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4th Year Revision > Special Care > Flashcards

Special Care Flashcards

1
Q

What is the equality act 2010’s definition of disability?

A

A person has a disability if they have a physical or mental impairment and the impairment has a substantial effect on their ability to perform normal day to day activities

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2
Q

What are the oral features of dentinogenesis imperfecta? (4)

A
  • teeth are weaker
  • bulbous crowns
  • reduced root length
  • obliteration of pulp chamber
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3
Q

What are the symptoms of hunting tons? (4)

A
  • general lack of coordination and unsteady gait
  • movements become worse
  • chorea writhing movements
  • problems swallowing, speaking and breathing
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4
Q

What are the symptoms of spina bifida?

A
  • weakness or total paralysis of legs
  • bowel and urinary incontinence
  • loss of skin sensation
  • hydrocephalus
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5
Q

What are the symptoms of cerebral palsy? (4)

A
  • muscle stiffness or floppiness
  • muscle weakness
  • random and uncontrolled movements
  • balance and coordination problems
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6
Q

What are the symptoms of motor neurone disease? (3)

A
  • causes muscular atrophy, weakness and spasticity
  • no sensory loss
  • dysphagia and drooling occur
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7
Q

What is parkinsons disease due to?

A

Degeneration of the pigmented cells of the substantial nigra leading to dopamine deficiency

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8
Q

What are the symptoms of parkinsons disease? (4)

A
  • tremor in arms and hands
  • rigidity on movement
  • slow movements and restlessness
  • expressionless face and stooped posture
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9
Q

What are the issues of dental treatment in parkinsons? (4)

A
  • tremor when using handpicks
  • ability to cooperate for treatment
  • difficulty communicating
  • hyper salivation
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10
Q

What is multiple sclerosis?

A

Chronic relapsing CNS disease affecting the portico spinal tract. It affects the myelin sheaths

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11
Q

What are the symptoms of multiple sclerosis?

A
  • blindness or visual disturbance
  • weakness or paralysis of limbs
  • ataxia
  • dysphagia
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12
Q

What are the 2 types of spinal cord injury?

A

Tetraplegic- damage to spinal cord in neck. Affects all 4 limbs and torso
Paraplegic- damage to mid/lower part of back. Affects legs and lower body

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13
Q

What is the most common cause of down syndrome?

A

Trisomy 21

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14
Q

What are the physical features of down syndrome? (4)

A
  • short stature
  • widely spaced upward slanting eyes
  • weight gain
  • brush field spots
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15
Q

What are the oral features of down syndrome? (4)

A
  • large tongue
  • cleft lip and cleft palate
  • malocclusion
  • missing teeth
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16
Q

Why is the dental management of fragile X syndrome difficult? (3)

A
  • short attention span
  • hyperactivity
  • behavioural disorders similar to autism
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17
Q

What are the features of cri du chat syndrome? (4)

A
  • high pitched cry
  • microcephaly
  • micrognathia
  • wide set eyes
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18
Q

What are the characteristics of autism spectrum disorder? (4)

A
  • poor social skills
  • lack of interpersonal relationships
  • delayed speech and language
  • ritualistic compulsive behaviour
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19
Q

What are the features of aspergers syndrome? (3)

A
  • repetitive behaviour
  • severe social problems
  • clumsy movements
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20
Q

What are the symptoms of autism? (4)

A
  • obsessional desire to follow routine
  • self mutilation
  • sensitivity to touch, smell and sound
  • avoid eye contact
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21
Q

What are the oral findings in autistic patients? (4)

A
  • bruxism
  • traumatic lesions
  • poor oral hygiene
  • poor attendance
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22
Q

What is the dental management of autistic patients? (4)

A
  • patient is not kept waiting
  • short quiet visit with the same staff
  • avid aspirator high speed etc
  • have a parent or carer present
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23
Q

What are the causes of visual impairment? (6)

A
  • glaucoma
  • cataract
  • macular degeneration
  • diabetic retinopathy
  • trachoma
  • dry eye syndrome
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24
Q

What are the symptoms of a visual impairment? (4)

A
  • reduction or loss of vision
  • eye pain
  • burning sensation
  • gritty feeling
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25
Q

