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Finals > Special Care > Flashcards

Special Care Flashcards

1
Q

What is Special Care?

A

Special care dentistry are those with a disability or activity restriction that directly or indirectly affects their oral health

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2
Q

What are the problems associated with providing dental treatment?

A

Communication
Anxiety
Moving target
Perception of reality
Previous experience

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3
Q

What are the common patient groups treated in special care?

A

Involuntary movements
Learning difficulties: congenital, acquired

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4
Q

What are some examples of congenital/genetic movement disorders?

A

Muscular dystrophy
Cerebral palsy
Multiple sclerosis
Parkinson’s disease
Huntingdon’s chorea

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5
Q

What is an example of an acquired movement disorder?

A

Head injury

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6
Q

What are the features of assessment for patients with involuntary movements?

A

Mental and physical status
Anxiety
Pain experience

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7
Q

What are the two types of congenital learning difficulties?

A

Syndromic
Non-syndromic

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8
Q

What are examples of acquired learning difficulties?

A

Trauma
Infection
Cerebrovascular Accident (CVA)
Alzheimer’s

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9
Q

What are the features of assessment for management of patients with learning difficulties?

A

Will behavioural management be possible
Is pharmacological management needed
Sedation or GA or both

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10
Q

What act defines capacity in Scotland?

A

Adult Incapacity Act (2000)

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11
Q

What are the modes of administration of conscious sedation?

A

Inhalation
Intravenous
Oral
Transmucosal; rectal, intranasal, sublingual

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12
Q

What influences your choice of sedation technique?

A

Patient co-operation
Degree of anxiety
Dentistry required
Skills of the dental team
Patients previous experience
Facilities available
Anaesthetist required

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13
Q

What are the advantages of inhalation sedation?

A

Useful for anxiety relief
Rapid recovery
Flexible duration

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14
Q

What are the disadvantages of inhalation sedation?

A

Keeping nasal hood in place
Less muscle relaxation
Co-ordination of nasal breathing when mouth open

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15
Q

What are the advantages of intravenous sedation?

A

Good sedation achieved
Less cooperation needed
Muscle relaxation

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16
Q

What are the disadvantages of intravenous sedation?

A

Baseline readings
IV cannulation required
Assessing sedation level
Behaviour during recovery
Efficacy swallowing

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17
Q

What are the techniques for intravenous sedation?

A

Midazolam
Propofol
Multiple agent

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18
Q

What are the considerations for safety associated with intravenous sedation?

A

Swallowing
Airway
Liver
Medication interactions
ASA

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19
Q

What are the advantages of oral/transmucosal sedation?

A

Avoid cannulation
Can make induction more pleasant
Better cooperation
Better future behaviour

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20
Q

What are the disadvantages of oral/transmucosal sedation?

A

Baseline readings
Bitter taste/stinging
Lag time
Untitrateable
Difficulty in monitoring level of sedation
Behaviour in recovery

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21
Q

What is remimazolam?

A

A sedative drug undergoing clinical trials
Benzodiazepine ring and methylene ester molecule
Rapid breakdown and onset
Distribution half life= 0.5-2mins
Terminal elimination half life= 7-11 mins

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22
Q

Compare the distribution half-life of midazolam to remimazolam?

A

4-18 mins
0.5-2mins

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23
Q

Compare the elimination half life of midazolam to remimazolam

A

1.5-2 hours
7-11 mins

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24
Q

Compare the elimination half life of midazolam to remimazolam

A

1.5-2 hours
7-11 mins

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25
Q

What are some examples of complications of intravenous sedation?

A

Venospasm
Extravascular injection
Intraarterial injection
Haematoma
Fainting

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26
Q

What is venospasm?

A

Disappearing vein syndrome
Veins collapse at attempted venepuncture

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27
Q

What may a patient with venospasm experience?

A

A burning sensation

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28
Q

What is venospasm associated with?

A

Poorly visible veins

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29
Q

What are the options for management of venospasm?

A

Time dilating vein
Efficient technique; slow puncture makes outcome worse
Warm water/gloves in winter

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30
Q

What is the definition of an extravascular injection?

A

Active drug placed into interstitial space

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31
Q

How does an extravascular injection present?

A

Pain
Swelling

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32
Q

What are some problems associated with an extravascular injection?

