Special Care Flashcards
1
Q
What is the definition of a learning disability?
A
a significantly reduced ability to understand new or complex information, to learn new skills & reduced ability to cope independently
IQ less than 70
2
Q
How many people in the UK have a learning disability?
A
1.5 million, 350,000 severe
3
Q
What are the clinical features of a learning disability?
A
epilepsy
visual defects
hearing and speech disorders
facial deformities
body-rocking and self-mutilation
feeding difficulties
4
Q
What are the causes of learning disabilites?
A
genetic
problems during pregnancy
problems during birth
post-natal problems
5
Q
What is the most common cause of Down’s Syndrom?
A
Trisomy 21 (extra chromosome)
6
Q
What are the physical features of Down’s Syndrome?
A
atlanto-axial joint instability
short stature
brachycephaly
widely spaced upward slanting eyes
weight gain
brushfield spots
7
Q
What health conditions are associated with Down’s Syndrome?
A
cardiac problems
spinal problems
malignant disease
dementia
immune disease
hearing loss
visual defects
seizures
8
Q
What are the oral features of Down’s syndrome?
A
large tongue
thick, dry and fissured lips
poor anterior oral seal
tongue thrust
early onset perio disease
cleft lip and palate
malocclusion
delayed eruption
missing teeth
morphological abnormalities
9
Q
What are dental aspects of fragile X syndrome?
A
short attention span
hyperactivity
behavioural disorders similar to autism
abnormally frequent open bite and crossbite
10
Q
What is Cri du chat Syndrome?
A
deletion short arm of chromosome 5
11
Q
What are the features of Cri du chat syndrome?
A
high pitched cry
microcephaly
micrognathia
wide set eyes
webbing or joining together of fingers and toes
slow development of motor skills, speech and language
12
Q
How is autism spectrum disorder characterised?
A
poor social skills
lack of interpersonal relationships
delayed speech and language
ritualistic, compulsive behaviour
13
Q
what is the clinical presentation of autism?
A
lives in ‘own’ world
avoid eye contact
echolalia
unaware of others
practice repetitive actions
obsessional desire to follow routine
self-mutilation
sensitivity to touch, smell and sound
14
Q
what are the oral findings in autistic patients?
A
bruxism
traumatic lesions
poor OH
poor attendance
prefer sweet foods
15
Q
how should you manage autistic patients?
A
patience
empathetic approach
OHI and support
pre-visit pack and questionnaire
short, quiet visits with same staff
avoid aspirator, high speed, etc
pain and anxiety control
16
Q
what is a sensory impairment?
A
when one or more of a person’s senses are no longer normal
17
Q
how many people are registered blind in the UK?
A
358,000
18
Q
what are the symptoms of visual impairment?
A
reduction or loss of vision
eye pain
burning sensation
gritty feeling
blurring of vision
19
Q
what are the causes of visual impairment?
A
glaucoma
cataract
macular degeneration
diabetic retinopathy
trachoma
20
Q
what causes glaucoma?
A
a rise in intraocular pressure
21
Q
what is a cataract?
A
clouding of the lens in the eye
22
Q
describe the effects of wet macular degeneration
A
severe sight loss in a matter of months
rapid loss of central vision
23
Q
describe the effects of dry macular degeneration
A
bilateral
gradual loss of central vision
24
Q
what conditions cause retinopathies?
A
diabetes
hypertension
25
what are retinopathies
a combination of retinal degeneration and inflammation
26
what is hemianopia?
blindness in one half of the visual field
27
what is the most common cause of hemianopia?
stroke
28
how are visual impairments treated and prevented?
early diagnosis
protect eyes from sun
medical, surgical, non-invasive
29
how many people in the UK are affected by a hearing impairment?