What is the result of wet macular degeneration? (3)

A
  • causes severe sight loss in a matter of months
  • growth of nerve vessels under retina which then break and leak into the macula
  • rapid loss of central vision
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26
Q

What are the predisposing factors of dry macular degeneration? (2)

A
  • hereditary element

- myopia

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27
Q

What is dry macular degeneration? (2)

A
  • gradual loss of central vision

- person becomes unable to recognise people because they cannot see their faces clearly

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28
Q

What are the causes of retinopathies? (3)

A
  • diabetes
  • hypertension
  • renal disease
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29
Q

What is the treatment and prevention of sensory impairment? (5)

A
  • regular eye exams
  • protect eyes from sun
  • know family history
  • seek treatment quickly
  • stop smoking
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30
Q

What is hemianopia caused by?

A

Stroke

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31
Q

What are the common causes of a hearing impairment?

A
  • build up of cerumen
  • medications and the use of ototoxic drugs
  • osteosclerosis and bony overgrowth of stapes
  • perforated ear drums
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32
Q

What are the symptoms of a hearing impairment? (4)

A
  • inactivity
  • reduced development of speech and language
  • deterioration of speech
  • instability
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33
Q

What are the clues to a hearing impairment? (4)

A
  • unawareness of surroundings
  • failure to respond to sound
  • asking for sentences to be repeated
  • spending time alone
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34
Q

What is the treatment and prevention of hearing impairments? (4)

A
  • immunisation
  • avoidance of some drugs
  • reducing occupational exposure
  • hearing aids
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35
Q

What can you do to help people with sensory impairments? (4)

A
  • speak clearly but not too slowly and do not exaggerate lip movements
  • use natural facial expressions and gestures
  • use plain language
  • be patient and take your time
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36
Q

What is dementia?

A

A collection of symptoms that include a decline in memory, reasoning and communication skills. It is the graded loss of skills needed to carry out daily activities

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37
Q

What is found in alzheimers disease? (4)

A
  • amyloid plaques (around brain cells)
  • tangles tau protein (tangled within brain cells)
  • loss of connections between neurones
  • decrease in acetylcholine
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38
Q

What is the percentage of dementia cases in:

a) alzheimers
b) vascular
c) mixed
d) lewy body

A

a) 62%
b) 17%
c) 10%
d) 4%

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39
Q

What is vascular dementia caused by?

A

Furring up of the small blood vessels in the brain

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40
Q

What is lewy body dementia?

A

Abnormal deposits of protein in nerve cells that depend on which part of the brain is affected

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41
Q

What is lewy body dementia associated with?

A

Parkinsons disease

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42
Q

Who does front temporal dementia affect?

A

People slightly younger

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43
Q

What are the symptoms of front temporal dementia? (5)

A
  • personality change
  • short temperedness
  • agression
  • mood swings
  • sexually inappropriate behaviour
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44
Q

What are the medical risk factors for dementia? (4)

A
  • type II diabetes
  • hypertension
  • obesity
  • depression
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45
Q

What lifestyle factors can cause dementia? (4)

A
  • physical inactivity
  • smoking
  • unhealthy diet
  • excessive alcohol
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46
Q

How do you reduce the risk factors for dementia? (4)

A
  • keep mentally active
  • keep physically active
  • eat healthily
  • reduce alcohol consumption
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47
Q

What is the treatment for dementia? (4)

A
  • counselling may delay residential care by up to 1 year
  • reducing cardiac risks may halt deterioration of vascular type dementias
  • NSAIDS may slow progression
  • vitamin E
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48
Q

What is the drug treatment for alzheimers? (4)

A
  • donepezil
  • glantamine
  • rivastigmine
  • memantine
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49
Q

What is capacity? (5)

A
  • to understand broadly what the treatment is its purpose and nature and why it is being proposed
  • to understand its main benefits, risks and alternative to be able to make a choice
  • to understand what the consequences of not having the treatment will be
  • to retain the information given long enough to weight it up and make a decision
  • to communicate that decision
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50
Q

What things are needed for consent to be given? (5)

A
  • pt must be informed
  • consent must be given freely
  • consent has to be given by a pt that has capacity
  • ability to make decision
  • pt has to be able to act on the basis of the information
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51
Q

What is the procedure for having a power of attorney? (3)

A
  • similar procedure to making a will
  • certified by a lawyer or medical practitioner
  • registered with the public guardian
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52
Q

A person is incapable when they cannot what? (5)

A
  • act
  • make a decision
  • communicate decision
  • understand a decision
  • retain the memory of a decision
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53
Q

Who do you contact if concerned about financial powers?

