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Dentistry year 4: Module 7 > Special Care Dentistry > Flashcards

Special Care Dentistry Flashcards

Intro: 1-9 Learning disability: 10-33 Sensory Impairment: 34-51 Physical disability: 52-72 AWI (Adults with Incapacity): 73-90 Dementia: 91-157 Bleeding Disorders: 158-195 Blood Cancers: 196-235 MRONJ: 236-260 Adults At Risk: 261-291 Head and Neck Oncology Surgery: 292-313 Anxiety Management: 314-344 Cardiac: 345-369 Renal care: 370-385

1
Q

Special care dentistry applies to people who are unable to access routine dental care because of various factors, what are these factors?

A
  1. Physical disability
  2. Intellectual disability
  3. Medical disability
  4. Emotional disability
  5. Sensory, mental or social impairment
  6. Combination of the above factors
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2
Q

Before we treat a patient, we must consider the following (two things), what are they?

A
  1. Is it safe? – what do we know from the medical history
  2. Is it legal? – do we have valid consent
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3
Q

The Equality Act (2010) harmonises and replaces previous legislation (such as the Race Relations Act 1976 and the Disability Discrimination Act 1995). The Equality Act (2010) covers:

A
  1. Age
  2. Disability
  3. Gender reassignment
  4. Race
  5. Religion or belief
  6. Sex
  7. Sexual orientation
  8. Marriage and civil partnership
  9. Pregnancy and maternity
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4
Q

What is the adults with incapacity act?

A

The Adults with Incapacity (Scotland) Act 2000 is an Act of the Scottish Parliament. It was passed on 29 March 2000, receiving royal assent on 9 May. It concerns the welfare of adults who are unable to make decisions for themselves because they have a mental disorder or are not able to communicate.

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5
Q

When did England and Wales release their own mental capacity act?

A

2005

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6
Q

There shall be no intervention in the affairs of an adult unless the person responsible for authorising or effecting the intervention is satisfied that the intervention will benefit the adult and that such benefit cannot reasonably be achieved without the intervention.

This principle is taken from subsections 2 – 4 from which Act?

A

Adults with incapacity act – this principle states that whatever decision is made for the person who is incapable of acting, must benefit the person and not the person making the decision.

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7
Q

Where it is determined that an intervention as mentioned in subsection (1 The adults with incapacity act) is to be made, such intervention shall be the least restrictive option in relation to the freedom of the adult, consistent with the purpose of the intervention. What does the bold statement mean?

A

Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms. This is called finding the “least restrictive alternative”.

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8
Q

In determining if an intervention is to be made and, if so, what intervention is to be made, account shall be taken of (4 accounts) what are they?

A

(a) the present and past wishes and feelings of the adult so far as they can be ascertained by any means of communication, whether human or by mechanical aid (whether of an interpretative nature or otherwise) appropriate to the adult

(b) the views of the nearest relative [F1, named person] and the primary carer of the adult, in so far as it is reasonable and practicable to do so;

(c) the views of—
(i)any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention; and
(ii)any person whom the sheriff has directed to be consulted,
in so far as it is reasonable and practicable to do so; and

(d) the views of any other person appearing to the person responsible for authorising or effecting the intervention to have an interest in the welfare of the adult or in the proposed intervention, where these views have been made known to the person responsible, in so far as it is reasonable and practicable to do so.

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9
Q

For the purpose of this act (adults with incapacity act), and unless the context otherwise requires – “adult” means a person who has attained the age of 16 years; “incapable” means incapable of?

A
  1. Acting; or
  2. Making decisions; or
  3. Communicating decisions; or
  4. Understanding decisions; or
  5. Retaining the memory of decisions,
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10
Q

An IQ less than 70 indicates what?

A

Learning disability

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11
Q

The severity of learning disability can be broken down to three categories, mild, moderate, and severe. People with mild cases of learning disability can talk and look after themselves.

What are the associated features of learning disability?

A
  1. Epilepsy
  2. Hearing and speech disorders
  3. Visual defects
  4. Facial deformities
  5. Body-rocking and self-mutilation
  6. Feeding difficulties
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12
Q

What are the causes of learning disability?

A
  1. Genetic
  2. Problems during pregnancy
  3. Problems during birth
  4. Post-natal problems
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13
Q

What is the most frequent genetic cause of learning impairment?

A

Down syndrome

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14
Q

Which chromosome is responsible for down syndrome?

A

Extra chromosome 21. Researchers believe having an extra chromosome 21, disrupts the course of normal development.

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15
Q

Down syndrome is present in how many live births?

A

1 in 800

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16
Q

What increases the chances of having an extra chromosome 21?

A

Increases with mother’s age.

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17
Q

What are the physical features of down syndrome?

A
  1. Atlanto-axial joint instability
  2. Short stature
  3. Brachcephaly
  4. Widely spaced upward slanting eyes
  5. Weight gain
  6. Brushfield spots
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18
Q

Which image shows atlantoaxial instability?

image missing

A

B.

The joint between the upper spine and base of the skull is called the atlanto-axial joint. In people with Down syndrome, the ligaments (connections between muscles) are “lax” or floppy. This can result in AAI where the bones are less stable and can damage the spinal cord.

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19
Q

What is Brachycephaly?

image missing

A

Brachycephaly, derived from the Greek ‘short head’, means the shape of the skull is shorter than average. A brachycephalic skull is flat in the rear. The crown of the head towards the back is often high, the baby’s face may be wide, and the ears can also protrude.

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20
Q

What are brushfield spots?

image x

A

Down syndrome is associated with common characteristic features of the eyes. This includes upward slanting of the eyelids, prominent folds of skin between the eye and the nose, and small white spots present on the iris (the colored part of the eye) called Brushfield’s spots.

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21
Q

What are the associated health conditions of down syndrome?

A
  1. Cardiac problems
  2. Spinal problems
  3. Malignant disease
  4. Dementia
  5. Immune disease
  6. Hearing loss
  7. Visual defects
  8. Seizures
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22
Q

What are the oral features of down syndrome?

A
  1. Large tongue
  2. Thick, dry and fissured lips
  3. Poor anterior oral seal
  4. Tongue thrust
  5. Early onset periodontal disease
  6. Cleft lip and cleft palate
  7. Malocclusion
  8. Delayed tooth eruption
  9. Missing teeth
  10. Morphological abnormalities
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23
Q

What is fragile x syndrome?

image x

A

is a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. FXS is caused by changes in a gene called Fragile X Messenger Ribonucleoprotein 1 (FMR1). FMR1 usually makes a protein called FMRP that is needed for brain development. People who have FXS do not make this protein. Occurs in 1 in 4000 males and 1 in 8000 females, with males experiencing more severe symptoms.