11 million
30
what are the causes of hearing impairment?
inherited
congenital
infections
trauma
drugs
foreign bodies
excessive noise
31
what are symptoms of hearing impairment in children?
inactivity
reduced development of speech and language skills
deterioration of speech
reduced social and emotional development
irratibility
autistic like behaviour
confusion
32
what are the signs and symptoms of hearing loss?
difficulty hearing clearly
misunderstanding
asking people to repeat themselves
listening to music or TV loudly
feeling tired or stressed
33
what are some ways to prevent hearing loss?
immunisation
avoidance of some drugs
reduction of occupational exposure
hearing aids
34
what are some ways to treat hearing loss?
early management - surgical or medical
rehabilitation
35
what is included in the equality act 2010?
age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation
36
what is the equality act 2010's definition of disability?
physical or mental impairment
the impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities
37
what are the most common impairments and their %'s?
mobility 49%
stamina/breathing/fatigue 37%
dexterity 26%
mental health 25%
38
what is a physical disability?
any condition that permanently prevents normal body movement and/or control
39
what are causes of physical disabilities?
inherited or genetic disorders
conditions present at birth
serious illness affecting brain, nerves or muscles
spinal cord injury
brain injury
accidents
40
What should valid consent be?
Informed, freely given by a capable patient
41
What acronym is used to define incapable?
AMCUR
42
What does AMCUR stand for?
Acting
Making a decision
Communicating a decision
Understanding a decision
Retaining memory of the decision
43
How do you assess capacity?
Open questions
‘Chunk and check’
‘Teach back’
44
What is applied if a person lacks capacity to consent to dental treatment?
Adults with Incapacity Act
45
What does the Adults with Incapacity Act 2000 do?
Safeguards the welfare and manages the finances of people aged 16 years and over who lack capacity
46
What are the 5 key principles of a section 47 certificate?
1. Benefit
2. Least restrictive of freedom
3. Wishes taken into account
4. Consult relevant others
5. Encourage residual capacity
47
What is a proxy?
Someone who has been authorised to act on behalf of an adult with incapacity
48
What is a power of attorney?
A person granted by the adult whilst they have capacity to choose who they wish to ack on their behalf, should the need arise
49
Who is a power or attorney registered with?
OPG
50
What types of power of attorneys is there?
Welfare
Continuing
Joint or combined
51
What documents should be checked for PoA’s?
All documents - need to read body of document as not all welfare PoA have the right to consent
52
What is the OPG?
Office of the public guardian
53
When would a guardian be granted?
- no longer has capacity to choose who they wish to make decisions for them
- the adult has never been able to make their own decisions
54
How does a person get a guardian?
Court process granted by a sheriff
55
What is required to get a guardian?
Medical reports
Social work report
56
Does a guardian have an expiry date?
Yes
57
Does a PoA have an expiry date?
No
58
What types of guardianship powers are there?
Financial/property
Welfare
Both
59
What statement would you look for in guardianship and PoA documents?
The power to consent or withhold consent to medical and dental treatment
60
What is an intervener?
Appointed for a one-off event
61
Who can legally consent for dental treatment?
- patients with capacity
- welfare PoA
- welfare guardians
62
Can medical and dental professionals consent a patient for treatment?
No - they can only authorise to under section 47 of AWI act
63
What must be done when getting consent from a proxy?
Have an AWI (s47) certificate issued
64
What should be done to consent if there is no proxy?
Follow the 5 key principles of the AWI (AMCUR)
S47 certificate to authorise tax to go ahead
65
Who is able to complete an AWI certificate?
Doctors
Health professionals with relevant training
66
What are the risk factors for dementia?
Age
Gender
Ethnicity
Genetics
Down’s syndrome
Medical factors
Lifestyle factors
Head injuries
67
What are the medical risk factors for dementia?
Type 2 diabetes
Hypertension
High cholesterol
Obesity
Depression
68
What are the lifestyle risk factors for dementia?
Physical inactivity
Smoking
Unhealthy diet
Excessive alcohol
69
What kind dementia do head injuries cause?
Chronic traumatic encephalopathy
70
What is the link between football and dementia?