A

Delayed absorption

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33
Q

How can you prevent an extravascular injection?

A

Good cannulation
Test dose of saline

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34
Q

What is the treatment for an extravascular injection?

A

Remove cannula
Apply pressure
Reassure

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35
Q

How will an intra-arterial injection present?

A

Pain on venepuncture
Red blood in cannula
Difficult to prevent leaks
Pain radiating distally from site of cannulation
Loss of colour or warmth to limb/weakening pulse

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36
Q

What are the prevention techniques for an intra-arterial injection?

A

Avoid anatomically prone sites; antecubital fossa (ACF) (medial to biceps tendon)
Palpate before attack

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37
Q

What are the management techniques for intra-arterial injection?

A

Monitor for loss of pulse- cold, discolouration
Leave cannula in situ for 5 mins post drug; if no problems, remove
If symptomatic leave and refer to hospital (procaine 1%)

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38
Q

What is a haematoma?

A

Extravasation of blood into soft tissues due to damage to vein walls

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39
Q

Why may a haematoma occur at venepuncture?

A

Poor technique

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40
Q

Why may a haematoma occur during cannula removal?

A

Failure to apply pressure

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41
Q

What is the treatment of a haematoma?

A

Time
Rest
Reassure
If severe- initial ice pack then moist heat 20 mins in hour after for 24 hours
May consider heparin containing gel

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42
Q

What is fainting during venepuncture associated with?

A

Anxiety related to venepuncture
Not eating prior

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43
Q

How can fainting during venepuncture be prevented?

A

Patient eat prior to
Topical skin anaesthesia
Risk assess first
Position patient well

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44
Q

What are the complications of intravenous sedations associated with drug administration?

A

Hyper-responders
Hypo-responders
Paradoxical reactions
Oversedation
Allergic reactions

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45
Q

What dose is a hyper responder associated with?

A

Deep sedation with minimal dose: 1-2mg midazolam

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46
Q

How should hyperresponders be managed?

A

Take care with titration:
1mg increments
Slow titration in elderly

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47
Q

How does a hyporesponder present?

A

Little sedative effect with large doses

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48
Q

How should you mange a hyporesponder?

A

Check the cannula is in the vein

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49
Q

What is hyporespondance associated with?

A

BZD induced
Cross tolerance
Idiopathic

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50
Q

How do paradoxical reactions present?

A

Appear to sedate normally
React extremely to all stimuli
Relax when stimuli removed

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51
Q

How do you manage a patient presenting with a paradoxical reaction?

A

Find another management technique

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52
Q

How does oversedation present?

A

Loss of responsiveness
Respiratory depression
Loss of ability to maintain airway
Respiratory arrest

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53
Q

How is oversedation managed?

A

Stop procedure
Try to rouse patient
ABC
If no response to stimulation and support:
Reverse with flumazenil 200ug, then 100ug increments at minute intervals
Monitor 1-4 hours

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54
Q

How can you manage respiratory depression?

A

Check the oximeter
Stimulate patient: ask patient to breathe
Supplemental oxygen: nasal cannulae 2 litres per minute
Reverse with flumazenil

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55
Q

How would you manage a loss of airway control and/or respiratory arrest?

A

Stimulate the patient/assess consciousness
Maintain/clean airway
Ventilate the patient
Reverse sedation
Consider other medical incident

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56
Q

Why should you ensure that patients are chaperoned?

A

Sexual fantasies common with inhalation sedation

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57
Q

What are the complications of inhalation sedation?

A

Oversedation
Patient panics

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58
Q

What are the signs and symptoms of a N2O overdose?

A

Patient discomfort
Lack of co-operation
Mouth breathing
Giggling
Nausea
Vomiting
Loss of consciousness

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59
Q

How do you treat an N2O overdose?

A

Decreased N2O concentration by 5-10%
Reassure
Don’t remove nosepiece

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60
Q

How should you manage a complication of oral/transmucosal sedation?

A

Place cannula and top up IV

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61
Q

How should you manage a complication of oral/transmucosal sedation?

A

Place cannula and top up IV

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62
Q

What is the definition of conscious sedation?

A

Use of a drugs or drugs to produce a state of depression of the CNS enabling treatment to be carried out
Verbal contact is maintained throughout

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63
Q

What are the medical indications aggravated by stress for sedation?

