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
2
Q
What are the problems associated with providing dental treatment?
A
Communication
Anxiety
Moving target
Perception of reality
Previous experience
3
Q
What are the common patient groups treated in special care?
A
Involuntary movements
Learning difficulties: congenital, acquired
4
Q
What are some examples of congenital/genetic movement disorders?
A
Muscular dystrophy
Cerebral palsy
Multiple sclerosis
Parkinson’s disease
Huntingdon’s chorea
5
Q
What is an example of an acquired movement disorder?
A
Head injury
6
Q
What are the features of assessment for patients with involuntary movements?
A
Mental and physical status
Anxiety
Pain experience
7
Q
What are the two types of congenital learning difficulties?
A
Syndromic
Non-syndromic
8
Q
What are examples of acquired learning difficulties?
A
Trauma
Infection
Cerebrovascular Accident (CVA)
Alzheimer’s
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
10
Q
What act defines capacity in Scotland?
A
Adult Incapacity Act (2000)
11
Q
What are the modes of administration of conscious sedation?
A
Inhalation
Intravenous
Oral
Transmucosal; rectal, intranasal, sublingual
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
13
Q
What are the advantages of inhalation sedation?
A
Useful for anxiety relief
Rapid recovery
Flexible duration
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
15
Q
What are the advantages of intravenous sedation?
A
Good sedation achieved
Less cooperation needed
Muscle relaxation
16
Q
What are the disadvantages of intravenous sedation?
A
Baseline readings
IV cannulation required
Assessing sedation level
Behaviour during recovery
Efficacy swallowing
17
Q
What are the techniques for intravenous sedation?
A
Midazolam
Propofol
Multiple agent
18
Q
What are the considerations for safety associated with intravenous sedation?
A
Swallowing
Airway
Liver
Medication interactions
ASA
19
Q
What are the advantages of oral/transmucosal sedation?
A
Avoid cannulation
Can make induction more pleasant
Better cooperation
Better future behaviour
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
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
22
Q
Compare the distribution half-life of midazolam to remimazolam?
A
4-18 mins
0.5-2mins
23
Q
Compare the elimination half life of midazolam to remimazolam
A
1.5-2 hours
7-11 mins
24
Q
Compare the elimination half life of midazolam to remimazolam
A
1.5-2 hours
7-11 mins
25
What are some examples of complications of intravenous sedation?
Venospasm
Extravascular injection
Intraarterial injection
Haematoma
Fainting
26
What is venospasm?
Disappearing vein syndrome
Veins collapse at attempted venepuncture
27
What may a patient with venospasm experience?
A burning sensation
28
What is venospasm associated with?
Poorly visible veins
29
What are the options for management of venospasm?
Time dilating vein
Efficient technique; slow puncture makes outcome worse
Warm water/gloves in winter
30
What is the definition of an extravascular injection?
Active drug placed into interstitial space
31
How does an extravascular injection present?
Pain
Swelling
32
What are some problems associated with an extravascular injection?
Delayed absorption
33
How can you prevent an extravascular injection?
Good cannulation
Test dose of saline
34
What is the treatment for an extravascular injection?
Remove cannula
Apply pressure
Reassure
35
How will an intra-arterial injection present?
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
36
What are the prevention techniques for an intra-arterial injection?
Avoid anatomically prone sites; antecubital fossa (ACF) (medial to biceps tendon)
Palpate before attack
37
What are the management techniques for intra-arterial injection?
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%)
38
What is a haematoma?
Extravasation of blood into soft tissues due to damage to vein walls
39
Why may a haematoma occur at venepuncture?
Poor technique
40
Why may a haematoma occur during cannula removal?
Failure to apply pressure
41
What is the treatment of a haematoma?
Time
Rest
Reassure
If severe- initial ice pack then moist heat 20 mins in hour after for 24 hours
May consider heparin containing gel
42
What is fainting during venepuncture associated with?
Anxiety related to venepuncture
Not eating prior
43
How can fainting during venepuncture be prevented?
Patient eat prior to
Topical skin anaesthesia
Risk assess first
Position patient well
44
What are the complications of intravenous sedations associated with drug administration?
Hyper-responders
Hypo-responders
Paradoxical reactions
Oversedation
Allergic reactions
45
What dose is a hyper responder associated with?