3.5x more likely to suffer dementia
71
How can you reduce risk factors for dementia?
Physically active
Stop smoking
Healthy eating
Healthy weight
Reduce alcohol
Mentally active
Be social
72
What are the different types of dementia?
Alzheimer’s disease
Vascular
Mixed
Lewy-body
Frontal-temporal
73
How does Alzheimer’s present?
Short-term memory loss and word-finding difficulties
Mood swings and frustration as it progresses
74
What causes Alzheimer’s?
Amyloid plaques - tangles tau protiein - loss of connection between neurons - decrease in acetylcholine
75
What infections are associated with Alzheimer’s?
Oral herpes
Pneumonia
Spirochete bacteria
76
What is the associating between periodontal disease and Alzheimer’s?
Gingivitis more common in Alzheimer’s, higher numbers of P.gingival present in brain producing proteins
77
What causes vascular dementia?
Reduced blood flow to the brain
78
What is mixed dementia?
Combination of Alzheimer’s and vascular dementia
79
What is lewy-body dementia?
Small deposits of protein in nerve cells
Associated with Parkinson’s disease
80
How does fronto-temporal dementia present?
Short temperedness
Aggression
Mood swings
Sexually inappropriate behaviour
81
What questionnaire is used to assess mental abilities?
MMSE (mini mental state exam)
82
What drugs are licensed for Alzheimer’s?
Donepezil
Galantamine
Rivastigmine
Memantine
83
What happens in the early stages of dementia?
Loss of short-term memory
Confusion, poor judgement
Anxiety, agitation
Communication problems
84
What happens in middle stages of dementia?
Increasingly forgetful
Distress, aggression, anger, mood changes
Risk of wandering or getting lost
Inappropriate behaviour
Hallucinations
85
What happens in late stage dementia?
Inability to recognise familiar objects, surrounding or people
Increased physical frailty
Difficulty eating and swallowing, weight loss, incontinence
86
Why should you avoid GA in dementia pts?
Evidence suggests dementia can worsen following GA
87
How can you tell someone has dental problems who can’t communicate?
Refusal to eat
Pulling at face/mouth
Not wearing denture
Disturbed sleep
Swelling
88
How can you make your home dementia friendly?
Good lighting
Reduce excess noise
Safer flooring
Labels and signs on cupboard
Phones with big buttons
89
What are the different types of platelet disorders?
Failed platelet production
Excessive platelet destruction
Abnormal platelet function
90
What is thrombocytopenia?
Too little platelets
91
What are the causes of thrombocytopenia?
Autoimmune
Alcoholism
Bone marrow diseases
Cancer
Viruses (Hep C, HIV)
Chemotherapy
92
What is ITP?
Idiopathic thrombocytopenic purpura
93
What is Glanzmanns?
Autosomal recessive condition that affects platelet aggregation
94
What does Glanzmanns cause?
Epistaxis
Menorrhagia
Gingival haemorrhage
95
What should platelet levels be above before XLA?
50x10^9/L
96
What should platelet levels be before major surgery?
Above 70x10^9/L
97
What is tranexamic acid?
Used to treat or prevent excessive blood loss through antifibrinolytic action
98
What clotting factor does haemophilia A affect?
Factor VIII
99
What clotting factor does haemophilia B affect?
Factor IX
100
What inheritance pattern is Von Willebrand disease?
Autosomal dominant
101
What is Von willebrand factor?
An easement ion co-factor for normal platelet adhesion & carrier for factor VIII
102
What is the treatments for VWB?
Tranexamic acid
Desmopressin
If severe, factor VIII
103
What is desmopressin? (DDAVP)
Synthetic version of vasopressin
Stimulates the release of VWF and increase in factor VIII levels
104
What inheritance pattern is haemophilia?
X linked recessive
105
What are the severity %’s of haemophilia?
Mild 5-50%
Moderate 1-5%
Severe <1%
106
What rate symptoms of haemophilia?