A

Conditions aggravated by the stress of dental treatment:
Ischaemic heart disease
Hypertension
Asthma
Epilepsy
Psychosomatic illness (somatoform disorders)
Ulcerative colitis
Crohn’s disease

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64
Q

What are the medical conditions that affect cooperation to be considered for sedation?

A

Mild to moderate movement or learning disabilities
Spasticity disorders
Parkinson’s disease

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65
Q

What are some psychosocial indications for sedation?

A

Phobias
Gagging
Persistent fainting
Idiosyncrasy to LA

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66
Q

Which phobias are associated with indication for sedation?

A

Things in mouth
Dental procedures
Needles
Drills

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67
Q

What is the definition of a phobia?

A

An irrational and uncontrollable fear which is related to a specific object or situation.
It is persistent despite avoidance of the provoking stimulus.
It has a direct effect on the patients lifestyle

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68
Q

What are causes of dental anxiety associated with trauma?

A

Primary traumatic experience
In childhood or cumulative

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69
Q

What are causes of dental anxiety associated with transference?

A

Parenteral
Playground

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70
Q

What are some general causes of dental anxiety?

A

Fear of criticism
Fear of dress
Lack of communication
Helplessness
Invasion of body orifice
Influenced by environment
Surgery appearance
Staff continuity
Age
Stage of development
Gender
SES

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71
Q

What are some examples of dental indications for sedation?

A

Difficult or unpleasant procedures: surgical/orthodontic extractions, implants

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72
Q

What are some medical contraindications for sedation?

A

Severe or uncontrolled systemic disease
Severe mental or physical disability
Severe psychiatric problems
Narcolepsy
Hypothyroidism

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73
Q

What is an ASA classification of 1?

A

A normal healthy patient

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74
Q

What is an ASA classification of 2?

A

A patient with mild systemic disease

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75
Q

What is an ASA classification of 3?

A

A patient with severe systemic disease

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76
Q

What is an ASA classification of 4?

A

A patient with severe systemic disease that is a constant threat to life

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77
Q

What is an ASA classification of 5?

A

A moribund patient who is not expected to live without the operationb

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78
Q

What is an ASA classification of 6?

A

A declared brain dead patient whose organs are being removed for donor purposes

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79
Q

What are medical contraindications to intravenous sedation?

A

Intracranial pathology
COPD
Myasthenia gravies
Hepatic insufficiency
Pregnancy and lactation

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80
Q

What are some medical contraindications to inhalation sedation?

A

Blocked nasal airway
COPD
Pregnancy

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81
Q

What are some social contraindications to sedation?

A

Unwilling
Uncooperative
Unaccompanied
Children (IV)
Elderly

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82
Q

What are some dental contraindications to sedation?

A

Procedure too difficult for LA alone; if patient willing
Procedure too long
Spreading infection: airway threatened, limits LA
Procedure too traumatic

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83
Q

What are the advantages of sedation?

A

Decrease dentist stress
Decrease staff stress
Decrease patient stress
Fewer medical incidents
More productive appointments

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84
Q

What are the disadvantages of sedation?

A

Training required
Equipment required
Recovery time and after care

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85
Q

Describe the mechanics of breathing:

A

Diaphragm is used for quiet breathing
Inspiratory muscles contract
Increase in thoracic volume
Decrease in thoracic pressure
Air pushed along pressure gradient

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86
Q

Which muscles are used for more forceful breathing?

A

Intercostal and accessory

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87
Q

What is the pressure gradient for inspiration?

A

Palv < Patm

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88
Q

What is the pressure gradient for expiration?

A

Palv > Patm

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89
Q

What does tidal volume represent?th

A

The amount of air that moves in or out of the lungs with each respiratory.cycle

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90
Q

What does Inspiratory Reserve Volume mean?

A

The amount of air a person can inhale forcefully after normal tidal volume inspirsation

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91
Q

What is expiratory reserve volume (ERV)

A

The amount of air that can be pushed out of the lungs upon forced expiration

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92
Q

What is residual volume (RV)?

A

The volume of air remaining in the lungs after maximum forceful expiration

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93
Q

What is vital capacity?

A

The total amount of air exhaled after maximal inhalation

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94
Q

What is total lung capacity?