Deep sedation with minimal dose: 1-2mg midazolam
46
How should hyperresponders be managed?
Take care with titration:
1mg increments
Slow titration in elderly
47
How does a hyporesponder present?
Little sedative effect with large doses
48
How should you mange a hyporesponder?
Check the cannula is in the vein
49
What is hyporespondance associated with?
BZD induced
Cross tolerance
Idiopathic
50
How do paradoxical reactions present?
Appear to sedate normally
React extremely to all stimuli
Relax when stimuli removed
51
How do you manage a patient presenting with a paradoxical reaction?
Find another management technique
52
How does oversedation present?
Loss of responsiveness
Respiratory depression
Loss of ability to maintain airway
Respiratory arrest
53
How is oversedation managed?
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
54
How can you manage respiratory depression?
Check the oximeter
Stimulate patient: ask patient to breathe
Supplemental oxygen: nasal cannulae 2 litres per minute
Reverse with flumazenil
55
How would you manage a loss of airway control and/or respiratory arrest?
Stimulate the patient/assess consciousness
Maintain/clean airway
Ventilate the patient
Reverse sedation
Consider other medical incident
56
Why should you ensure that patients are chaperoned?
Sexual fantasies common with inhalation sedation
57
What are the complications of inhalation sedation?
Oversedation
Patient panics
58
What are the signs and symptoms of a N2O overdose?
Patient discomfort
Lack of co-operation
Mouth breathing
Giggling
Nausea
Vomiting
Loss of consciousness
59
How do you treat an N2O overdose?
Decreased N2O concentration by 5-10%
Reassure
Don’t remove nosepiece
60
How should you manage a complication of oral/transmucosal sedation?
Place cannula and top up IV
61
How should you manage a complication of oral/transmucosal sedation?
Place cannula and top up IV
62
What is the definition of conscious sedation?
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
63
What are the medical indications aggravated by stress for sedation?
Conditions aggravated by the stress of dental treatment:
Ischaemic heart disease
Hypertension
Asthma
Epilepsy
Psychosomatic illness (somatoform disorders)
Ulcerative colitis
Crohn’s disease
64
What are the medical conditions that affect cooperation to be considered for sedation?
Mild to moderate movement or learning disabilities
Spasticity disorders
Parkinson’s disease
65
What are some psychosocial indications for sedation?
Phobias
Gagging
Persistent fainting
Idiosyncrasy to LA
66
Which phobias are associated with indication for sedation?
Things in mouth
Dental procedures
Needles
Drills
67
What is the definition of a phobia?
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
68
What are causes of dental anxiety associated with trauma?
Primary traumatic experience
In childhood or cumulative
69
What are causes of dental anxiety associated with transference?
Parenteral
Playground
70
What are some general causes of dental anxiety?
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
71
What are some examples of dental indications for sedation?
Difficult or unpleasant procedures: surgical/orthodontic extractions, implants
72
What are some medical contraindications for sedation?
Severe or uncontrolled systemic disease
Severe mental or physical disability
Severe psychiatric problems
Narcolepsy
Hypothyroidism
73
What is an ASA classification of 1?
A normal healthy patient
74
What is an ASA classification of 2?
A patient with mild systemic disease
75
What is an ASA classification of 3?
A patient with severe systemic disease
76
What is an ASA classification of 4?
A patient with severe systemic disease that is a constant threat to life
77
What is an ASA classification of 5?
A moribund patient who is not expected to live without the operationb
78
What is an ASA classification of 6?
A declared brain dead patient whose organs are being removed for donor purposes
79
What are medical contraindications to intravenous sedation?
Intracranial pathology
COPD
Myasthenia gravies
Hepatic insufficiency
Pregnancy and lactation
80
What are some medical contraindications to inhalation sedation?
Blocked nasal airway
COPD
Pregnancy
81
What are some social contraindications to sedation?
Unwilling
Uncooperative
Unaccompanied
Children (IV)
Elderly
82
What are some dental contraindications to sedation?
Procedure too difficult for LA alone; if patient willing
Procedure too long
Spreading infection: airway threatened, limits LA
Procedure too traumatic
83
What are the advantages of sedation?
Decrease dentist stress
Decrease staff stress
Decrease patient stress
Fewer medical incidents
More productive appointments
84
What are the disadvantages of sedation?