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24
Q

What are the dental aspects of fragile x syndrome, dental management difficult due to?

A
  1. Short attention span
  2. Hyperactivity
  3. Behavioural disorders similar to autism
  4. Abnormally frequent open bite and crossbite
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25
Q

What is Cri du chat syndrome (CdCS or 5p-)?

A

is a rare genetic disorder in which a variable portion of the short arm of chromosome 5 is missing or deleted (monosomic). Symptoms vary greatly from case to case depending upon the exact size and location of the deleted genetic material. Affecting 1 in 30000 births.

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26
Q

What are the features of Cri du chat syndrome?

A
  1. High pitched cry
  2. Microcephaly - a condition where a baby’s head is much smaller than expected.
  3. Micrognathia – a condition where the lower jaw is undersized
  4. Wide set eyes
  5. Webbing or joining together of fingers and toes
  6. Slow development of motor skills, speech and language
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27
Q

A lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them, this statement is taken from which society?

A

National Autistic Society

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28
Q

Autism develops at a very early stage in life, when is it seen?

A

Usually begins in first 30 months of life. And is four times more in boys than girls.

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29
Q

What are the characteristics of autism?

A
  1. Poor social skills
  2. Lack of interpersonal relationships
  3. Delayed speech and language
  4. Ritualistic, compulsive behaviour
  5. Can have average or above average intelligence
  6. Learning disabilities
  7. ADHD or depression
  8. Epilepsy
  9. Other conditions – visual, hearing impairment
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30
Q

What are the clinical presentation of autism?

A
  1. Live in their ‘own world’
  2. Avoid eye contact
  3. Echolalia
  4. Unaware of others
  5. Practice repetitive actions
  6. Obsessional desire to follow routine
  7. Self-mutilation
  8. Sensitivity to touch, smell and sound
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31
Q

Some suspected risk factors for ASD include:

A
  1. having an immediate family member who’s autistic
  2. certain genetic mutations
  3. fragile X syndrome and other genetic disorders
  4. being born to older parents
  5. low birth weight
  6. metabolic imbalances
  7. exposure to heavy metals and environmental toxins
  8. a maternal history of viral infections
  9. fetal exposure to the medications valproic acid or thalidomide (Thalomid)
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32
Q

what are the oral findings in autistic patients?

A
  1. Bruxism – teeth grinding
  2. Traumatic lesions
  3. Poor oral hygiene
  4. Poor attendance
  5. Prefer sweet foods
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33
Q

What are dental management of autistic patients

A
  1. Patience
  2. Empathetic approach
  3. Oral hygiene education and support
  4. Previous training at school or home with visual aids
  5. Pre-visit packs and questionnaire
  6. Patient is not kept waiting
  7. Short, quiet visit with same staff
  8. Avoid aspirator, high-speed etc
  9. Have a parent or carer present
  10. Pain and anxiety control: LA, Sedation, GA
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34
Q

What is sensory impairment?

A

When one or more of a person’s senses is no longer normal: a person does not have to have full loss of a sense to be sensory impairment.

  1. Sight
  2. Hearing
  3. Smell
  4. Touch
  5. Taste
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35
Q

Blind and partially sighted come under visually impaired, how many people are registered blind or partially blind in the UK?

A

358,000

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36
Q

Symptoms of visual impairment are?

A
  1. Reduction or loss of vision
  2. Eye pain
  3. Burning sensation – optic neuritis occurs when swelling damages, the optic nerve
  4. Gritty feeling – also known as dry eye syndrome
  5. Blurring of vision
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37
Q

What is glaucoma?

image x

A

Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged. Glaucoma is typically caused by high intraocular pressure inside your eyes.

Symptoms of glaucoma can include blurred vision or seeing rainbow-coloured circles around bright lights. Both eyes are usually affected (generally a bilateral condition).

Treatment for glaucoma will depend on your symptoms. It can include eyedrops, laser treatment and surgery.

Your age, ethnicity, family history and some medical conditions can increase your chances of getting glaucoma.

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38
Q

What is the normal intraocular pressure?

A

15-20mmHg

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39
Q

What is cataract?

image x

A

Cataracts are when the lens, a small transparent disc inside your eye, develops cloudy patches. Over time these patches usually become bigger causing blurry, misty vision and eventually blindness. When we’re young, our lenses are usually like clear glass, allowing us to see through them.

Most cataracts develop when aging or injury changes the tissue that makes up the eye’s lens. Proteins and fibres in the lens begin to break down, causing vision to become hazy or cloudy. Some inherited genetic disorders that cause other health problems can increase your risk of cataracts.

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40
Q

What is macular degeneration?

image x

A

Age-related macular degeneration (AMD) is an eye disease that can blur your central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye)

It’s generally caused by abnormal blood vessels that leak fluid or blood into the macula (MAK-u-luh). The macula is in the part of the retina responsible for central vision.

AMD is a very common cause of vision loss in older adults. Dry AMD makes up the majority of cases, progressing slowly and causing permanent vision damage. Wet AMD is rarer and more severe but also more treatable than dry AMD.

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41
Q

Which macular degeneration causes severe sight loss in a matter of months, due to the growth of new vessels under retina which then break and leak into the macula?

image x

A

Wet macular degeneration.

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42
Q

Which macular degeneration is usually a bilateral condition, which develops overtime giving a gradual loss of central vision?

image x

A

Dry macular degeneration.

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43
Q

What is diabetic retinopathy?

image x

A

Diabetic retinopathy is a complication of diabetes/hypertension or a combination of both, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated.

However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight
As diabetic retinopathy progresses, new blood vessels may grow and threaten your vision.

Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels.

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44
Q

What is hemianopia?

image x

A

A hemianopia is where there is a loss of one half of your visual field. Hemianopia is caused by damage to the brain, for example, by a stroke, trauma or tumour.

The extent of field loss can vary and depends on the area of your brain that has been affected.

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45
Q

What is trachoma?

A

Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. It is a public health problem in 44 countries and is responsible for the blindness or visual impairment of about 1.9 million people. Blindness from trachoma is irreversible
Trachoma is caused by certain subtypes of Chlamydia trachomatis, a bacterium that can also cause the sexually transmitted infection chlamydia.

Trachoma spreads through contact with discharge from the eyes or nose of an infected person. Hands, clothing, towels and insects can all be routes for transmission.

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46
Q

What is the estimated figure of people affected by hearing impairment in the UK?

image x

A

11 million approx. 75% are > 60 years old

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47
Q

Causes of hearing impairment include the following, which of these is the most common cause of hearing impairment?