A

Office of public guardian

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54
Q

Who do you talk to if you need advice about an adult at risk of harm?

A

Mental welfare commission

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55
Q

What are the principles of adult safeguarding? (6)

A
  • empowerment
  • prevention
  • proportionality
  • protection
  • partnership
  • accountability
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56
Q

What can occur to a patient after head and neck surgery? (5)

A
  • altered anatomy
  • altered appearance
  • difficult access for OH
  • trismus
  • fistula
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57
Q

What does hyperbaric oxygen do and what are the disadvantages of it?

A

Used for ORN and increases oxygen to damaged bone. Promotes healing
The disadvantages are cost and compliance

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58
Q

How does chemotherapy work? (4)

A
  • uses drugs to kill rapidly dividing cells
  • interferes with mitosis
  • interferes with apoptosis
  • interferes with tumour cell DNA
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59
Q

What are the oral side effects of chemotherapy? (4)

A
  • mucositis
  • infection
  • bleeding
  • temporary xerostomia
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60
Q

What is the management of mucositis? (4)

A
  • soft splints
  • caphosol
  • low level laser therapy
  • HPT before chemo starts
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61
Q

What are the causes of congenital cardiac conditions? (2)

A
  • environmental

- genetic

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62
Q

What are the types of congenital cardiac conditions? (2)

A
  • tetralogy of fallot (cyanotic)

- ventricular septal defect (acyanotic)

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63
Q

What are the oral findings of congenital cardiac conditions? (4)

A
  • delayed eruption of both dentitions
  • increased positional abnormalities
  • enamel hypoplasia
  • vasodilation of pulp
  • increased periodontal disease
  • increased caries
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64
Q

What are the dental considerations for congenital cardiac conditions? (4)

A
  • bleeding tendency
  • anti coagulated
  • risk of infective endocarditis
  • hypertension with adrenaline containing products
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65
Q

What is ischaemic heart disease?

A

The result of progressive myocardial ischaemia due to persistently reduced coronary blood flow

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66
Q

What are the causes of ischaemic heart disease? (2)

A
  • atherosclerosis

- hypertension

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67
Q

What can be linked to atherosclerosis? (3)

A
  • smoking
  • lack of exercise
  • obesity
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68
Q

What are the causes of ischaemic heart disease? (2)

A
  • angina

- myocardial infarction

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69
Q

What are the oral findings of angina? (4)

A
  • rare cause of pain in mandible
  • more severe caries
  • more severe periodontal disease
  • drugs may cause lichenoid reaction, gingival swelling, angioedema and ulcers
70
Q

What is hypertension?

A

BP consistently over 140/90mmHg

71
Q

What are the causes of hypertension? (2)

A
  • renal disease

- endocrine conditions

72
Q

What is the treatment of hypertension? (5)

A
  • lifestyle changes
  • diuretics
  • b blockers
  • statins
  • aspirin/clopidogrel
73
Q

What are the side effects of hypertension medications that can impact upon oral health? (7)

A
  • xerostomia
  • salivary gland swelling
  • lichenoid reactions
  • angio oedema
  • gingival hyperplasia
  • sore mouth
  • paraesthesia
74
Q

What is cardiomyopathy?