A

The volume of air in the lungs upon the maximum effort inspiration

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95
Q

What is the effect of restrictive and obstructive conditions on FEV1?

A

Reduces the FEV1

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96
Q

What is the function of the conducting zone of the airways?

A

No gas exchange
Anatomical dead space
Trachea and bronchi

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97
Q

What is the function of the respiratory zone in breathing?

A

Region of gas exchange
Respiratory bronchioles
Alveolar duct and sac

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98
Q

What is the average tidal volume?

A

450ml

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99
Q

What is the average alveolar ventilation?

A

300ml
Amount of fresh air entering the alveoli

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100
Q

Discuss the process of pulmonary gas exchange?

A

Gas exchange occurs between the alveolar air and the pulmonary capillary blood
Gases move across the alveolar wall by diffusion which is determined by partial pressure gradients

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101
Q

What is V and Q greater?

A

Base of the lung

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102
Q

What is the PO2 and PCO2 of mixed venous blood?

A

PO2=40mmHg
PCO2= 46mmHg

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103
Q

What is the PO2 and PCO2 of arterial blood?

A

PO2= 100mmHg
PCO2= 40mmHg

104
Q

What are erythrocytes?

A

Red blood corpuscles

105
Q

What molecule carried in the blood does not bind haemoglobin?

A

Nitrous oxide

106
Q

What is the structure of haemoglobin?

A

2 alpha and 2 beta chains
4 haem groups
Pophyrin ring
Iron atom (Fe reversible binds O2)

107
Q

How many haemoglobin are in a red blood cell?

A

200-300

108
Q

What is a feature of fetal haemoglobin, Hb-F?

A

Stronger bond to oxygen

109
Q

What percentage of oxygen is attached to haemoglobin?

A

97% attached to haemoglobin
3% dissolved in plasma

110
Q

What is a left Bohr shift caused by and what does it cause?

A

Leads to increased affinity for O2
Caused by decrease in temperature or increase in pH

111
Q

What is a right Bohr shift caused by and what does it cause?

A

Leads to a decreased affinity for O2
Caused by increased temperature, decreased pH, increased 2,3 DPG

112
Q

What is 2,3 DPG

A

An alternative product of glycolysis
Part of a feedback loop that can prevent tissue hypoxia

113
Q

How many ml O2 can a full saturated gram of Hb carry?

A

1.34ml

114
Q

How is carbon dioxide transported?

A

In erythrocytes or plasma

115
Q

What is CO2 transported as?

A

Dissolved CO2 (10%)
Combined to protein: carbamino compounds (20%)
Bicarbonate ions (70%)

116
Q

What type of muscles are used for breathing?

A

Skeletal

117
Q

What part of the brain generated the breathing rhythm?

A

Respiratory centres in the brainstem

118
Q

How can the respiratory rate be increased?

A

Cerebral cortex
Peripheral (arterial) chemoreceptors: decrease in PO2, increase PCO2
Central chemoreceptors: decrease pH, increase PCO2 (CSF)
Joint and muscle receptors: movement

119
Q

How can the respiratory rate be decreased?

A

Lung stretch receptors: inflation

120
Q

What is hypoxia?

A

A decrease in oxygen delivery to tissues

121
Q

What is the cause of hypoxic hypoxia?

A

Decrease in oxygen reaching alveoli
Decrease in oxygen diffusion into blood

122
Q

What is the cause of anaemia hypoxia?

A

Decrease in oxygen transport in the blood (low haemoglobin)

123
Q

What is the cause of stagnant (ischaemic) hypoxia?

A

Decrease in oxygen transport in blood (low blood flow)

124
Q

What is the cause of cytotoxic hypoxia?

A

Decreased oxygen utilisation by cells

125
Q

What is cyanosis due to?

A

> 5gm deoxygenated haemoglobin / dl of blood
One third of normal Hb

126
Q

What are the two forms of cyanosis?

A

Central
Peripheral

127
Q

What are the causes of central cyanosis?

A

Decreased O2 delivery to blood (hypoxic hypoxia)
Low atmospheric PO2
Decreased airflow in airways (obstruction)
Decreased O2 diffusion into blood
Decreased pulmonary blood flow
Shunting (venous blood in arteries)

128
Q

What is peripheral cyanosis due to?