  1. Inherited
  2. Congenital
  3. Infections
  4. Trauma
  5. Drugs
  6. Foreign bodies
  7. Excessive noises

image x

A

Excessive noise (prolonged loud noise/industrial deafness)

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48
Q

What are the symptoms of hearing impairment in children?

A
  1. Inactivity
  2. Reduced development of speech & language skills
  3. Deterioration of speech
  4. Reduced social & emotional development
  5. Irritability
  6. Autistic like behaviour
  7. Confusion
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49
Q

What are the signs and symptoms of hearing loss?

A
  1. Difficulty hearing people clearly
  2. Misunderstanding
  3. Asking people to repeat themselves
  4. Listening to music or watching tv loudly
  5. Difficulty hearing on the phone
  6. Finding it hard to keep up with conversations
  7. Feeling tired or stressed
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50
Q

What are the three types of hearing aids available?

image x

A
  1. Behind the ear hearing aids
  2. In the ear hearing aids
  3. In the canal hearing aids
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51
Q

What are the 4 types of hearing implants?

A
  1. Bone anchored hearing aids
  2. Cochlear implants
  3. Auditory brainstem implants
  4. Middle ear implants
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52
Q

There are 11.9 million disabled people in the UK accounting for 19% of the population, more females than males. Of that population what percentage are the following

  1. Children –
  2. Working age adult –
  3. Adults over pension age –
  4. Disabled people born with their disabilities –
A
  1. Children – 6%
  2. Working age adult – 16%
  3. Adults over pension age – 45%
  4. Disabled people born with their disabilities – 17%
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53
Q

The equality act 2010 defines disability, a person has a disability if:

A
  1. They have a physical or mental impairment
  2. The impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities
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54
Q

What is a physical disability?

A

Any condition that permanently prevents normal body movement and/or control

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55
Q

What are the causes of physical disabilities?

A
  1. Inherited or genetic disorders
  2. Conditions present at birth
  3. Serious illnesses affecting brain, nerves or muscles
  4. Spinal cord injury
  5. Brain injury
  6. Accidents
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56
Q

What is osteogenesis imperfecta?

A

Osteogenesis imperfecta (OI) is an inherited (genetic) bone disorder that is present at birth. It is also known as brittle bone disease. A child born with OI may have soft bones that break (fracture) easily, bones that are not formed normally, and other problems. Signs and symptoms may range from mild to severe, such as

  1. Collagen defects
  2. Short stature
  3. Hearing loss
  4. Blue sclera
  5. Dentinogenesis imperfecta
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57
Q

What is dentinogenesis imperfecta?

A

Dentinogenesis imperfecta is a disorder of tooth development. This condition causes the teeth to be discoloured (most often a blue-grey or yellow-brown colour) and translucent. Teeth are also weaker than normal, making them prone to rapid wear, breakage, and loss, bulbous crowns, obliteration of pulp chambers, and reduced root length.

Dentinogenesis imperfecta can affect both primary (baby) teeth and permanent teeth. People with this condition may also have speech problems or teeth that are not placed correctly in the mouth. Dentinogenesis imperfecta is caused by genetic changes in the DSPP gene and is inherited in an autosomal dominant manner

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58
Q

What is spina bifida?

image x

A

Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way.

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59
Q

At which stage (month) in life does the embryo grow the neural tube which forms spine and nervous system?

A

1st month of intrauterine life.

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60
Q

What is the cause of spina bifida?

A

Exact cause unknown, but lack of folic acid and in early pregnancy increases the risk.

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61
Q

What are the complications of spina bifida?

A
  1. Weakness or total paralysis of legs
  2. Bowel and urinary incontinence
  3. Loss of skin sensation
  4. Hydrocephalus - Hydrocephalus is a build-up of fluid in the brain. The excess fluid puts pressure on the brain, which can damage it. If left untreated, hydrocephalus can be fatal.
  5. Most cases normal intelligence but learning difficulties associated with hydrocephalus
  6. Repeated fits or seizures
  7. Drooling problems and dysphagia
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62
Q

What is cerebral palsy?

A

CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles, affecting 1/400 babies born in UK.

Cerebral palsy is usually caused by a problem that affects the development of a baby’s brain while it’s growing in the womb. These include damage to part of the brain called white matter, possibly as a result of a reduced blood or oxygen supply – this is known as periventricular leukomalacia (PVL)

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63
Q

What are the early detection signs for cerebral palsy?

A
  1. Symptoms obvious within first 3 months
  2. Muscle stiffness or floppiness
  3. Muscle weakness
  4. Random and uncontrolled body movements
  5. Balance and co-ordination problems
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64
Q

Someone who is tetraplegic will have damage to the spinal cord in which location?

A

Damage to spinal cord in the neck, affecting all four limbs and torso.

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65
Q

Someone who is paraplegic will have damage to the spinal cord in which location?

A

Damage to mid/lower part of back. Affects legs and lower body.

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66
Q

Of the causes of spinal injury which is the most common?

A
  1. Falls – 41%
  2. RTA – 36.8%
  3. Sports injuries
  4. Trauma
  5. Work related accidents
  6. Male to female ration 2:1
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67
Q

Brain injury arises from two types of trauma, what are they?

A
  1. External events – closed head trauma, or missile penetrating the brain
  2. Internal events – CVA, tumour.
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68
Q

What are the clinical features of a CVA – stroke?

A
  1. Face drooped on one side
  2. Weakness/numbness in one arm
  3. Dysphagia
  4. Aphasia
  5. Slurred speech (dysarthia)
  6. Sudden loss or blurring of vision
  7. Confusion
  8. Sudden and severe headache
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69
Q

What are the implications of stroke on dental health?

A
  1. Difficulty wearing dentures
  2. Difficulty brushing teeth
  3. Consent issues
  4. Accessing the surgery, wheelchair transfer
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70
Q

What are the difficulties with dental treatment for physically disabled people?

A
  1. Attendance
  2. Getting into dental chair
  3. Positioning
  4. Length of appointments
  5. Compliance
  6. Oral hygiene
  7. Be realistic
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71
Q

According to the disability act 2010Reasonable adjustments should be made so that people with disabilities receive the same services as far as possible, as someone who is not disabled. Reasonable adjustments include: -

A
  1. Designated parking spaces
  2. Providing ramps and lifts
  3. Making doorways wider
  4. Installing automatic doors
  5. Hand rails
  6. Lower reception desks
  7. Providing more lighting and clearer signs
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72
Q

What is domiciliary care?