A

A group of conditions that affect the structure of the heart muscle and its ability to pump blood around the body

75
Q

What are the causes of cardiomyopathy? (4)

A
  • genetic
  • viral infections
  • autoimmune
  • medications
76
Q

What is the treatment of cardiomyopathy? (4)

A
  • b blockers anticoagulants and diuretics
  • pacemakers
  • surgery
  • transplant
77
Q

What are the oral findings of chronic kidney disease? (4)

A
  • osseous lesions
  • dry mouth
  • metallic taste
  • halitosis
78
Q

What is the dental management for chronic kidney disease? (4)

A
  • bleeding tendency
  • infections are poorly controlled
  • antibiotic prophylaxis
  • impaired drug excretion
79
Q

What is the dental treatment for patients with renal dialysis? (4)

A
  • for extractions FBC and coagulation screen
  • best time for treatment is day after ahem dialysis
  • safest treatment is LA
  • avoid aspirin and other NSAIDS
80
Q

What is the dental impact of a renal transplant? (4)

A
  • lifelong immunosuppression
  • gingival hyperplasia
  • increased risk of oral tumours
  • candidiasis and herpes simplex
81
Q

What is the dental impact for a pt with asthma? (5)

A
  • inhalers may cause candida infection
  • dry mouth
  • anti asthmatic drugs may lower salivary pH
  • periodontal infiammato is greater in asthmatics
  • avoid aspirin and ibuprofen
82
Q

What are the dental aspects of COPD? (4)

A
  • reduce LA dose with adrenaline
  • avoid benzodiazepine and nitrous oxide
  • short appointments, upright position
  • may not tolerate rubber dam
83
Q

What is cystic fibrosis?

A

The build up of sticky mucous in lungs and digestive tract. Don’t absorb nutrients well and need to eat more calories to avoid nutrition

84
Q

What is the dental treatment on patients with platelet disorders? (5)

A
  • liase with haematology
  • FBC prior to procedure
  • tranexamic acid
  • steroids
  • platelet transfusion
85
Q

What does tranexamic acid do?

A

Used to treat or prevent excessive blood loss.

Antifibrinolytic action

86
Q

What is the treatment for von willebrands disease?

A
  • tranexamic acid

- desmopressin to raise vwf

87
Q

What is the dental treatment for haemophilia? (6)

A
  • contact haematology
  • cons can be carried out in practice but avoid IDB
  • extractions need to be carried out with haematology
  • factor cover
  • surgicel
  • sutures
88
Q

What type of drugs affect bleeding? (3)

A

Anti platelet drugs- aspirin and clopidogrel
Anticoagulants- warfarin and heparin
Newer anticoagulants- dabigatran, apixaban, rivaroxaban

89
Q

What are the dental aspect of myeloma? (6)

A
  • root resorption
  • loose teeth
  • mental anaesthesia
  • pathological fracture
  • anaemia
  • infection
90
Q

What are the dental aspects of leukaemia? (7)

A
  • crowding out of normal blood cells by leukaemic cells
  • anaemia
  • bleeding tendencies
  • susceptibility to infections
  • septicaemia from oral infections
  • mucosal pallor
  • ulceration
91
Q

What are the types of anxiety disorders? (6)

A
  • phobic anxiety disorders
  • panic disorders
  • generalised anxiety disorders
  • post traumatic stress disorder
  • adjustment disorders
  • hypochondriac disorders
92
Q

What are the three types of phobias?

A
  • specific phobia
  • social phobia
  • agoraphobia
93
Q

What is agoraphobia?

A

A well defined cluster of phobias that involve being away from perceived safety

94
Q

What are the stages of behavioural models of phobias and anxiety? (2)

A
  • classic conditioning

- operant conditioning

95
Q

What are the trigger zones for anxiety and gagging? (5)

A
  • palatoglossal and palatopharyngeal folds
  • base of tongue
  • palate
  • uvula
  • posterior pharyngeal wall
96
Q

What is the applied tension method for needle phobia?

A

Muscles in arms, legs and torso tensed but not relaxed for 10-15 seconds at a time. Helps to prevent a drop in blood pressure

97
Q

Why is sedation safe? (3)

A
  • pt is conscious and communication is maintained
  • pt spontaneously maintains own airway
  • cardio respiratory function is normal and there is minimal depression of the CVS/RS
98
Q

What are the clinical effects of benzodiazepines? (5)

A
  • anxiolysis
  • anticonvulsant
  • sedation
  • amnesia
  • muscle relaxation
99
Q

How does the patient recover from sedation? (2)

A
  • redistribution of the drug from the CNS into body fat

- uptake and metabolism of the drug by the liver and elimination by the kidneys

100
Q

What is the mode of action of GABA? (3)

A
  • activation of the benzodiazepine receptors enhances the flow of chloride ions
  • chloride ions enter the cell making the resting membrane potential more negative
  • this makes it even more difficult to fire an action potential so reducing polysynaptic transmission and depressing the uptake of sensory information
101
Q

What is an advantage of midazolam and diazemuls?