A

Decreased blood flow to tissues; stagnant hypoxia
Peripheral vascular diseases

129
Q

What percentage of blood is in the pulmonary circulation and the systemic circulation?

A

20% in pulmonary
80% in systemic

130
Q

What are the four chambers of the heart?

A

Right atrium
Right ventricle
Left atrium
Left ventricle

131
Q

What are the four main valves of the heart?

A

Tricuspid
Pulmonary
Mitral (tricuspid)
Aortic

132
Q

Where is the mitral valve?

A

Between the left atrium and left ventricle

133
Q

Where is the pulmonary valve?

A

Between the pulmonary artery and right ventricle

134
Q

Where is the tricuspid valve?

A

Between the right atrium and right ventricle

135
Q

Where is the aortic valve?

A

Between the left ventricle and aorta

136
Q

What is the arterial blood supply to the heart?

A

Left and right coronary arteries

137
Q

What is the venous drainage of the heart?

A

Coronary veins into the right atrium

138
Q

What is the hearts natural pacemaker?

A

Sinoatrial node

139
Q

How does the heart conducting system work?

A

Sinoatrial node stimulates atrial contraction
The atrial contraction stimulates the atrio-ventricular node which delays the electrical conduction and gives time for the ventricles to fill
The electric signal then travels through the right and left bundles of His to the apex of the heart and then initiate ventricular contration

140
Q

What is the parasympathetic innervation of the heart?

A

Vagus nerve
Acts on SAN, AVN via muscarinic cholinergic receptors
Negative chronotropic and dromotropic effect

141
Q

What is the sympathetic innervation of the heart?

A

Acts on SAN, AVN and myocytes
Via b1 adrenal receptors
Positive chronotropic and dromotropic effect
Positive inotropic effect

142
Q

What happens during ventricular systole?

A

Isovolumetric contraction
Ejection phase

143
Q

What happens in ventricular diastole?

A

Isovolumetric relaxation
Passive filling
Active filling (atrial systole)

144
Q

What are the 5 stages of the cardiac cycle?

A

Atrial systole
Isovolumetric ventricular contraction
Ejection
Isovolumetric ventricular relaxation
Passive ventricular filling

145
Q

What is the P wave?

A

Atrial depolarisation

146
Q

What is the QRS wave?

A

Ventricular depolarisation

147
Q

What is the T wave?

A

Ventricular repolarisation

148
Q

When is coronary blood flow greatest?

A

During ventricular diastole
As coronary arteries are compressed during systole

149
Q

When is coronary blood flow greatest?

A

During ventricular diastole

150
Q

What decreases coronary blood flow?

A

Increased heart rate
Low aortic diastolic blood pressure

151
Q

How is Mean arterial blood pressure (BP) measured?

A

BP= CO x TPR
CO: Cardiac Output
TPR: Total peripheral resistance

152
Q

What is the measurement for cardiac output?

A

CO= Stroke volume x heart rate

153
Q

What does stroke volume depend on?

A

Venous return
Heart rate
Ventricular contractability
After load (TPR)

154
Q

What is the heart rate dependent on?

A

SAN

155
Q

What contributes to the hearts push forces?

A

Momentum: from systole
Muscle pump

156
Q

What contributes to the hearts push forces?

A

Momentum: from systole
Muscle pump

157
Q

What contributes to the hearts pull forces?

A

Thoracic pump (negative intrathoracic pressure)

158
Q

What is preload?

A

The tension in the heart wall as a result of filling
Determined by end-diastolic volume

159
Q

What is Starling’s Law of the heart?

A

The force of muscle contraction increases as the muscle is being stretched to respond to an increased filling of the hearts chambers
Increased end diastolic volume —> increased stroke volume

160
Q

What is the after load?

A

The force that the heart must develop to pump blood against the arterial blood pressure and peripheral resistance

161
Q

What type of patients have increased after load?

A

Hypertension

162
Q

What is the blood pressure of blood in the capillaries of the lungs?

A

8mmHg

163
Q

What is the blood pressure of blood in the veins from lungs to left atrium?

A

0-4mmHg

164
Q

What is the blood pressure of blood in arteries from the left ventricle to the body?

A

120/80mmHg

165
Q

What is the blood pressure of blood in the bodies capillaries?