Nosebleeds
Prolonged bleeding from wounds
Bleeding gums
Easily bruised
Pain and stiff joints
Internal bleeding
107
What bleeding disorders would require referral to hospital for routine dentistry?
Severe haemophilia
Those with inhibitors
Rare bleeding disorders
108
What LA injections don’t enquire haemostatic cover therapy?
Buccal infiltration
Palatial infiltration
Intraligamentary injection
Intrapapillary injection
109
What dental tx requires haemostatic cover therapy?
Extractions
Oral surgery
Periodontal surgery
Implant surgery
IDBs, lingual infiltrations
110
Explain the XLA procedure for a pt with a bleeding disorder
Liaise with haemophilia centre to organise factor replacement therapy
Use buccal articaine
Tranexamic acid mouthwash (5%) or tablets (1g)
Topical haemostatic agents - pressure packs, sutures, Surgicel, Fibrin glue
111
Name 2 anti-platelet drugs
Aspirin
Clopidogrel
112
Name 2 anti-coagulants
Warfarin
Heparin
113
What are the newer anticoagulants?
Dabigatran
Apixaban
Rivaroxaban
Edoxaban
114
What types of blood cancers are there?
Myeloma
Leukaemia
Lymphoma
Myelodysplasia
115
What does multiple myeloma cause?
Bone infiltration and destruction
Bone pain, pathological #
Hyperviscosity syndrome
Renal failure
Anaemia
Neurological lesions
116
What are the dental aspects of myeloma?
Root resorption
Loose teeth
Mental anaesthesia
Pathological #
Rare cause of mandibular radiolucencies
117
What are the medical implications of myeloma?
Anaemia
Infection
Haemorrhagic tendencies
Renal failure
118
What therapies would be used in myeloma cases?
Steroids
Bisphosphonates
Biological therapies
119
What forms of acute leukaemia are there?
acute lymphoblastic leukaemia
acute myeloid leukaemia
120
What forms of chronic leukaemia are there?
chronic lymphocytic leukaemia
chronic myeloid leukaemia
121
What is chronic leukaemia?
proliferation of more mature cells
122
How might chronic leukaemia present?
Splenomegaly
Lymph node enlargement
123
What are dental aspects of leukaemia?
Septicaemia from oral infections
Mucosal pallor
Ulceration
Gingival swelling
Spontaneous bleeding
124
What is lymphoma?
Cancer of the lymph glands or other organs of the lymphatic organs
125
What are the 2 types of lymphoma?
Hodgkin's lymphoma
Non Hodgkin's
126
What are the symptoms of lymphoma?
Non-tender swollen lymph nodes
Fever
Night sweats
Unexplained weight loss `
127
What is Hodgkin's lymphoma?
Develops from B lymphocytes
Characterised by Reed-Sternberg cells
Aggressive but good prognosis if treated well
128
What is non-hodgkin's lymphoma?
affects either B lymphocytes or T lymphocytes
129
What is the treatment for low grade lymphoma?
Watch and wait
130
What is the treatment for high grade lymphoma?
Chemotherapy, radiotherapy, monoclonal antibody therapy (rituximab)
131
What is myelodysplasia?
rare type of blood cancer
don't have enough healthy blood cells
bone marrow makes abnormal cells instead of healthy cells
132
What are the symptoms of myelodysplasia?
Weakness, tiredness and breathlessness
Frequent infections
Bruising and easy bleeding, such as nose bleeds
133
What are the treatments for myelodysplasia?
Injections of growth factor medicines such as Erythropoeitin to increase numbers of blood cells
Blood transfusion
Antibiotics
Biological therapies - Lenalidomide
Chemotherapy
Immunosuppressants
Stem cell (bone marrow) transplant
134
What should you do when treating patients with blood cancers?