A

Non irritant to veins

102
Q

Why are diazemuls not well suited to short dental procedures?

A

Due to there long recovery period and possibility of rebound sedation

103
Q

What are the advantages of midazolam? (4)

A
  • faster acting
  • 2 and a half times more potent than diazepam
  • produces more predictable amnesia
  • once in the bloodstream it becomes lipid soluble at physiological pH. Can then readily penetrate the blood brain barrier
104
Q

What are the disadvantages of midazolam? (4)

A
  • no analgesia
  • for a short time after infection laryngeal reflexes may be dulled
  • too rapid injection can cause respiratory depression and apnoea
  • possibility of disinhibition
105
Q

What are the side effects of benzodiazepines? (4)

A
  • respiratory depression
  • cardiovascular effects
  • drug interactions
  • hallucinations
106
Q

What are the effects of ageing on sedation? (4)

A
  • altered drug distribution
  • altered hepatic metabolism
  • altered renal excretion
  • less drug is needed and slow titration
107
Q

What are the advantages of propofol? (3)

A
  • rapid onset of action
  • rapid clearance
  • distribution and metabolism
108
Q

What are the problems with propofol? (4)

A
  • pain on injection
  • expensive
  • narrow margin of safety between conscious sedation, deep sedation and anaesthesia
  • not licensed for dentists to use
109
Q

What is in ametop gel?

A

4% amethoaine in a 1.5g tube

110
Q

What is the calculation for BMI?

A

Weight/height squared

111
Q

What is oxygen saturation?

A

The percentage of haemoglobin which is bound to oxygen

112
Q

What are the contraindications for IV sedation? (6)

A
  • allergy to benzodiazepines
  • pregnancy
  • age under 12 years
  • alcohol/ drug dependency
  • psychiatric illness
  • liver or kidney disease
113
Q

What are the limitations of conscious sedation? (4)

A
  • individual response
  • extreme anxiety
  • hysterics
  • resistance to drugs
114
Q

What are the instructions for sedation? (6)

A
  • written pre and post sedation instructions
  • need for responsible adult escort
  • transport by private car or taxi
  • starve 4 hours before appointment
  • take normal medications
  • no driving, operating machinery, signing important documents, alcohol for 24 hours
115
Q

What is involved in the pre operative equipment check for IV sedation? (4)

A
  • oxygen cylinders full and tested
  • emergency drug box present and correct
  • monitoring equipment is working
  • dental equipment and suction is working
116
Q

What drugs do you use for IV sedation? (3)

A
  • midazolam 5ml ampoule
  • sterile saline in 2ml syringe
  • flumazenil 5ml ampoule
117
Q

How do you prepare a patient for IV sedation? (4)

A
  • tourquinet/nurse squeeze to occlude venous return
  • select a suitable vein
  • straight thick vein
  • encourage vein to fill
118
Q

What makes a good vein for IV cannulation? (6)

A
  • visible
  • palpable
  • long
  • straight
  • wide
  • no infection in area
119
Q

How do you do IV cannulation? (5)

A
  • swab with 2% chlorohexidine in 70% alcohol and dry for 30 seconds
  • hold the hand firmly and stretch the skin
  • cannula 22G
  • bevel up the way, 10-15 degree angle pierce the skin
  • primary flashback, secondary flashback
120
Q

What are the problems with cannulation? (4)

A
  • difficulty locating
  • veins collapse
  • veins tissue
  • cannula kinks
121
Q

How do you administer midazolam?

A
  • inject slowly
  • pt should be warned of a cold sensation as the drug tracks up the arm
  • start with 1mg and wait 60 seconds
  • stop immediately if the patient complains of pain radiating down the forearm or towards the fingers as this indicated accidental entry into an artery
  • further increments of 1mg are then given every 60 seconds
  • gradually titrate until satisfactory end point
  • don’t give any more than 10mg
122
Q

What are the signs of a sedation end point? (4)

A
  • relaxed demeanour
  • slowed response to commands
  • slurring of speech
  • eves sign
123
Q

What will happen if the oxygen drops to below 90%?