Training required
Equipment required
Recovery time and after care
85
Describe the mechanics of breathing:
Diaphragm is used for quiet breathing
Inspiratory muscles contract
Increase in thoracic volume
Decrease in thoracic pressure
Air pushed along pressure gradient
86
Which muscles are used for more forceful breathing?
Intercostal and accessory
87
What is the pressure gradient for inspiration?
Palv < Patm
88
What is the pressure gradient for expiration?
Palv > Patm
89
What does tidal volume represent?th
The amount of air that moves in or out of the lungs with each respiratory.cycle
90
What does Inspiratory Reserve Volume mean?
The amount of air a person can inhale forcefully after normal tidal volume inspirsation
91
What is expiratory reserve volume (ERV)
The amount of air that can be pushed out of the lungs upon forced expiration
92
What is residual volume (RV)?
The volume of air remaining in the lungs after maximum forceful expiration
93
What is vital capacity?
The total amount of air exhaled after maximal inhalation
94
What is total lung capacity?
The volume of air in the lungs upon the maximum effort inspiration
95
What is the effect of restrictive and obstructive conditions on FEV1?
Reduces the FEV1
96
What is the function of the conducting zone of the airways?
No gas exchange
Anatomical dead space
Trachea and bronchi
97
What is the function of the respiratory zone in breathing?
Region of gas exchange
Respiratory bronchioles
Alveolar duct and sac
98
What is the average tidal volume?
450ml
99
What is the average alveolar ventilation?
300ml
Amount of fresh air entering the alveoli
100
Discuss the process of pulmonary gas exchange?
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
101
What is V and Q greater?
Base of the lung
102
What is the PO2 and PCO2 of mixed venous blood?
PO2=40mmHg
PCO2= 46mmHg
103
What is the PO2 and PCO2 of arterial blood?
PO2= 100mmHg
PCO2= 40mmHg
104
What are erythrocytes?
Red blood corpuscles
105
What molecule carried in the blood does not bind haemoglobin?
Nitrous oxide
106
What is the structure of haemoglobin?
2 alpha and 2 beta chains
4 haem groups
Pophyrin ring
Iron atom (Fe reversible binds O2)
107
How many haemoglobin are in a red blood cell?
200-300
108
What is a feature of fetal haemoglobin, Hb-F?
Stronger bond to oxygen
109
What percentage of oxygen is attached to haemoglobin?
97% attached to haemoglobin
3% dissolved in plasma
110
What is a left Bohr shift caused by and what does it cause?
Leads to increased affinity for O2
Caused by decrease in temperature or increase in pH
111
What is a right Bohr shift caused by and what does it cause?
Leads to a decreased affinity for O2
Caused by increased temperature, decreased pH, increased 2,3 DPG
112
What is 2,3 DPG
An alternative product of glycolysis
Part of a feedback loop that can prevent tissue hypoxia
113
How many ml O2 can a full saturated gram of Hb carry?
1.34ml
114
How is carbon dioxide transported?
In erythrocytes or plasma
115
What is CO2 transported as?
Dissolved CO2 (10%)
Combined to protein: carbamino compounds (20%)
Bicarbonate ions (70%)
116
What type of muscles are used for breathing?
Skeletal
117
What part of the brain generated the breathing rhythm?
Respiratory centres in the brainstem
118
How can the respiratory rate be increased?
Cerebral cortex
Peripheral (arterial) chemoreceptors: decrease in PO2, increase PCO2
Central chemoreceptors: decrease pH, increase PCO2 (CSF)
Joint and muscle receptors: movement
119
How can the respiratory rate be decreased?
Lung stretch receptors: inflation
120
What is hypoxia?
A decrease in oxygen delivery to tissues
121
What is the cause of hypoxic hypoxia?
Decrease in oxygen reaching alveoli
Decrease in oxygen diffusion into blood
122
What is the cause of anaemia hypoxia?
Decrease in oxygen transport in the blood (low haemoglobin)
123
What is the cause of stagnant (ischaemic) hypoxia?
Decrease in oxygen transport in blood (low blood flow)
124
What is the cause of cytotoxic hypoxia?
Decreased oxygen utilisation by cells
125
What is cyanosis due to?
>5gm deoxygenated haemoglobin / dl of blood
One third of normal Hb
126
What are the two forms of cyanosis?