- Dental screening prior to treatment
- Make patient dentally fit
- Liaise with haematology consultant
135
What should you be aware of when treating pts with blood cancers?
risk of bleeding
timing of extractions
platelet transfusion
sepsis
chemotherapy
MRONJ
136
What is MRONJ?
exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in pts taking anti-resorptive or anti-angiogenic drugs and where there is no history of radiation or no obvious metastatic disease to the jaws
137
What are the symptoms of MRONJ?
- delayed healing after extraction or other trauma
- sometimes spontaneous without an obvious trauma
- pain
- soft tissue infection and swelling
- numbness
- exposed bone (sometimes absent)
138
What is the incidence of MRONJ?
1% in cancer patients treated with anti-resorptive or anti-angiogenic drugs
0.01-0.1% in osteoporosis patients treated with anti-resorptive drugs
139
What are the risk factors for MRONJ?
underlying medical condition
cumulative drug dose
concurrent treatment with steroids
surgery/trauma
140
What drugs can cause MRONJ?
bisphosphates
RANKL inhibitors
anti-angiogenic drugs
141
What are bisphosphonates?
Drugs that reduce bone resorption by hindering the formation, recruitment and function of osteaclasts
142
What is the most common condition that bisphosphonates are used for?
osteoporosis
143
What is the half life of alendronate?
10 years
144
What are the oral bisphosphonates?
Alendronic acid
Risedronate sodium
145
What are the IV bisphosphonates?
Pamidronate
Zolendronic acid
146
What are RANKL inhibitors?
Anti-resorptive drugs
147
How do RANKL inhibitors work?
Inhibit osteoclast function and bone resorption
148
Name a RANKL inhibitor
Denosumab
149
How frequently is denosumab given for osteoporosis?
Every 6 months
150
How often is denosumab given for cancer?
Every month
151
What do anti-angiogenic drugs do?
Restrict the grown of tumour blood vessels
152
Name 3 anti-angiogenic drugs
Lenalidomide
Aflibercept
Sunitinib
153
What is the guidance regarding denosumab and dental extractions?
9 month stop prior to XLA
154
When would you use antibiotics to reduce the risk of MRONJ following XLA?
Only when clear evidence of infection and that patient will benefit from them
155
What is the aim of the dental team in pre-treatment cancer patients?
Remove potential sources of infection so cancer treatment can proceed without delay
156
How does radiotherapy work?
Uses ionising radiation
Radiation kills DNA of cancer cells
Also destroys healthy cells
157
What are the general side effects of radiotherapy?
Fatigue
Nausea
Burns
Pain
158
What are the dental side effects of radiotherapy?
Mucositis
Xerostomia
Radiation caries
Periodontal disease
Dysgeusia/ageusia
Trismus
Osteoradionecrosis
159
What is dysgeusia/ageusia?
Loss of one or more taste sensations
May recover after 9-18 months
160
What can we do pre-cancer treatment to prevent dental infection?
XLA hopeless teeth
Duraphat toothpaste/varnish
Fluoride trays
HPT
Therabite
161
What would class as hopeless teeth?
Gross caries
Mobile teeth (grade 2 or >)
Pockets 5mm and greater
Periapical pathology
Furcation involvement
162
How often would you tell a patient to wear fluoride trays?
Minimum 5 min per day
163
How can hygiene phase therapy help pre-cancer tx?
May lessen severity of mucositis
164
What is undergoing trials currently to help cancer patients?
LLLT low level laser therapy
165
What is the preventative prophylaxis for ORN?
Pentoxyfylline
Vitamin E
166
How does chemotherapy work?
Interferes with mitosis
Interferes with apoptosis
Interferes with tumour cell DNA
167
Name 3 chemotherapy drugs
Cisplatin
Cetuximab
TPF
168
What are the general side effects of chemotherapy?
Fatigue
Nausea
Vomiting & diarrhoea
Skin rash
Hair loss
Thrombocytopenia
Neutropenia
169
What are the oral side effects of chemotherapy?
Mucositis
Infection
Bleeding
Temporary xerostomia
170
What can we do to help Mucositis post chemotherapy?