A

15-35mmHg

166
Q

What is the blood pressure of blood in the veins from the body to the right atrium?

A

0-5mmHg

167
Q

What is the pressure of blood in arteries from the right ventricle to the lungs?

A

25/12mmHg

168
Q

What arteries can be used to measure pulse?

A

External carotid artery
Facial artery
Superficial temporal artery
Radial artery

169
Q

What vein can be used to measure pulse?

A

Jugular venous pulse

170
Q

What formula can be used to measure blood flow?

A

Poiseuille’s Law

171
Q

What can affect arterial radius?

A

Local factors: O2, CO2, pH, temperature, vasoactive agents
Sympathetic nerves: alpha and beta receptors
Hormones: adrenaline, ADH, Angiotensin II

172
Q

What is hypovolaemia?

A

State of abnormally low extracellular fluid

173
Q

What are the two most commonly used cannulation sites?

A

Cubital fossa
Dorsum of hand

174
Q

What are the advantages of using the dorsum of the hand as a cannulation site?

A

Access
No nearby arteries
No nearby nerves
No joints

175
Q

What are the disadvantages of the dorsum of the hand as a cannulation site?

A

Small veins
Susceptible to cold/anxiety
Mobile veins
More painful

176
Q

What vasculature is found in the cubital fossa?

A

Cephalic vein
Median cephalic vein
Brachial artery
Median basilic vein
Basilic vein

177
Q

What vasculature is found in the cubital fossa?

A

Cephalic vein
Median cephalic vein
Brachial artery
Median basilic vein
Basilic vein

178
Q

What are the advantages of the cubital fossa as a cannulation site?

A

Larger veins are more predictably sited
Better suited to underlying connective tissue
Less painful
Less vasoconstriction

179
Q

Which veins are mainly used when cannulating the cubital fossa?

A

Cephalic vein
Basilic vein
Median cubital vein
Cannulate lateral to biceps tendon

180
Q

What are the disadvantages of the cubital fossa as a cannulation site?

A

Access
Potential nerve damage
Potential intra arterial injection
Joint immobilisation

181
Q

What are the three main points of conscious sedation?

A

Remains conscious
Retains protective reflexes
Understands and responds to verbal commands

182
Q

What percentage of children report moderate dental anxiety?

A

30%

183
Q

What percentage of adults report severe dental anxiety?

A

11%

184
Q

What percentage of adults report moderate dental anxiety?

A

36%

185
Q

What is cognitive behavioural therapy?

A

A brief psychological therapy
Effective in helping people with anxiety, depression, ptsd and phobias
Provides psychoeducation and uses behavioural modification techniques and cognitive restructing skills to challenge unhelpful beliefs and behaviours

186
Q

What is cognitive therapy based on?

A

The idea that our thoughts, feelings and behaviours are all linked

187
Q

What is dental anxiety?

A

Type of fear.
Occurs without a present triggering stimulus
Emotional response to an unknown danger or percieved threat

188
Q

What is a phobia?

A

A clinical mental disorder
Overwhelming and debilitating fear of an object, place, situation or animal
Interferes with daily life

189
Q

What is dental fear?

A

An intense biological response to immediate danger which is specific
Encourages caution and safety

190
Q

What is the aetiology of dental anxiety?

A

Direct experiences
Your obersvations
What you are told
Your personality
Your genes

191
Q

What are the four triggers of dental anxiety?

A

Fearful of specific stimuli: sight/sound/smell/setting
Fearful of medical catastrophe
Generalised dental anxiety: general worry
Mistrustful of dental personnel

192
Q

What is trauma?

A

An event of actual or extreme threat of physical or psychological harm which an individual experiences as traumatic and which causes long lasting effects

193
Q

What are the two types of trauma?

A

Single incident trauma
Complex trauma

194
Q

How may a fearful patient present?

A

Anxious
Cancellations
Frozen
Crying
Shaking
Angry
Judged
Shamed
Embarrassed
FTA

195
Q

What is the impact of dental fear and anxiety on dentists?

A

Stress for GDP
Time consuming- 20 minutes more chair time
More extensive treatment required due to neglect
Failed appointments

196
Q

What is the assessment used for adult patients with dental fear and anxiety?