Central
Peripheral
127
What are the causes of central cyanosis?
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
What is peripheral cyanosis due to?
Decreased blood flow to tissues; stagnant hypoxia
Peripheral vascular diseases
129
What percentage of blood is in the pulmonary circulation and the systemic circulation?
20% in pulmonary
80% in systemic
130
What are the four chambers of the heart?
Right atrium
Right ventricle
Left atrium
Left ventricle
131
What are the four main valves of the heart?
Tricuspid
Pulmonary
Mitral (tricuspid)
Aortic
132
Where is the mitral valve?
Between the left atrium and left ventricle
133
Where is the pulmonary valve?
Between the pulmonary artery and right ventricle
134
Where is the tricuspid valve?
Between the right atrium and right ventricle
135
Where is the aortic valve?
Between the left ventricle and aorta
136
What is the arterial blood supply to the heart?
Left and right coronary arteries
137
What is the venous drainage of the heart?
Coronary veins into the right atrium
138
What is the hearts natural pacemaker?
Sinoatrial node
139
How does the heart conducting system work?
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
What is the parasympathetic innervation of the heart?
Vagus nerve
Acts on SAN, AVN via muscarinic cholinergic receptors
Negative chronotropic and dromotropic effect
141
What is the sympathetic innervation of the heart?
Acts on SAN, AVN and myocytes
Via b1 adrenal receptors
Positive chronotropic and dromotropic effect
Positive inotropic effect
142
What happens during ventricular systole?
Isovolumetric contraction
Ejection phase
143
What happens in ventricular diastole?
Isovolumetric relaxation
Passive filling
Active filling (atrial systole)
144
What are the 5 stages of the cardiac cycle?
Atrial systole
Isovolumetric ventricular contraction
Ejection
Isovolumetric ventricular relaxation
Passive ventricular filling
145
What is the P wave?
Atrial depolarisation
146
What is the QRS wave?
Ventricular depolarisation
147
What is the T wave?
Ventricular repolarisation
148
When is coronary blood flow greatest?
During ventricular diastole
As coronary arteries are compressed during systole
149
When is coronary blood flow greatest?
During ventricular diastole
150
What decreases coronary blood flow?
Increased heart rate
Low aortic diastolic blood pressure
151
How is Mean arterial blood pressure (BP) measured?
BP= CO x TPR
CO: Cardiac Output
TPR: Total peripheral resistance
152
What is the measurement for cardiac output?
CO= Stroke volume x heart rate
153
What does stroke volume depend on?
Venous return
Heart rate
Ventricular contractability
After load (TPR)
154
What is the heart rate dependent on?
SAN
155
What contributes to the hearts push forces?
Momentum: from systole
Muscle pump
156
What contributes to the hearts push forces?
Momentum: from systole
Muscle pump
157
What contributes to the hearts pull forces?
Thoracic pump (negative intrathoracic pressure)
158
What is preload?
The tension in the heart wall as a result of filling
Determined by end-diastolic volume
159
What is Starling’s Law of the heart?
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
What is the after load?
The force that the heart must develop to pump blood against the arterial blood pressure and peripheral resistance
161
What type of patients have increased after load?
Hypertension
162
What is the blood pressure of blood in the capillaries of the lungs?
8mmHg
163
What is the blood pressure of blood in the veins from lungs to left atrium?
0-4mmHg
164
What is the blood pressure of blood in arteries from the left ventricle to the body?
120/80mmHg
165
What is the blood pressure of blood in the bodies capillaries?
15-35mmHg
166
What is the blood pressure of blood in the veins from the body to the right atrium?
0-5mmHg
167
What is the pressure of blood in arteries from the right ventricle to the lungs?
25/12mmHg
168
What arteries can be used to measure pulse?
External carotid artery
Facial artery
Superficial temporal artery
Radial artery
169
What vein can be used to measure pulse?
Jugular venous pulse
170
What formula can be used to measure blood flow?
Poiseuille’s Law
171
What can affect arterial radius?
Local factors: O2, CO2, pH, temperature, vasoactive agents
Sympathetic nerves: alpha and beta receptors
Hormones: adrenaline, ADH, Angiotensin II
172
What is hypovolaemia?