A

Domiciliary care involves providing dental treatment out with dental clinics for patients whose personal circumstances make it unfeasible to attend a dental clinic.

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73
Q

The following points below under pin which GDC Standard?

3.1You must obtain valid consent before starting treatment, explaining all the relevant options and possible costs

3.1.4 You must check and document that patients have understood the information you have given

3.2 You must make sure that patients (or their representatives) understand the decisions they are being asked to make

A

Valid consent

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74
Q

For the purpose of this act (adults with incapacity act), and unless the context otherwise requires – “adult” means a person who has attained the age of 16 years; “incapable” means incapable of?

A
  1. Acting; or
  2. Making decisions; or
  3. Communicating decisions; or
  4. Understanding decisions; or
  5. Retaining the memory of decisions,

Capacity = AMCUR

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75
Q

What methods would you use to check if the patient has understood and has the capacity to consent?

A
  1. Open questions
  2. Chunk and check
  3. Teach back
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76
Q

If a person lacks capacity to consent to dental treatment, which act comes into place?

A

Adults with incapacity act applies.

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77
Q

If a person lacks capacity to consent to dental treatment, a ‘section 47’ certificate should be issued according to these 5 key principles, what are they?

A
  1. BENEFIT
  2. LEAST restrictive of freedom
  3. The person’s past and present WISHES should be taken into account
  4. CONSULT relevant others
  5. Encourage RESIDUAL capacity
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78
Q

What is a proxy?

A

The term ‘proxy’ is used for someone who has been authorised to act on behalf of an adult with incapacity

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79
Q

What is power of attorney?

A

Granted by the adult whilst they have capacity to choose who they wish to act on their behalf, should the need arise

  1. Must be in writing
  2. Must be registered with the OPG
  3. Powers are ‘dormant’ until needed
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80
Q

What will electronic versions of power of attorney documents not have, that a written document will have?

image x

A

Embossed seal.

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81
Q

do you need to check each PoA document?

A

Yes, remember the powers are ‘dormant’ until it is demonstrated that the patient does not have the capacity to make necessary decision

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82
Q

When can Power of Attorney be granted?

A

Whilst the person is capable, this must be in writing and registered with OPG

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83
Q

When do Power of Attorneys expire?

A

They do not have an expiry date; they remain in place even after death.

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84
Q

When are guardians granted? Granted when an adult either:

A
  1. No longer has capacity to choose who they wish to make decisions for them or
  2. The adult has never been able to male their own decisions
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85
Q

How does a person get a guardian?

A
  1. Court process
  2. Granted by sheriff
  3. Requires medical reports
  4. Requires a social work report
  5. Must be registered with the OPG
  6. Continuous powers
  7. Has an expiry date
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86
Q

What are the types of guardian powers?

A
  1. Financial/property
  2. Welfare
  3. Both
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87
Q

What is an intervener?

A

An intervener is a person who regularly works one-to-one with an individual who is deaf-blind.

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88
Q

When checking proxy status what information can and cannot be obtained?

A
  1. Can confirm proxy in place
  2. Can confirm welfare powers exist
  3. Can’t confirm what they are
  4. Can’t give contact details
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89
Q

Who can consent for dental treatment?

A
  1. Patients with capacity
  2. Welfare power of attorneys
  3. Welfare guardians
  4. Medical and dental practitioners can AUTHORISE treatment under section 47 of AWI act
  5. A DENTIST CAN ONLY AUTHORISE DENTAL TREATMENT.
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90
Q

If there is no proxy and the patient is not deemed to have capacity for the particular decision then what do you do?

A
  1. Have an AWI (s47) certificate
  2. The s47 certificate authorises the treatment to go ahead.
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91
Q

What is the definition of dementia?

A

A collection of symptoms that get worse over time, memory loss, problems with language and understanding, changes in behaviour, confusion and needing help with daily tasks which is not a natural part of ageing.

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92
Q

What is the incidence of dementia in UK 2019?

A

900,00

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93
Q

What is the projected incidence of dementia by 2040 in the UK?

A

1.6 million

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94
Q

What is the incidence rate of dementia around the globe

A

57.4 million

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95
Q

1 in 3 people will develop dementia by what age?

A

65

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96
Q

1 in 6 people will have dementia by what age?

A

80

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97
Q

What is currently one of the biggest challenges facing the NHS?

A

The rise in dementia

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98
Q

The average cost of dementia to the UK economy per patient per year is how much?

A

Just over 25K

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99
Q

Of the four diseases, rank them in their order of how much research investment per million is given per year.
1. Cancer
2. Dementia
3. Heart disease
4. Stroke

  1. 10 million
  2. 20 million
  3. 80 million
  4. 140 million
A
  1. Cancer – 140 million
  2. Heart disease – 80 million
  3. Stroke – 20 million
  4. Dementia – 10 million
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100
Q

What are the risk factors for dementia?

A
  1. Age
  2. Gender
  3. Ethnicity
  4. Genetics
  5. Down syndrome
  6. Medical factors
  7. Lifestyle factors
  8. Head injuries
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101
Q

What are the medical risk factors for dementia?

A
  1. Type 2 diabetes
  2. Hypertension
  3. High cholesterol
  4. Obesity
  5. Depression
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102
Q

What are the lifestyle risk factors for dementia?

A
  1. Physical inactivity
  2. Smoking
  3. Unhealthy diet
  4. Excessive alcohol
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103
Q

Which sports have the highest incident of head injuries?

A
  1. American football
  2. Football
  3. Ice hockey
  4. Rugby
  5. Boxing
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104
Q

What is chronic traumatic encephalopathy?

A

Chronic traumatic encephalopathy (CTE) is a progressive brain condition that’s thought to be caused by repeated blows to the head and repeated episodes of concussion. It’s particularly associated with contact sports, such as boxing or American football.

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105
Q

University of Glasgow conducted a study in October 2019 with retired professional footballers and found that retired players are likely to suffer by dementia by how much?

A

3.5x

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106
Q

University of Glasgow conducted a study in October 2019 with retired professional footballers and found that retired players are likely to die from Parkinson’s disease by how much?

A

5x

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107
Q

Children under what age are banned from heading footballs in training SFA?

A

Under 12

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108
Q

How can you reduce the risk factors of developing dementia?

A
  1. Be physically active
  2. Stop smoking
  3. Eat healthily
  4. Healthy weight
  5. Reduce alcohol consumption
  6. Keep mentally active
  7. Be social
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109
Q

There are 5 types of dementia, what are they?

A
  1. Alzheimer’s disease
  2. Vascular
  3. Mixed
  4. Lewy-body
  5. Fronto-temporal
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110
Q

Alzheimer’s disease accounts for what percentage of dementia?

