Special Care Flashcards
Define, learning disability.
A significantly reduced ability to understand new or complex information, learn new skills and cope independently
What are associated clinical features of a an individual with a learning disability?
- epilepsy
- visual defects
- hearing and speech disorders
- facial deformities
- body-rocking and self-mutilation
- feeding difficulties
What are the 8 associated health conditions a person with Down syndrome may suffer from?
- Cardiac problems
- Spinal problems
- Malignant disease
- Dementia
- Immune disease
- Hearing loss
- Visual defects
- Seizures
What are common oral findings in autistic patients?
- Bruxism
- Traumatic lesions
- Poor oral hygiene
- Preference for sweet foods (higher caries risk)
What act of UK parliament states that it is against the law to discriminate against someone because of age, disability, gender reassignment, Marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or sexual orientation.
Equality Act 2010
What is domiciliary dental care?
Providing dental treatment out with dental clinics for patients whose personal circumstances makes it infeasible to attend a dental clinic.
What type of dementia is most common in women?
Alzheimer’s disease
What type of dementia is most common in men?
Vascular dementia
What are the medical risk factors for dementia?
- type 2 diabetes
- hypertension
- high cholesterol
- obesity
- depression
What are the lifestyle factors for dementia?
- physical inactivity
- smoking
- unhealthy diet
- excessive alcohol
What specific form of dementia usually occurs in individuals who have experienced head injuries playing sports?
Chronic traumatic encephalopathy
What are the 5 types of dementia?
- Alzheimer’s disease
- Vascular
- Mixed
- Levy body
- Fronto temporal
What are the main clinical features of Alzheimer’s disease?
- Short-term memory loss and word-finding difficulties
- confusion
- mood swings and frustration
- withdrawn
What is the association between periodontal disease and Alzheimer’s?
Evidence that pathogens from periodontal disease and/or their virulence factors are able to enter the brain via vascular and neural pathways.
What causes vascular dementia?
Reduced blood flow to the brain
What is lewy-body dementia?
Where, Lewy bodies, small deposits of protein in nerve cells, cause problems with thinking, movement, behaviour and mood.
What are the features of lewy-body dementia?
- Unpredictable changes in attention and alertness
- visual hallucinations
- disturbed sleep
- associated with Parkinson’s disease
What type of dementia generally affects people of slightly younger age (e.g. 40/50 years old)?
Fronto-temporal dementia
What are the key features of fronto-temporal dementia?
- personality change
- challenging behaviour/sexually inappropriate behaviour
- short temperedness/aggression
- mood swings
What drug, approved in the UK, is the first drug to convincingly slow progression of early stage Alzheimer’s disease?
Lecanemab
Why might a GA be contraindicated for a patient with dementia if there are other suitable options?
As there is evidence to suggest that dementia can worse following a GA
Prior to dental procedures, what would a patient with a platelet disorder require?
A full blood count
What is von willebrand disease?
Inherited bleeding disorder where there is deficiency in von willebrand factor, an essential co-factor for normal platelet adhesion.
What is more common, haemophilia A or B?
More common: Haemophilia A (1/5000 live male births)
Haemophilia B (1/20000 live male births)
For what dental procedures is haemostatic cover therapy required?
- Extractions
- Oral surgery
- Periodontal surgery
- Implant surgery
- Inferior dental blocks
- Lingual infiltrations
For what dental procedures is haemostatic cover therapy NOT required?
- Buccal infiltration
- Palatal infiltration
- Intraligamentary injection
- Intrapapillary injection
For dental extractions, what 4 measures should be in place if a patient has a bleeding disorder?
- Liase with haemophilia centre to organise factor replacement therapy
- Use of buccal articiane
- Tranexamic acid mouthwash and/or tablets
- Topical haemostatic agents- e.g. pressure packs, sutures, oxidised cellulose, fibrin glue.
Name 3 dental aspects of myeloma.
- Root resorption
- Loose teeth
- Mental anaesthesia
Name 4 dental aspects of leukaemia.
- Mucosal pallor
- Ulceration
- Gingival swelling
- Spontaneous bleeding
Define MRONJ.
“Exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in patients taking anti-resorptive or anti-angiotensin drugs and where there is no history of radiation or no obvious metastatic disease to the jaws”
What are key symptoms of MRONJ?
- Delayed healing
- Can be spontaneous without trauma
- Pain
- Soft tissue infection/swelling
- Numbness
- Exposed bone (not always)
Which drugs will put a patient at higher risk of developing MRONJ?
- Bisphosphonates
- RANKL inhibitors
- Anti-angiogenic drugs
What is the action of Bisphosphonates?
“Drugs that reduce bone resorption by hindering the formation, recruitment and function of osteoclasts.”
According to the Adults with incapacity Act 2000, what does incapacity mean?
Incapable of:
1. Acting
2. Making a decision
3. Communicating a decision
4. Understanding a decision
5. Retaining memory of a decision
What is the important pneumonic used to assess capacity?
AMCUR
What 4 ways can you check that a patient has understood and has the capacity to consent?
- Open questions
- ‘Chunk and check’
- ‘Teach back’
- ‘Taking the blame’
What should be issued if a patient is deemed to lack capacity to consent to dental treatment?
Section 47 certificate
According to what 5 key principles from AWI is section 47 certificate issued?
- BENEFIT
- Least restrictive of freedom
- The persons past and present wishes should be taken into account
- Consult relevant others
- Encourage residual capacity
What is a proxy?
Legally recognised individual who has been authorised to act on behalf of an adult with incapacity