State of abnormally low extracellular fluid
173
What are the two most commonly used cannulation sites?
Cubital fossa
Dorsum of hand
174
What are the advantages of using the dorsum of the hand as a cannulation site?
Access
No nearby arteries
No nearby nerves
No joints
175
What are the disadvantages of the dorsum of the hand as a cannulation site?
Small veins
Susceptible to cold/anxiety
Mobile veins
More painful
176
What vasculature is found in the cubital fossa?
Cephalic vein
Median cephalic vein
Brachial artery
Median basilic vein
Basilic vein
177
What vasculature is found in the cubital fossa?
Cephalic vein
Median cephalic vein
Brachial artery
Median basilic vein
Basilic vein
178
What are the advantages of the cubital fossa as a cannulation site?
Larger veins are more predictably sited
Better suited to underlying connective tissue
Less painful
Less vasoconstriction
179
Which veins are mainly used when cannulating the cubital fossa?
Cephalic vein
Basilic vein
Median cubital vein
Cannulate lateral to biceps tendon
180
What are the disadvantages of the cubital fossa as a cannulation site?
Access
Potential nerve damage
Potential intra arterial injection
Joint immobilisation
181
What are the three main points of conscious sedation?
Remains conscious
Retains protective reflexes
Understands and responds to verbal commands
182
What percentage of children report moderate dental anxiety?
30%
183
What percentage of adults report severe dental anxiety?
11%
184
What percentage of adults report moderate dental anxiety?
36%
185
What is cognitive behavioural therapy?
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
What is cognitive therapy based on?
The idea that our thoughts, feelings and behaviours are all linked
187
What is dental anxiety?
Type of fear.
Occurs without a present triggering stimulus
Emotional response to an unknown danger or percieved threat
188
What is a phobia?
A clinical mental disorder
Overwhelming and debilitating fear of an object, place, situation or animal
Interferes with daily life
189
What is dental fear?
An intense biological response to immediate danger which is specific
Encourages caution and safety
190
What is the aetiology of dental anxiety?
Direct experiences
Your obersvations
What you are told
Your personality
Your genes
191
What are the four triggers of dental anxiety?
Fearful of specific stimuli: sight/sound/smell/setting
Fearful of medical catastrophe
Generalised dental anxiety: general worry
Mistrustful of dental personnel
192
What is trauma?
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
What are the two types of trauma?
Single incident trauma
Complex trauma
194
How may a fearful patient present?
Anxious
Cancellations
Frozen
Crying
Shaking
Angry
Judged
Shamed
Embarrassed
FTA
195
What is the impact of dental fear and anxiety on dentists?
Stress for GDP
Time consuming- 20 minutes more chair time
More extensive treatment required due to neglect
Failed appointments
196
What is the assessment used for adult patients with dental fear and anxiety?
Modified Dental Anxiety Scale (MDAS)
197
What is the Modified Dental Anxiety Scale?
A structured, validated, self-report anxiety questionnaire
16 years and over
Score of 5-15
>19 suggests severe dental anxiety/phobia
198
What is the assessment used for child patients with dental fear and anxiety?
Modified child dental anxiety scale-faces version (MCDASf)
199
What is the modified child dental anxiety scale-faces version?
A structured, validated, self-report anxiety questionnaire
Validated for use 8-15 years
Score 9-45
>27 severe dental fear and anxiety/phobia
200
What can a patient gain from CBT?
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
What is the emotional component of anxiety?
Anxious
Scared
Shame
Guilt
Angry
202
What is the physiological component of anxiety?
Increased heart rate
Dry mouth
Increased perspiration
Butterflies in stomach
Flushed face
Increased muscle tension
203
What is the cognitive component of anxiety?
Expectation of failure
Catastrophising
Fortune telling
Magnifying and minimising
204
What is the behavioural component of anxiety?
Avoidance
Disruptive behaviour (esp in children)
Increased muscle tension
Safety behaviours
205
What is the cycle of fear and avoidance?
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
What is the model for breaking the emotional cycle?
Breathing control
Relaxation
This will pass
Stepping back
Grounding
Stop
207
What is the physical response to anxiety?
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
How can you break the cycle of physical anxiety reactions?
Controlled breathing
Progressive muscle relaxation
209
What are the three steps to breaking the cycle in regard to thoughts?