Soft splints
Caphosol
LLLT?
HPT before chemo starts
171
What should you check if doing an extraction during/soon after chemotherapy?
Check bloods - FBC, coag screen
172
What are the GDC standards for releasing confidential information?
In any circumstance where you decide to release confidential info, you must document your reasons and be prepared to explain and justify your decision and actions
173
What age is an adult regarding the Adult Support and Protection act 2007?
16 years or older
174
Who isn’t automatically protected by the Adult support and protection act?
Dementia
Learning disabled
Physical impairment
175
What is financial harm?
Theft
Fraud
Misuse of money, property or resources without informed consent
176
What is physical harm?
Physical assault
Bruising
Abrasions
Bites/burns/scalds
Scars
Fractures
177
What counts as emotional/psychological harm?
Excessive shouting
Bullying
Humiliation
Rejection
Scapegoating
Denigration of culture/gender/religion/sexuality/disability
Denial of opportunities for appropriate socialisation
178
What counts as sexual harm?
Incest/rape/acts of gross indecency
Exploitation through prostitution
FGM
179
What counts as neglect?
Failure to provide access to appropriate healthcare
Withholding necessities such as nutrition, heating etc
Lack of appropriate food or clothing
Unhygienic home conditions
Isolation and withdrawal from social activities
180
Who does the adult support and protection act 2007 support and protect?
Adults at risk of harm
Adults more at risk because they are affected by a disability, mental disorder, illness or physical or mental infirmity
Adults who are unable to safeguard their own wellbeing, property, rights or other interests
181
When should intervention in an adults affairs occur?
When:
- it will provide benefit to the adult, which could not reasonably be provided without intervention
- the chosen intervention is likely to succeed and is the least restrictive of the adult’s freedom
182
What should you record in your notes when you are concerned an adult is a risk?
- was the adult with anyone? Who? Role/relationship?
- Observe behaviour and physical signs
- summary of discussions
- record/draw/photograph injuries and reasons given for them
- recognise historical patterns
- distinguish between facts and opinion
183
How do you report concerns?
Recognise - signs of harm
Record - believe. Listen. Take notes
Report - tell someone (preferable to get consent from patient for this)
184
What should you never do when reporting concerns?
- put yourself/team at risk of harm
- attempt to confront an abuser
- promise you will keep secrets for the victim
185
What is it not your responsibility to do when reporting concerns?
- assess legislative criteria
- investigate harm
- seek proof
186
Who do you report concerns to if there is immediate danger?
999
187
Who do you contact with concerns about proxy’s?
Welfare - social work
Financial - OPG
Advice - mental welfare commission
188
What are the 6 principles of adult safeguarding?
Empowerment
Prevention
Proportionality
Protection
Partnership
Accountability
189
What does the domestic abuse Scotland act 2018 cover?
Any form of:
- physical
- verbal
- sexual
- psychological
- financial
Abuse which might amount to criminal conduct anadromous which takes place within the context of a relationship (partners or ex-partners)
190
What age range had the highest incident rate for domestic abuse?
26-30 years
191
What behaviours are coercive control?
Isolation from support
Exploitation
Deprivation of independence
Regulating behaviour
192
Name 5 types of exploitation
slavery
forced labour
prostitution
removal of organs
securing services and benefits
193
What signs should you be aware of for exploitation?
physical abuse
isolation
poor living conditions
few or no personal effects
restricted movement
unusual travel times
reluctance to seek help
194
What is fear?
the physiological reaction to actual threat/danger
195
What is anxiety?
the physiological reaction to perceived threat/danger
196
What is phobia?
a persistent and excessive fear of an object or situation that is not in fact dangerous
197
What types of anxiety disorders are there?
phobic
panic disorder
generalised (GAD)
PTSD
adjustment disorders
hypochondrial disorders
198
Explain the 2 groups of gagging
somatogenic - physical stimulation produces the reflex
psychogenic - stimulation appears to be psychological origin
199
What are the types of triggers to gagging?