A

62%

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111
Q

How does Alzheimer’s disease present with?

A

Short-term memory loss and word-finding difficulties

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112
Q

As Alzheimer’s progresses how does it present?

A

More confusion, mood swings, frustration and become more withdrawn.

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113
Q

What are amyloid plaques?

A

Amyloid plaques are aggregates of misfolded proteins that form in the spaces between nerve cells.

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114
Q

What are tangles – tau protein?

A

These abnormal forms of tau protein cling to other tau proteins inside the neuron and form tau tangles.

Tau tangles and amyloid plaques accumulate in the space between the nerve cells, that slow a person’s ability to think and remember.

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115
Q

What is acetylcholine?

A

Acetylcholine is an organic chemical that functions in the brain and body of many types of animals as a neurotransmitter.

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116
Q

Which neurotransmitter is decreased In Alzheimer’s?

A

acetylcholine

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117
Q

Which infections are thought to be linked to Alzheimer’s disease?

A

Some of the infections that are thought to be linked to Alzheimer’s include oral herpes, pneumonia and infection with spirochete bacteria (the type which cause Lyme disease and some types of gum disease).

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118
Q

Which oral condition is more common among patients with Alzheimer’s?

A

gingivitis and periodontal disease.

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119
Q

Which protein is produced in higher concentrations in the brain in patients with Alzheimer’s?

A

proteins produced by P.gingivalis are present in higher concentrations in brain.

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120
Q

Vascular dementia accounts for how many patients with dementia?

A

17% of cases

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121
Q

What causes vascular dementia?

A

Caused by a reduced blood flow to the brain

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122
Q

When is vascular dementia usually diagnosed?

A

Often diagnosed after stroke, or series of transient ischaemic attacks. Deterioration is stepwise and linked to cerebrovascular changes in the brain.

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123
Q

What percentage of dementia is mixed dementia?

A

10% which is a combination of Alzheimer’s disease and vascular dementia.

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124
Q

The progression of dementia is greater in which type of dementia, Alzheimer’s, vascular or mixed?

image x

A

Alzheimer’s

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125
Q

Lewy-Body dementia accounts for how many patients with dementia?

A

4% cases

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126
Q

What are Lewy Bodies?

A

Are small deposits of protein in nerve cells

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127
Q

Lewy-Body dementia is associated with which disease?

A

Parkinson’s disease

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128
Q

Presentation of Lewy-Body dementia is dependant on what?

image x

A

Presentation on which part of the brain is affected.

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129
Q

Lewy-Body dementia affects the base of brain which affects what functions?

A

Motor problems

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130
Q

Lewy-Body dementia affects the outer layers of the brain which affects what functions?

A

Cognitive symptoms

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131
Q

What is frontotemporal dementia?

A

Frontotemporal dementia is an uncommon type of dementia that causes problems with behaviour and language. Dementia is the name for problems with mental abilities caused by gradual changes and damage in the brain. Frontotemporal dementia affects the front and sides of the brain (the frontal and temporal lobes).

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132
Q

Fronto-temporal dementia generally affects people slightly younger, with symptoms presenting in the 6th decade, what are the early features of Fronto-temporal dementia?

A

Personality change, that include disinhibition, short temperedness, aggression, mood swings and sexually inappropriate behaviour.

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133
Q

How do you diagnose dementia?

A
  1. Attendance at GP
  2. Taking personal and medical history
  3. Physical exam and other appropriate investigations – bloods, urine, ECG.
  4. Review of medication that may be adversely affecting cognitive functioning.
  5. Check mental abilities.
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134
Q

Questionnaires known as Mini Mental State Exam (MMSE) can be conducted to diagnose dementia, this exam assesses a number of different mental abilities including?

A
  1. Short and long term memory
  2. Attention span
  3. Concentration
  4. Language and communication skills
  5. Ability to plan
  6. Ability to understand instructions
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135
Q

Other than the Mini Mental State Exam what other 4 tests can be done to screen for dementia?

A
  1. Abbreviated mental test score (AMTS)
  2. 6-item Cognitive impairment test (6-CIT)
  3. General practitioner assessment of cognition (GPCOG)
  4. 7 minute screen
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136
Q

If you detect dementia then a referral needs to be made for further tests and diagnostic test, what are they?

A
  1. Refer to a specialist dementia diagnostic service which includes
    - Memory clinic
    - Old age psychiatry
    - Geriatrician
  2. CT/MRI scan
  3. Perfusion scan
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137
Q

There is currently no treatment for dementia, what form services are available for dementia?

A
  1. Talking therapies
  2. Reducing cardiac risks – may halt deterioration of vascular type dementias
  3. NSAIDS may slow progression
  4. Drug treatment for Alzheimer’s
  5. Alternative therapies
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138
Q

What are the four licensed drugs for Alzheimer’s disease?

A
  1. Donepezil – mild to moderate Alzheimer’s
  2. Galantamine
  3. Rivastigmine
  4. Memantine – blocks the effects of glutamate, moderate to severe Alzheimer’s
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139
Q

Aducanumab – IV infusion reduces the clinical decline of Alzheimer’s, what does the drug target?

A

Targets amyloid

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140
Q

Why do people experience dementia differently?

A

Depends on how and what parts of the brain are affected.

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141
Q

Progression of dementia is categorised as early, middle, late. What do you see during the early stages of dementia?

A
  1. Changes in ability and behaviour is minor
  2. Often misattributed to stress, bereavement or normal ageing
  3. Loss of short-term memory
  4. Confusion, poor judgement, unwilling to make decisions
  5. Anxiety, agitation
  6. Inability to manage everyday tasks
  7. Communication problems
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142
Q

what signs should dental teams look out for early stages of dementia?

A
  1. Forgotten appointments
  2. Difficulty making decisions
  3. Deterioration in oral hygiene
  4. Forgotten conversations
  5. Repetition
  6. Confusion in grasping new ideas
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143
Q

Progression of dementia is categorised as early, middle, late. What do you see during the middle stages of dementia?

A
  1. More support needed in day to day to life – reminders to eat, wash, dress, go to toilet
  2. Increasingly forgetful and may fail to recognise people
  3. Distress, aggression, anger mood changes
  4. Risk of wandering or getting lost
  5. May behave inappropriately. e.g., going out in pyjamas
  6. May experience hallucinations, throw back memories
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144
Q

what signs should dental teams look out for middle stages of dementia?