A

Means inhibited respiratory or cardiovascular activity. Can result in cardiac arrest and brain damage

124
Q

If the oxygen saturation drops to below 90% and you have asked the patient to take a few deep breathes and the problem still persists what do you do?

A

Give 100% oxygen via nasal cannula at 2-4 litres/min

125
Q

What do you do if there is persistent oxygen saturation below 90% that is not corrected by breathing and giving oxygen? (3)

A
  • reverse sedation with flumazenil
  • bag and mask ventilation
  • summon help
126
Q

What is the definition of premedication?

A

Preliminary administration of a drug preceding a diagnostic, therapeutic or surgical procedure as an antibiotic or anti anxiety agent

127
Q

What are the long term side effects of benzodiazepines? (3)

A
  • tolerance
  • dependance
  • withdrawal symptoms
128
Q

Name 4 types of benzodiazepines

A
  • diazepam
  • temazepam
  • midazolam
  • flumazenil
129
Q

What are the drug interactions of diazepam? (3)

A

Antibacterials- isonzid inhibits metabolism. Rifampicin increases metabolism

Antivirals- ritonavir

Proton pump inhibitors- omeprazole

130
Q

What are the advantages of premedication? (4)

A
  • patient become relaxed enough to be able to attend the dental surgery
  • helps the patient to sleep the night before
  • helps nervousness and anxiety before undergoing an operation
  • produces some muscle relaxation and dryness of secretions post op
131
Q

What are the disadvantages of premedication? (3)

A
  • poor compliance
  • have to be careful with your prescribing e.g the young and elderly
  • tolerance, dependance and withdrawal symptoms
132
Q

What are the indications for premedication? (3)

A
  • very anxious patients
  • patients where sedation is contraindicated
  • to take the edge of before more complex and long procedures
133
Q

What are the contraindications for diazepam? (4)

A
  • hepatic impairment
  • renal impairment
  • pregnancy
  • breast feeding
134
Q

What are the cautions for diazepam? (4)

A
  • avoid prolonged use
  • reduce dose in debilitated patients
  • reduce dose in elderly
  • respiratory disease
135
Q

What is the definition of oral sedation?

A

Sedative drugs given produce a state of depression of the central nervous system enabling treatment to be carried out. Verbal contact with the patient is maintained

136
Q

What are the advantages of oral sedation? (4)

A
  • easy administration
  • avoids cannulation
  • decreased incidence and severity of adverse reactions
  • learning disabled patients
137
Q

What are the disadvantages of oral sedation? (4)

A
  • patient compliance
  • still need to cannulate
  • inability to titrate
  • prolonged latent period
138
Q

What are the indications for oral sedation? (4)

A
  • needle phobic patients
  • unsuitable for inhalation sedation
  • learning disabled patients
  • poor venous access
139
Q

What are the contraindications for oral sedation? (3)

A
  • very poor venous access
  • very poor cooperation
  • pt cannot follow pre and post sedation instructions
140
Q

What is the technique for oral sedation? (3)

A
  • assess patient to give consent prior to day of sedation
  • oral sedative given in a drink
  • need to cannulate for safety once sedated
141
Q

How much midazolam do you give for oral sedation?

A

20mg midazolam

142
Q

What should you be aware of when doing oral sedation? (5)

A
  • high individual variation in response to drugs
  • low doses needed in elderly and frail
  • high doses needed in children and adolescents
  • risk of resection
  • risk of overdose
143
Q

What is the definition for general anaesthesia?