A

Modified Dental Anxiety Scale (MDAS)

197
Q

What is the Modified Dental Anxiety Scale?

A

A structured, validated, self-report anxiety questionnaire
16 years and over
Score of 5-15
>19 suggests severe dental anxiety/phobia

198
Q

What is the assessment used for child patients with dental fear and anxiety?

A

Modified child dental anxiety scale-faces version (MCDASf)

199
Q

What is the modified child dental anxiety scale-faces version?

A

A structured, validated, self-report anxiety questionnaire
Validated for use 8-15 years
Score 9-45
>27 severe dental fear and anxiety/phobia

200
Q

What can a patient gain from CBT?

A

Create a personalised plan with clinician
Gain an understanding and ability to test their negative thinking
Receive psychoeducation and learn coping skills to allow behavioural exposure
Learn to face their anxiety and disengage from avoidance
Challenge their anxiety

201
Q

What is the emotional component of anxiety?

A

Anxious
Scared
Shame
Guilt
Angry

202
Q

What is the physiological component of anxiety?

A

Increased heart rate
Dry mouth
Increased perspiration
Butterflies in stomach
Flushed face
Increased muscle tension

203
Q

What is the cognitive component of anxiety?

A

Expectation of failure
Catastrophising
Fortune telling
Magnifying and minimising

204
Q

What is the behavioural component of anxiety?

A

Avoidance
Disruptive behaviour (esp in children)
Increased muscle tension
Safety behaviours

205
Q

What is the cycle of fear and avoidance?

A

You encounter the thing that scares you
You think about the scary things that could happen
You feel afraid
You avoid or move away from the thing that scares you
You feel relieved
Your beliefs about how dangerous the thing is stays the same
(cycle)

206
Q

What is the model for breaking the emotional cycle?

A

Breathing control
Relaxation
This will pass
Stepping back
Grounding
Stop

207
Q

What is the physical response to anxiety?

A

Brain hijacked
Eyes widen
Mouth dries
Body heats and sweats
Heart beats faster
Bladder relaxes
Stomach churns
Breathe fast and shallow
Head is dizzy

208
Q

How can you break the cycle of physical anxiety reactions?

A

Controlled breathing
Progressive muscle relaxation

209
Q

What are the three steps to breaking the cycle in regard to thoughts?

A

Catching the thoughts
Challenging the thoughts
Find alternative thoughts

210
Q

How can you break the cycle in regard to behaviours?

A

Face your fears
Exposure

211
Q

What is a fear hierarchy?

A

You create a fear ladder by giving your fears a rating between 1-10 then putting them in order
You expose yourself to the lower ranking fears and then work your way up

212
Q

What are the four factors of graded exposure?

A

Graded
Prolonged
Repeated
No distraction

213
Q

How can you make a practice dementia friendly?

A
214
Q

What does dentally fit mean?

A

Stable oral health
Free from disease or potential future disease

215
Q

What are the main challenges faced by autistic patients in their day to day life?

A

Difficulty with communications and language
Difficulty forming relationships
Limited pattern of behaviour and resistance to small changes in familiar surroundings

216
Q

What are the main challenges faced by autistic patients in the dental environment?

A

Sensory overload: new environment, people, change in routine
New smells
Auditory: suction, handpiece, waiting rooms
Tactile: cold, metal instruments, tastes, invasion of personal space

217
Q

What is the MDT associated with autistic patients?

A

Paediatrician
Dietician
Educational Psychologist
Psychiatrist
GP
Occupational Therapist
Social Worker
Health Visitor
Speech and Language Therapist

218
Q

What dental problems are associated with autism?

A

NCTSL
Caries
Trauma/Self-injurious behaviours
Xerostomia (from medication)

219
Q

What can be done in preparation for an appointment for a child with autism?

A

Drop in/Hello visit
Minimise wait: first in morning or first after lunch or a time of day that suits child’s routine
Social story/story boards
Speak to patient to gauge information prior to app
ASD friendly: big, tidy rooms
Comforters: ear defenders, weighted blanket, own toothbrush/sunglasses

220
Q

What can be done during an appointment for a child with autism?