A
  1. Dental team may notice confusion and agitation
  2. Patient may not recognise the dental team
  3. Repeatedly ask the same questions, forgetting the answer given
  4. Family likely to notice changes
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145
Q

Progression of dementia is categorised as early, middle, late. What do you see during the late stages of dementia?

A
  1. Become increasingly dependant on others for their care
  2. Inability to recognise familiar objects, surroundings or people. Maybe some flashes of recognition
  3. Increased physical frailty – eventually confined to wheelchair or bed
  4. Difficulty eating and swallowing, weight loss, incontinence and gradual loss of speech
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146
Q

what signs should dental teams look out for late stages of dementia?

A
  1. Difficult for patient to come to dental surgery
  2. Difficulty eating and swallowing
  3. Weight loss, difficulty wearing dentures
  4. Loss of speech and communication difficulties
  5. Focus on making mouth comfortable and those carers carry out regular oral healthcare
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147
Q

What should you take into consideration when seeing a patient suffering from dementia?

A
  1. Helpful to bring someone with them – partner, carer
  2. What time of the day best?
  3. Longer appointments
  4. Assess capacity/consent
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148
Q

What must we consider when we are communicating with a patient with dementia?

A
  1. Simple, clear and slow
  2. Time – take time and give time
  3. Body language
  4. Repeat
  5. Inclusion in conversation
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149
Q

When planning for treatment for a dementia patient, what must we consider?

A
  1. Oral hygiene
  2. Reliance on others
  3. Polypharmacy
  4. Dentures
  5. Plan for the future
  6. Simple treatment plans
  7. Prevention
  8. Consent
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150
Q

Co-operation for treatment declines as dementia progresses, what issues can you face with co-operation with the early stages of dementia?

A

Behavioural management

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151
Q

Evidence has suggested that dementia can worsen with treatments under what?

A

GA

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152
Q

With late stage dementia there is very limited treatment options we can offer patients, when treating them what is the best possible outcome for dementia patients?

A
  1. Prevention of oral disease
  2. Maintain comfort and function
  3. Emergency treatment
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153
Q

How can you tell a patient of late stage dementia has dental pain?

A
  1. Refusal to eat (particularly hard or cold foods)
  2. Frequent pulling at face or mouth
  3. Leaving previously worn denture out
  4. Increased restlessness, moaning or shouting
  5. Disturbed sleep
  6. Refusal to take part in daily activities
  7. Aggressive behaviour
  8. Swelling
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154
Q

What can help dementia patients reduce their need for medication?

A

Meaningful music alleviates dementia symptoms such as anxiety and agitation, which helps family members reconnect.

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155
Q

Which sense is the last to go for dementia patients?

A

Response to music is the last sense to go at the end of life.

156
Q

What are the best tips to help cope with dementia?

A
  1. Regular routine
  2. Weekly timetable on wall or fridge
  3. Put keys in an obvious place
  4. Keep a list of telephone numbers by the phone
  5. Put regular bills on direct debits
  6. Use a pill organiser box
157
Q

What can you do to male your home dementia friendly?

A
  1. Good lighting
  2. Reduce excess noise
  3. Safer flooring
  4. Contrasting colours
  5. Labels and signs on cupboards/doors
  6. Clocks with large LCD displays
  7. Telephones with big buttons
  8. Reminder devices – to take medicine/lock front door
158
Q

What are the 4 stages of normal haemostasis?

A
  1. Blood vessels – vasoconstriction
  2. Platelet plug
  3. Activation of coagulation – stable fibrin plug
  4. Activation of fibrinolysis – clot dissolution
159
Q

Platelet disorders can be categorised in three groups what are they?

A
  1. Failed platelet production
  2. Excessive platelet destruction
  3. Abnormal platelet function
160
Q

What is thrombocytopenia?

A

Thrombocytopenia is a condition that occurs when the platelet count in your blood is too low

161
Q

What is the normal platelet level?

A

150 – 300 x10 9/l

162
Q

What can cause thrombocytopenia?

A
  1. Autoimmune
  2. Alcoholism
  3. Bone marrow disease
  4. Cancer
  5. Viruses – Hep C, HIV
  6. Chemotherapy
163
Q

What is Idiopathic thrombocytopenic purpura?

A

Idiopathic thrombocytopenic purpura is a blood disorder characterized by an abnormal decrease in the number of platelets in the blood.

164
Q

What is Glanzmann?

A

Glanzmann thrombasthenia is an autosomal recessive bleeding disorder that is characterized by prolonged or spontaneous bleeding starting from birth

165
Q

What does Glanzmann affect?

A

Platelet aggregation

166
Q

What is epistaxis?

A

Nose bleeds

167
Q

What is menorrhagia?

A

Heavy menstrual bleeding

168
Q

Who must you liaise with before conducting a procedure with someone suffering from a bleeding disorder?

A

Haematology, a full FBC prior to procedure

169
Q

What is the required platelet level before for an extraction?

A

50x10 9/l

170
Q

What is the required platelet level for major surgery?

A

70x10 9/l

171
Q

How do steroids regulate bleeding?

A

Corticosteroids (“steroids”) — Steroids prevent bleeding by decreasing the production of antibodies against platelets. If effective, the platelet count will rise within two to four weeks of starting steroids.

172
Q

What is eltrombopag?

A

Eltrombopag is a thrombopoietin receptor agonist that binds to and activates the thrombopoietin (TPO) receptor, thereby increasing platelet production.

173
Q

What is tranexamic acid?

A

Tranexamic acid is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation. It is also used for hereditary angioedema. It is taken either orally or by injection into a vein.

174
Q

How many clotting factors are there?

A

12 clotting factors

175
Q

What disorder is Von Willebrand’s Disease – is the most common inherited bleeding disorder affecting 1% of population.

A

Von Willebrand disease (VWD) is a condition that causes heavy or long-lasting bleeding.

176
Q

What autosomal disease is VWD?

A

Autosomal dominant

177
Q

hat drugs can be given to raise VWF? Tranexamic acid and desmopressin

A

Tranexamic acid and desmopressin

178
Q

What is desmopressin?

A

Is a synthetic version of vasopressin, which stimulates the release of VMF and increase in factor VIII levels.

179
Q

How can desmopressin be delivered?

A
  1. Intravenous
  2. Intramuscular
  3. Subcutaneous
  4. Intranasal
180
Q

What is haemophilia?

A

Haemophilia is usually an inherited (70% positive family history) bleeding disorder in which the blood does not clot properly. This can lead to spontaneous bleeding as well as bleeding following injuries or surgery.

181
Q

Who are affected with haemophilia?

A

It is an X linked recessive, males are affected, and all daughters are carriers.

182
Q

Which factor is deficient in Haemophilia A?

