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BDS 3 BAMS > Special Care > Flashcards

Special Care Flashcards

1
Q

describe impairment

A

any loss or abnormality in an anatomical, physiological and psychological structure or function, abnormality in body part or function

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2
Q

describe disability

A

the inability or lack (due to an impairment) to carry out an activity that would be considered normal for a human being, concerned with the performance of activities

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3
Q

describe handicap

A

concerned with the societal impact and consequence of living with an impairment or disability, unable to fulfill a role (due to an impairment or disability) that would be normal for that individual

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4
Q

what types of disability are there

A 
sensory - sight and hearing loss
physical - spina bifida, arthritis
intellectual - downs syndrome, autistic spectrum disorder
mental - alzheimer's, dementia
emotional - eating disorder, depression
social - alcohol misuse, drug misuse
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5
Q

what legislation aims to protect disabled people

A

disability discrimination act 2004 - end discrimination against disabled, allow them to access services, purchase goods, purchase housing, renting

equality act 2010 - bring together legislation, equality for all, further protect disabled, ensure organisations implement protocols to remove barriers, to ensure disabled people have same access than those without a disability

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6
Q

what can dental practices implement to remove barriers to those with a disability

A

provide ground floor access
provide a ramp for wheelchair access
provide a handrail
ensure corridors and door frames are wide for wheelchair access
provide signposting for those with a sensory impairment - braille or hearing loop sign
designated parking close to premises
area for turning wheelchair

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7
Q

what can we do to help those with a sensory impairment

A 
identify yourself
speak using names
let them know if anyone leaves the surgery
let them know what we do before we do it
listen to their needs and wishes
respect them
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8
Q

what is the triage of legislation

A

adults with incapacity scotland 2000
mental health act 2003
human rights act 1998

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9
Q

what is the three point test in adult support and protection

A

an adult must pass the 3 points
unable to safeguard their own wellbeing
at risk of harm
have a co-exisiting disability or mental illness that makes them more vulnerable

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10
Q

name 4 types of inherited blood disorders

A

haemophilia a - factor VIII deficiency
haemophilia b - factor IX deficiency
von willebrand disease - factor VIII and platelet dysfunction
haemophilia c - factor XI deficiency

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11
Q

what is platelet dysfunction

A

lack of platelet aggregation, unable to stick together to form initial clot in coagulation cascade - alters the rest of coagulation

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12
Q

what is thrombocytopenia

A

lack of platelet’s in circulating blood, due to lack of synthesis from liver

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13
Q

what does apixaban inhibit

A

factor Xa

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14
Q

what does warfarin inhibit

A

vitamin K dependant clotting factors - 2, 7, 9 and 10

and protein C and S

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15
Q

what is the use of aspirin and clopidogrel

A

anti-platelets, reduce clotting

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16
Q

what blood tests would be useful if a patient was on anti-coagulants or haemophiliac

A

full blood count - RBC’s, platelets
PTT - prothrombin time, measures extrinsic pathway and medication, altering time to clot
APTT - activated partial thromboplasin time, measures intrinsic pathway, factors VIII, IX, XI, XII - useful for haemophiliacs
Time taken to clot
INR - ratio of PTT in patient, compared with normal level

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17
Q

what must the INR be in the range of to allow us to treat patient’s

A

must be lower than 4, 1.5-2.5 is safest

must be carried out 24 hours -72 hours before treatment, 72 only if patient is stable

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18
Q

what local anaesthetic should be used if patient has liver problems

A

articaine - only 5-10% metabolised in liver, the rest metabolised in plasma

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19
Q

what type of injection should a haemophiliac or liver patient receive

A

infiltration - except lingual infiltration
intraligamentary
block should be avoided - if absolutely necessary, should be delivered slowly, with aspirating, if high risk patient - should be at special care
vasoconstrictor should be used, and a short 27 gauge needle

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20
Q

what measures can be taken to achieve homeostasis

A

use an atraumatic technique
apply pressure for 20 minutes on site, using gauze and patient biting on area - dampen gauze so not to pull out clot when removing
pack in homeostatic dressing into socket - oxidised cellulose (surgicel)
suture the wound to aid homeostasis

avoid ibruprofen, NSAID higher chance of bleeding - paracetamol better

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21
Q

if patient on apixaban and simple extraction of 1 tooth is this a high risk procedure

A

no

22
Q

if patient on apixaban twice a day and high risk of bleeding, what would be suggested

A

patient should miss dose in the morning, receive treatment early in the week and early in the day, then take evening dose as normal

23
Q

what should the level of platelets be above

A

50x10^9

24
Q

what score determines if patients require a liver transplant

A

UKELD score - takes into account INR, creatinine etc, a score higher than 49 suggests the patient requires a liver transplant or higher than 9% chance they’ll die in 1 year