tactile - exam, radiographs, imps
gustatory - taste
olfactory - smell
visual - room, white coat, dental chair
auditory - sound of handpiece
cognitions - memories
200
What factors contribute to gagging?
anatomical - soft palate
medical - nasal obstruction, gastric, MND
psychological- fear, stress, phobia, alcoholism
dental/iatrogenic - overloaded imp tray, denture design faults
201
What are the 5 intraoral trigger points for gagging?
palatoglossal and palatopharyngeal folds
base of tongue
palate
uvula
posterior pharyngeal wall
202
what % of adults have moderate dental anxiety?
36%
203
What percentage of the population are phobic of the dentist?
10%
204
What does MDAS score 5-9 indicate?
no-low anxiety
205
What does MDAS score 10-18 indicate?
moderate anxiety
206
What does MDAS score 19 or above indicate?
significant dental anxiety/phobia
207
name 3 coping strategies for anxiety?
deep breathing
progressive muscular relaxation (PMR)
grounding
208
what techniques can help with gagging?
temporal tap
salt on anterior dorsum of tongue 5 secs prior to procedure
rinse with ice cold water prior to radiographs
209
What are the 2 types of congenital cardiac conditions?
cyanotic
acyanotic
210
what are the dental findings of congenital cardiac conditions?
delayed eruption of both dentitions
increased positional abnormalities
enamel hypoplasia
vasodilation of pulp
increased perio and caries
211
what are the dental considerations of congenital heart conditions?
anticoagulation
risk of infective endocarditis
212
what causes ischaemic heart disease?
atherosclerosis and hypertension
213
what are the oral findings of IHD?
severe caries
severe perio
lichenoid reactions
gingival swelling
angiodema
ulcers
214
how long should you defer tx post MI?
6 months
215
what are the tx options for hypertension?
lifestyle changes
diuretic
b blocker
ca channel blockers
statins
aspirin/clopidogrel
216
what are the dental considerations of hypertension?
xerostomia
salivary gland pain/swelling
lichenoid reactions
angio-oedema
gingival hyperplasia
sore mouth
paraesthesia
217
what is the tx for cariomyopathy?
b blockers, anitcoagulants, diuretics
pacemakers or ICD's
surgery
transplant
218
what is the dental issues of B blockers?
interact with LA with adrenaline
219
what teeth should you extract pre-cardiac surgery?
severe periodontal disease
gross caries
apical pathology
220
what are the renal functions?
excretion of waste products
maintaining fluid and electrolyte balance
secretion of hormones
excretion of drugs
221
what are the most common causes of chronic kidney disease?
diabetes
hypertension
glomerulonephritis
222
what are the 5 stages chronic kidney disease?
1. early CKD
2. mild CKD
3. moderately severe
4. severe CKD
5. end stage renal failure
223
what is the clinical presentation of renal failure?
depression, lethargy
nausea, vomiting, anorexia
weakness, fatigue
peptic ulceration
bruising
diarrhoae
bone pain
224
what are oral findings of CKD?
osseous lesions
dry mouth, metallic taste, halitosis
reduced salivary flow, protein and electrolyte changes
accelerated calculus production
pale oral mucosa
oedema, oral ulceration
paraesthesia
225
what does haemodialysis do?
removes excess fluid and uraemic solutes
226
when is the best time for treatment for renal dialysis patients?
the day after haemo-dialysis
227
What are the implications of renal transplants?
lifelong immunosuppression
gingival hyperplasia
increased risk of oral tumours
candidiasis, herpes simplex
228
how long do renal transplants last?
90% success at 1 year
70% survival at 5 years
less than 5% mortality
229
what should be done dentally pre-renal transplant?
full dental assessment
extract teeth of poor prognosis
preventative regime
230
what should be done dentally post renal transplant?
defer elective dental care for 6 months
consult with renal physician
delayed wound healing