A

factor VIII 1/5000 live male births

183
Q

Which factor is deficient in Haemophilia B?

A

factor IX 1/20000 live male births

184
Q

The severity of haemophilia depends on the level of clotting factor, what percentage of haemophilia is mild, moderate and severe?

A
  1. Mild – 5-50%
  2. Moderate – 1.5%
  3. Severe – less than 1%
185
Q

What are the symptoms of haemophilia?

A
  1. Nosebleeds
  2. Prolonged bleeding from wounds
  3. Bleeding gums
  4. Skin that bruises easily
  5. Pain and stiffness around joints
  6. Internal bleeding
186
Q

What is a haematoma?

A

A hematoma is a collection (or pooling) of blood outside the blood vessel

187
Q

In cases of severe haemophilia what must children aged 9-11 learn to do?

A

Administer factor concentrate which helps them to be independent.

188
Q

Current WFH guidelines state the aim is to allow dental treatment to be carried out safely while minimising the use of? factor concentrates

A

factor concentrates

189
Q

Current WFH guidelines state that haemostatic cover therapy required for which procedures?

A
  1. Extractions
  2. Oral surgery
  3. Periodontal surgery
  4. Implant surgery
  5. IDBs, lingual
190
Q

A patient with haemophilia having a dental extraction, the dentist should do what?

A

Liaise with haemophilia centre to organise factor replacement therapy.

191
Q

What type of method of administrating LA should you do when doing a extraction for haemophilia?

A

Use of buccal Articaine

192
Q

Do you need factor replacement for the treatment of gingivitis, if you have haemophilia?

A

No

193
Q

What manages post-op bleeding effectively for periodontal treatment for a haemophilia patient?

A

TA mouthwash

194
Q

Haemophilia patients with prolonged bleeding can be encountered in periodontitis, how do you manage this patient?

A

No factor replacement required but pre-op TA and post op TA mouthwash is advised

195
Q

What are the challenges of patients with bleeding disorders?

A
  1. Reluctance to brush teeth due to fear of bleeding
  2. Reluctance to access regular dental care due to fear of haemorrhage
  3. Poorer attendance
  4. Increased rate of extractions
196
Q

What is the three main types of blood and bone marrow cancer?

A
  1. Leukaemia
  2. Lymphoma
  3. Myeloma
197
Q

Name the 7 types of cells of the blood?

A
  1. Platelets
  2. Red blood cells
  3. Basophil
  4. Neutrophil
  5. Eosinophil
  6. Lymphocytes
  7. Monocytes
198
Q

What is myeloma?

image x

A

A neoplastic clonal proliferation of plasma cells chrarcterized by the production of a monoclonal immunoglobulin. The bone marrow is the site of origin of nearly all myelomas and in most cases, there is disseminated marrow involvement.

In myeloma, the cells grow too much, crowding out normal cells in the bone marrow that make red blood cells, platelets, and other white blood cells.

199
Q

Neoplasm of plasma cells and production of abnormal serum immunoglobulins is found in which blood cancer?

A

Myeloma

200
Q

What age does myeloma affect people?

A

Mainly affects people aged over 60

Multiple myeloma usually presents many years before symptoms.

201
Q

The cause of multiple myeloma can be related to what?

A

Radiotherapy or petroleum products

202
Q

What is the function of plasma cells?

A

Plasma cells are differentiated B-lymphocyte white blood cells capable of secreting immunoglobulin, or antibody.

These cells play a significant role in the adaptive immune response, namely, being the main cells responsible for humoral immunity.

203
Q

How does multiple myeloma affect the bone?

A

Bone infiltration and destruction

204
Q

What are the presentations of multiple myeloma?

A
  1. Bone pain
  2. Hyper viscosity syndrome – blood thickens and doesn’t flow freely
  3. Renal failure
  4. Anaemia
  5. Neurological lesions
205
Q

How does multiple myeloma affect the renal system?

A

In MM, the abnormal plasma cells produce abnormal proteins. These abnormal proteins can bind with other proteins in the kidneys to form large casts. The casts can block tubes within the kidneys, leading to kidney failure. Medical professionals refer to this as myeloma kidney

206
Q

Dental aspects of multiple myeloma include?

A
  1. 70% cases skull affected
  2. Root resorption
  3. Loose teeth
  4. Mental anesthesia
  5. Pathological fractures
  6. Rare cause of mandibular radiolucency
  7. Anemia
  8. Infection
  9. Hemorrhagic tendencies
  10. Renal failure
207
Q

What medication would you expect a patient to be on who is suffering from multiple myeloma?

A
  1. Steroids
  2. Bisphosphonates
  3. Biological therapies
208
Q

What is leukemia?

A

Is a broad term for cancers of the blood cells. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly. Leukemia occurs most often in adults older than 55, but it is also the most common cancer in children younger than 15.

209
Q

What are the four types of leukemia?

A
  1. Acute lymphoblastic leukaemia
  2. Acute myeloid leukaemia
  3. Chronic lymphocytic leukaemia
  4. Chronic myeloid leukaemia
210
Q

Which of the acute leukaemia is commonest in children?

A

Acute lymphoblastic leukaemia

211
Q

Acute myeloid leukaemia is more common in adults, what is the prognosis for it?

A

Poor

212
Q

which chronic or acute leukaemia have a better prognosis?

A

chronic.

213
Q

Which cells proliferate in chronic leukaemia?

A

Proliferation of more mature cells.

214
Q

Chronic leukaemia is otherwise asymptomatic however patients may present with?

A

Splenomegaly and lymph node enlargement.

215
Q

What are the dental aspects of leukaemia?

A
  1. Crowding out of normal blood cells by leukemic cells
  2. Anaemia
  3. Bleeding tendencies
  4. Susceptibility to infections
  5. Septicemia from oral infections
  6. Mucosal pallor
  7. Ulceration
  8. Gingival swelling
  9. Spontaneous bleeding
216
Q

What is lymphoma?

image x

A

Lymphoma is a cancer of the lymphatic system, which is part of the body’s germ-fighting network.

The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body

217
Q

What are the two types of lymphoma? Hodgkins and non hodgkins

A

Hodgkins and non hodgkins

218
Q

What are the symptoms of lymphoma?

A
  1. Non tender swollen lymph nodes
  2. Fever
  3. Night sweats
  4. Unexplained weight loss
219
Q

Which lymphoma develops from B lymphocytes?

A

Hodgkin’s lymphoma

220
Q

Which cells have to be present to be characterised as Hodgkin’s lymphoma?

A

Characterised by reed-sternberg cells

221
Q

Hodgkin’s lymphoma affect which category of adults?

