3. Strontium chloride - Sensodyne rapid Relief - immidiate closure of dentinal tubules
4. Novamin - Sensodyne Complete Care - forms artifical enamel when appliead
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What are the suggested use of 38% silver diamine fluoride for aresting of caries?
topically, 2 times per year.
Use Riva Star
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When should you not use SDF?
1. Heavy metal allergy
2. Pregnancy or breastfeeding
3. Lesions close to the pulp/possible pulpal involvement
4. Signs or symptoms of periapical pathology
5. Ulceration, mucositis or stomatitis
6. Restoratio of permanenet anterior teeth
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What is the use of benzydamine?
Benzydamine is an NSAID that reduces inflammation and pain in oral mucositis.
Available of as DifFlam or DifFlam C
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What are non-pharmacological behaviour management technique?
1. Tell-show-do, voice control, non-verbal communication positive reinforcement, distraction, modelling, desensitization
2. Physical restrain like weighted blankets, movement control, clinical holding
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What are pharmacological behaviour management technique?
1. Oral sedation - benzodiazapine pre-medication
2. Relative analgesia - nitrous analgesia
3. Conscious/iv sedation (need to follow appropriate legislation)
4. General anaesthesia
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How can you use force to special needs patients?
You can apply for SACAT special powers Section 32 powers.
Application is made by the guardian
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What are the aims of RA?
To enhance comfort whilst facilitating completion of the planned procedure
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What are the Seattle Care Pathway process of assessment and decision-making for complex older patients?
1. Complex older patient referred
2. Medicala ssessment
3. Assess mobility and ability to attend clinic
4. Dental assessment
5. mental capacity assessment
6. Decision making
7. treatment indication
8. Treatment delivery
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Who are vulnerable people?
They are people aged under 18 or other individuals who may be unable to take care of themselves or are unable to protect themselves againt harm or exploitation.
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What are the signs of dental anxiety?
1. Muscle tightness
2. Sweating
3. Stiff posture
4. holding things tightly
5. other
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What are some good relaxation techniques?
1. Deep breathing
2. Muscle relaxation (like progressive msucle relaxation)
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What are some of the factors affecting the uptake of oral healthcare by those who experience homelessness?
1. Dental care is a low priority
2. Higher level of dental phobia
3. Reporting being treated with low respect
4. Low number of information and available services
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What is trauma?
Trauma is simply exposure to any traumatic situation or event that overwhelms your ability to cope
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What makes an experience traumatic?
1. It involves a threat to one's physical or emotional well-being
2. it is overwhelming
3. It result in intense feelings of fear
4. it leaves people feeling helpless
5. It changes the way a person understands themselves
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What is trauma-informed care?
It is an approach to engaging people with histories of trauma that recognise the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.
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What are the essential parts of trauma informed care?
1. Respectful and non-judgmental communication
2. Emotional safety
3. Trust and providing opportunity for choice and collaboration
4. Empowernment
5. Respect for diversity