A

Turn off radio
Keep surfaces/bracket table clear
Used toothbrush and plastic mirror
Acclimisation: gradual intro: tell, show, do
Structured and predictable appointment style
Dim bright lights, Snoezelen effect (sensory room), singing while brushing
Examining out of dental chair
Take home plastic mirror and microbrush (acclimitisation)

221
Q
A
222
Q

What are examples of legislation associated with protecting dementia patients?

A

Human Rights Act 2000
Disability Discrimination Act 2005
Equality Act 2010
Adults with Incapacity (Scotland) Act
Mental Capacity (England and Wales) Act

223
Q

Who is involved in the MDT for dementia patients?

A

GP
Dentist
Consultant Neurologist
Dementia Nurse
MacMillan Nurse (late stage)
Physiotherapy
Carers

224
Q

What is a welfare guardian?

A

Has responsibility over an individual’s health and financial status
Must be applied for

225
Q

What does a power of attorney have power over?

A

Wellbeing

226
Q

What does a continuing power of attorney have power over?

A

Finance

227
Q

What can be done to a Parkinson’s patients dentures?

A

Initials carved in
Stored in labelled container

228
Q

What is the Mental Health Act (Scotland) 2003 concerned with?

A

Management and treatment of psychiatric disorders
Can detain patient in the community: leave of absence

229
Q

How long is an emergency detention?

A

72 hours

230
Q

How long is a short term detention?

A

28 days

231
Q

How long is a compulsory treatment order?

A

6 months

232
Q

Who carries out a removal to place of safety?

A

Police

233
Q

Who carries out a detention for assessment?

A

Doctor

234
Q

How long is a detention for assessment?

A

2 hours

235
Q

When is the Mental Health Act (Scotland) 2003 applied?

A

Person has a mental disorder
Medical treatment is available which could stop their condition getting worse or help treat symptoms
If medical treatment is not provided there is a risk of harm to self or others
Individuals ability to make decisions about medical treatment is impaired by a medical disorder
Use of compulsory powers is necessary

236
Q

What are the principles of adult with incapacity act?

A

Benefit
Least restrictive option
Takes account wishes of patient
Consultation of relevant others
Encourages residual capacity

237
Q

What is the three-point test?

A
  1. Unable to safeguard their own wellbeing, property, rights or other interests
  2. At risk of harm
  3. Because they are affected by disability, mental disorder, illness or physical or mental infirmity, more vulnerable to being harmed
238
Q

What are the timescales for AWI?

A

Acknowledgement- 1 day
Duty to enquire- 5 days
Investigation complete- 20 days
Case conference- 20 days
Protection plan - 10 days

239
Q

What are the timescales for AWI?

A

Acknowledgement- 1 day
Duty to enquire- 5 days
Investigation complete- 20 days
Case conference- 20 days
Protection plan - 10 days

240
Q

What methods can be used to transfer a patient to the dental chair?

A

Hoist
Banana board
Reclining wheelchair
Turn table
Wheelchair recliner
Stand aid

241
Q

What are the benefits of hoist?

A

Can be used for non weight bearing individuals
Allows transfer to dental chair
Overall safe

242
Q

What are the disadvantages of hoists?

A

Additional training required
Additional equipment required

243
Q

What are the benefits of a banana board?

A

Self transfer

244
Q

What are the disadvantages of a banana board?

A

Requires leg break chair

245
Q

What are the benefits of a reclining wheelchair?

A

No transfer needed

246
Q

What are the disadvantages of a reclining wheelchair?

A

Difficult access
Expensive

247
Q

What are the advantages of a turn table?

A

Promotes patient involvement

248
Q

What are the disadvantages of a turn table?

A

Additional equipment

249
Q

What are the disadvantages of a turn table?

A

Additional equipment

250
Q

What are the advantages of a wheelchair recliner?

A

No need to transfer
No cost

251
Q

What are the disadvantages of a wheelchair recliner?

A

Difficult transfer

252
Q

What are the advantages of a stand aid?

A

Patient involvement

253
Q

What are the disadvantages of a stand aid?

A

Must be able to weight bear

254
Q

What are the stages of general anaesthetic?

A

Induction
Excitement
Surgical anaesthesia
Respiratory paralysis/ OD

255
Q

What are the indications for general anaesthetic?

A

Pre-cooperative / anxious
Child required to be still

256
Q

What are the contraindications for general anaesthetic?

A

Risk of death
Coma
Future anxiety

Finals (20 decks)

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