25
Q

what is the difference between MRONJ and ORN

A

MRONJ is caused by medication, ORNJ is caused by radiotherapy

26
Q

what is mronj

A

medication related osteonecrosis of the jaw - patient taking biphosphonates for osteoporosis - stops osteoclast activity to prevent breakdown of bone. Has an affect on alveolar bone - bone cant heal - failure of healing due to medication related osteonecrosis

27
Q

what patients are at risk of developing MRONJ

A

if they have had it before, if they have been on bisphosphonates for longer than 5 years or if they are also on steroids

28
Q

what are risk factors for angular chelitis

A

poor oral hygiene, smoker, denture wearer - poor denture fit, reduced OVD, more folds, age - less collagen, more sagging

29
Q

how would you describe an oral ulcer

A

if it is well demarkacted, inflammed, trauma induced. healing - white, full breakage of epithelium

30
Q

what are some issues with an aging population

A

1 - not necessarily a healthy longer life, many co-morbidities, resulting in poly-pharmacy - xerostomia
2- keeping their dentition longer, not always good, more disease in older patient who can’t co-operate
3 - more patients with dementia, difficulty with capacity, co-operation and communication

31
Q

what were some of the main findings from the francis report

A

1 - tolerance of poor standard of care
lack of oral hygiene, means infection and cancer is not picked up and dentist is not alerted
2 - patients must be protected from avoidable harm
one of the main causes of aspiration pneumonia is oral bacteria - poor oral hygiene, higher bacterial load, higher risk of aspiration pneumonia
3 - protected from any deprivation of human rights
4 - patient safety and care should be at the centre of everyone working for the NHS
5 - need to enhance training, education and support

32
Q

what is the impact of poor oral health

A

pain - not free and comfortable
spread of infection - can be life threatening
nutrition - if not functional, difficult to eat
social interaction - difficulty talking, eating, foul smelling, appearance

33
Q

what is the aim of caring for smiles

A

provides a guide for oral health professionals to train care home staff to deliver a high standard of oral care for care home residents and older people

34
Q

what are the principles of capacity

A

must be able to act, make a decision, understand the decision, retain the memory of the decision and communicate the decision

35
Q

what is the underlying principles of Adults with Incapacity Act 2000

A

must benefit the patient
must be the least restrictive option
must take into account the wishes of the patient
must take into account the wishes of relevant others
must aid patient in exercising residual capacity

36
Q

who can consent for dental treatment

A

those with capacity
Welfare power of attorney
welfare guardians
medical and dental practitioners

37
Q

what is a section 47 form

A

filled out when patient doesnt have capacity, treatment plan is confirmed and signed by medical practitioner or dentist with specialist treatment

38
Q

what is dementia

A

progressive syndrome, affects cognitive behaviours such as memory, concentration, disorientation and intellectual impairment

39
Q

name 3 types of dementia

A

alzheirmer’s, dementia with lewy bodies, vascular dementia

40
Q

what are the early stage symptoms

A

short term memory loss, agitation, confusion, unable to make decisions

41
Q

what are the middle stage symptoms of dementia

A

needing reminders to wash, change and eat. increased forgetfullness, disorientated, may start wandering, inapropriate socially - going out in night clothes, aggression and mood changes

42
Q

what are the late stage symptoms of dementia

A

increased frailty, reduced eating and swallowing, might be unable to walk, forget people and objects

43
Q

how can health care setting;s be made dementia friendly

A

make walls and floors different colours, staff only doors blend in with walls, make reception desk visible from door

44
Q

what tests can be used for dementia

A

mini-mental state examination

blessed-dementia scale

45
Q

what are the risk factors for oral cancer

A

alcohol, smoking, age, gender

46
Q

what are the oral implications of radiotherapy to head and neck

A

inflammation of mucosa - mucositis, ulcers
reduced salivary flow - caries, xerostomia
osteoradionecrosis - necrosis of bone after extraction
trismus - reduced mouth opening

47
Q

what is the role of the dental team when someone is diagnosed with oral cancer

A

need to be dentally fit - remove any sources of potential infection. provide a soft splint for if/when teeth are sharp on inflammed mucosa, prevention of oral disease

48
Q

why can chlorhexidine be useful for patients with oral cancer

A

sore mouth with inflammation and ulcers - difficult to carry out oral hygiene, this can be used if unable to brush - in gel form

49
Q

what are side effects of chemotherapy

A

targets rapidly dividing cells - hair loss, ulceration on GI lining, including mouth. reduced white blood cells, red blood cells and platelets - pancytopenia

50
Q

what is downs syndrome and what medical defects may a person with DS have

A

an extra chromosome on chromosome 21. congenital heart defects, epilepsy, hearing and intellectual impairment.

51
Q

what is the link between DS and periodontal disease

A

immune system up-regulates inflammatory mediators - MMP, higher response and more inflammation. Also reduced neutrophil chemotaxis - less able to deal with inflammation. Patient might also have higher plaque levels due to poor dexterity and reduced OH. Diet might also be high in cariogenic sugar

BDS 3 BAMS (2 decks)

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