Catching the thoughts
Challenging the thoughts
Find alternative thoughts
210
How can you break the cycle in regard to behaviours?
Face your fears
Exposure
211
What is a fear hierarchy?
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
What are the four factors of graded exposure?
Graded
Prolonged
Repeated
No distraction
213
How can you make a practice dementia friendly?
214
What does dentally fit mean?
Stable oral health
Free from disease or potential future disease
215
What are the main challenges faced by autistic patients in their day to day life?
Difficulty with communications and language
Difficulty forming relationships
Limited pattern of behaviour and resistance to small changes in familiar surroundings
216
What are the main challenges faced by autistic patients in the dental environment?
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
What is the MDT associated with autistic patients?
Paediatrician
Dietician
Educational Psychologist
Psychiatrist
GP
Occupational Therapist
Social Worker
Health Visitor
Speech and Language Therapist
218
What dental problems are associated with autism?
NCTSL
Caries
Trauma/Self-injurious behaviours
Xerostomia (from medication)
219
What can be done in preparation for an appointment for a child with autism?
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
What can be done during an appointment for a child with autism?
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
222
What are examples of legislation associated with protecting dementia patients?
Human Rights Act 2000
Disability Discrimination Act 2005
Equality Act 2010
Adults with Incapacity (Scotland) Act
Mental Capacity (England and Wales) Act
223
Who is involved in the MDT for dementia patients?
GP
Dentist
Consultant Neurologist
Dementia Nurse
MacMillan Nurse (late stage)
Physiotherapy
Carers
224
What is a welfare guardian?
Has responsibility over an individual’s health and financial status
Must be applied for
225
What does a power of attorney have power over?
Wellbeing
226
What does a continuing power of attorney have power over?
Finance
227
What can be done to a Parkinson’s patients dentures?
Initials carved in
Stored in labelled container
228
What is the Mental Health Act (Scotland) 2003 concerned with?
Management and treatment of psychiatric disorders
Can detain patient in the community: leave of absence
229
How long is an emergency detention?
72 hours
230
How long is a short term detention?
28 days
231
How long is a compulsory treatment order?
6 months
232
Who carries out a removal to place of safety?
Police
233
Who carries out a detention for assessment?
Doctor
234
How long is a detention for assessment?
2 hours
235
When is the Mental Health Act (Scotland) 2003 applied?
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
What are the principles of adult with incapacity act?
Benefit
Least restrictive option
Takes account wishes of patient
Consultation of relevant others
Encourages residual capacity
237
What is the three-point test?
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
What are the timescales for AWI?
Acknowledgement- 1 day
Duty to enquire- 5 days
Investigation complete- 20 days
Case conference- 20 days
Protection plan - 10 days
239
What are the timescales for AWI?
Acknowledgement- 1 day
Duty to enquire- 5 days
Investigation complete- 20 days
Case conference- 20 days
Protection plan - 10 days
240
What methods can be used to transfer a patient to the dental chair?
Hoist
Banana board
Reclining wheelchair
Turn table
Wheelchair recliner
Stand aid
241
What are the benefits of hoist?
Can be used for non weight bearing individuals
Allows transfer to dental chair
Overall safe
242
What are the disadvantages of hoists?
Additional training required
Additional equipment required
243
What are the benefits of a banana board?
Self transfer
244
What are the disadvantages of a banana board?
Requires leg break chair
245
What are the benefits of a reclining wheelchair?
No transfer needed
246
What are the disadvantages of a reclining wheelchair?
Difficult access
Expensive
247
What are the advantages of a turn table?
Promotes patient involvement
248
What are the disadvantages of a turn table?
Additional equipment
249
What are the disadvantages of a turn table?
Additional equipment
250
What are the advantages of a wheelchair recliner?
No need to transfer
No cost
251
What are the disadvantages of a wheelchair recliner?
Difficult transfer
252
What are the advantages of a stand aid?
Patient involvement
253
What are the disadvantages of a stand aid?
Must be able to weight bear
254
What are the stages of general anaesthetic?
Induction
Excitement
Surgical anaesthesia
Respiratory paralysis/ OD
255
What are the indications for general anaesthetic?
Pre-cooperative / anxious
Child required to be still
256
What are the contraindications for general anaesthetic?
Risk of death
Coma
Future anxiety