A

A state of controlled consciousness

144
Q

What are the properties of nitrous oxide? (5)

A
  • not metabolised
  • quick uptake
  • tissue saturation to 90% of the inspired concentration in 5 mins
  • rapid recovery
  • 95% eliminated in 10 mins
145
Q

What are the physiological effects of IHS? (4)

A
  • oxygen saturation at normal or higher than normal level
  • blood pressure may drop from baseline
  • pulse rate may drop from baseline
  • respiratory rate may drop from baseline
146
Q

What are the advantages of inhalation sedation? (5)

A
  • less equipment than for general anaesthesia
  • no anaesthetist required
  • more relaxed patient than with LA alone
  • more work per visit
  • patient safety
147
Q

What are the disadvantages of inhalation sedation? (4)

A
  • proper equipment with fail safe
  • increased surgery time
  • second appropriate person required
  • scavenging required
148
Q

What is the clinical status of a sedated patient? (5)

A
  • maintains patent airway independently
  • verbal contact with operator
  • keeps mouth open independently
  • able to keep eyes open
  • able to swallow
149
Q

What drugs are classified as depressants? (5)

A
  • alcohol
  • solvents
  • heroin
  • morphine
  • benzodiazepines
150
Q

What drugs are classified as hallucinogenics? (3)

A
  • LSD
  • magic mushrooms
  • canabis
151
Q

What are the main statues relating to drugs in the UK? (2)

A
  • the medicines act 1968

- the misuse of drugs act 1971

152
Q

Name 5 class A drugs

A
  • heroin
  • cocaine
  • methamphetamine
  • ecstasy
  • methadone
153
Q

Name 3 class C drugs

A
  • benzodiazepines
  • ketamine
  • anabolic steroids
154
Q

What are the possible effects of opiates? (4)

A
  • initial euphoria
  • removal of tension
  • tranquility
  • sense of control
155
Q

What are the negative effects of opiates? (4)

A
  • itching
  • flushing
  • slurred speech
  • depression
156
Q

What are the problems associated with injections? (4)

A
  • blood borne viruses
  • collapsed veins
  • amputation
  • abscesses
157
Q

What is ffoulds classification of mental illnesses? (5)

A
  • organic
  • psychosis
  • neuroses
  • personality disorder
  • eating disorder
158
Q

What is the difference between neurosis and psychosis?

A

Neurosis is contact retained with reality whereas psychosis is contact lost with reality

159
Q

What disorders are classified as neurosis? (4)

A
  • anxiety
  • phobic
  • obsessional
  • depressive
160
Q

What disorders are classified as functional psychosis? (2)

A
  • bipolar

- schizophrenia

161
Q

What are the oral problems with eating disorders? (4)

A
  • ANUG common
  • poor aesthetics
  • poor attendance
  • poor perio conditions
162
Q

What is methadone also called?

A

Methadone hydrochloride

Trade name is dolophine

163
Q

What type of drug is methadone?

A

Synthetic opiate analgesic

164
Q

How is methadone provided?

A

As a white powder mixed with a green syrup

165
Q

How does methadone work? (4)

A
  • action on the CNS
  • absorbed from buccal mucosa and stomach
  • continuous occupancy of Mu opiod receptors
  • stabilises neurochemistry previously chaotic from highs and lows of heroin use
166
Q

What are the effects of methadone on teeth? (3)

A
  • high caries risk with 50% sugar
  • often methadone held in mouth to increase absorption from buccal mucosa
  • opiate analgesic therefore decreases salivary flow
167
Q

What are the oral findings of patients that use amphetamines? (3)

A
  • xerostomia therefore increased caries and perio disease
  • bruxism grinding therefore TMJD
  • attrition/erosion
168
Q

What are the oral findings of ecstasy? (4)

A
  • bruxism grinding therefore TMJD
  • occlusal wear on posterior teeth
  • xerostomia
  • mucosal burns
169
Q

What are the oral effects of cocaine? (4)

A
  • gingival and tongue erosions
  • ulceration of palate
  • cluster headaches may mimic atypical facial pain
  • bruxism and TMJD
170
Q

What are the oral effects of cannabis? (4)

A
  • decreased respiratory rate
  • impaired memory
  • soft tissue disease
  • increased heart rate following adrenaline in LA
171
Q

What dental advice can you give patients using methadone? (6)

A
  • drink methadone with a straw
  • try to take near a mealtime
  • swallow it immediately don’t hold in mouth
  • rinse with water afterwards
  • chew sugar free chewing gum to increase saliva
  • brush teeth before taking it

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