A

Young adults and people over 75.

222
Q

How is Hodgkin’s lymphoma treated?

A

Hodgkin’s lymphoma is very aggressive and treated with chemotherapy and radiotherapy.

223
Q

Non-Hodgkin’s lymphoma affects which lymphocytes?

A

B lymphocytes or T lymphocytes

224
Q

How many types of non-Hodgkin’s lymphoma are there?

A

More than 30 types

225
Q

Non-Hodgkin’s lymphoma affects which age group?

A

Any ages but risk increases with age. >1/3 aged over 75

226
Q

Treatment of lymphoma depends on what?

A

Depends on type, grade and extent of lymphoma, age.

227
Q

What is the treatment plan for low grade lymphoma?

A

Watch and wait

228
Q

What is the treatment option for high grade lymphoma?

A

Chemotherapy, radiotherapy, monoclonal antibody therapy – rituximab

229
Q

What is myelodysplasia?

A

A rare type of blood cancer Myelodysplastic syndromes are a group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells.

in a healthy person, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time.

230
Q

Myelodysplasia is most common in adults over the age of?

A

70

231
Q

Myelodysplasia can develop in which type of cancer?

A

Acute myeloid leukaemia

232
Q

What are the symptoms of myelodysplasia?

A
  1. Weakness
  2. Tiredness
  3. Breathlessness
  4. Frequent infections
  5. Bruising and easy bleeding – such as nose bleeds
233
Q

What are the treatment options for myelodysplasia?

A
  1. Injections of growth factor medicines such as erythropoietin to increase numbers of blood cells
  2. Blood transfusions
  3. Antibiotics
  4. Biological therapies – lenalidomide
  5. Chemotherapy
  6. Immunosuppressants
  7. Stem cell (bone marrow) transplant
234
Q

What is advised before treating patients with blood cancers?

A
  1. Dental screening prior to treatment
  2. Make patient dentally fit
  3. Liaise with haematology consultant
235
Q

What are the dental aspects that need to be considered for blood cancers?

A
  1. Risk of bleeding – platelets, clotting
  2. Timing of extractions
  3. Platelet transfusions
  4. Infection - ?antibiotic
  5. Steroids
  6. Sepsis
  7. Chemotherapy
  8. MRONJ
236
Q

What is MRONJ?

A

Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. Several studies have proposed that bisphosphonates cause excessive reduction of bone turnover, resulting in a higher risk of bone necrosis when repair is needed.

It is also thought that bisphosphonates bind to osteoclasts and interfere with the remodelling mechanism in bone.

237
Q

What qualifies as MRONJ?

A

Exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in patients taking anti-resorptive or anti-angiogenic drugs and where there is no history of radiation or no obvious metastatic disease to the jaws.

238
Q

What are the symptoms of MRONJ?

A
  1. Delayed healing after extraction or other trauma
  2. Sometimes spontaneous without an obvious trauma
  3. Pain
  4. Soft tissue infection and swelling
  5. Numbness
  6. Exposed bone – sometimes absent
239
Q

What is the incidence of MRONJ in cancer patients treated with anti-resorptive or anti-angiogenic drugs?

A

1% (1 case per 100)

240
Q

What is the incidence of MRONJ in osteoporosis patients treated with anti-resorptive drugs?

A

0.01-0.1% (1-10 cases per 10,000.)

241
Q

What are the risk factors for MRONJ?

A
  1. Underlying medical condition
  2. Cumulative drug dose
  3. Concurrent treatment with steroids
  4. Surgery/trauma
242
Q

What drugs increase the risk of MRONJ?

A
  1. Bisphosphonates
  2. RANKL inhibitors
  3. Anti-angiogenic drugs
243
Q

Bisphosphonates affect osteoclasts or osteoblasts?

A

Bisphosphonates are drugs that reduce bone resorption by hindering the formation, recruitment and function of osteoclasts.

244
Q

Bisphosphonates most commonly used for?

A

Osteoporosis and in the management of other non-malignant and malignant conditions.

245
Q

What is the positive effect of bisphosphonates?

A

Reduce or delay onset of disease or treatment complications, such as bone fractures, pain.

246
Q

Bisphosphonates have a high affinity to what?

A

High affinity for hydroxyapatite and persist in the skeletal system for many years.

247
Q

What is the half life of alendronate?

A

10 years

248
Q

How does bisphosphonates affect the blood supply of bone?

A

Bisphosphonates accumulate at sites of high bone turnover, e.g., jaw. This may reduce bone turnover, bone blood supply and lead to death of bone -> osteonecrosis

249
Q

Bisphosphonates such as alendronic acid, risedronate sodium are administered how?

A

Orally

250
Q

Bisphosphonates such as pamidronate, zolendronic acid are administered how?

A

IV

251
Q

RANKL inhibitors is an anti-resorptive drugs and inhibits what?

A

Inhibits osteoclast function and bone resorption.

252
Q

What is the function of RANKL inhibitors?

A

Reduce risk of fracture and chronic pain in osteoporosis

253
Q

How often is Denosumab administered for osteoporosis?

A

Given 6 monthly for osteoporosis

254
Q

How often is Denosumab administered for cancer treatment?

A

Given every month

255
Q

RANKL inhibitors effects diminish within how many months of treatment completion?

A

9 months

256
Q

Anti-angiogenic drugs are given for the treatment of cancer, how are these types of drugs affective towards cancer?

A

Anti-angiogenic restrict the growth of tumour blood vessels

257
Q

Lenalidomide, aflibercept, sunitinib are examples of which drugs?

A

Anti-angiogenic drugs

258
Q

Is there a drug holiday for bisphosphonates?

A

No evidence to support drug holidays as drug remains embedded within bone with half life that can be several decades.

259
Q

What is the guidance for drug holiday for denosumab?

A

Guidance states a 9 month stop prior to extraction, although evidence is weak.

260
Q

There is insufficient evidence to support the use of antibiotics to reduce the risk of MRONJ following extractions, when should you only consider giving them?

A

When there is clear evidence of infection and that the patient will benefit from them.

261
Q

Which act helps identify adults at risk?

A

Adults support and protection act 2007

262
Q

If you have information that a patient is or could be at risk of significant harm, or you suspect that a patient is a victim of abuse, you must inform?

A

the appropriate social care agencies or the police.

263
Q

You must raise concerns you may have about a possible abuse or neglect of vulnerable adults. You must know how to refer concerns to an appropriate authority.

In which cases would you expect to release confidential patient information without their consent?

A

In the best interests of the public or the patient. This could be the case if a patient puts their own safety or that of others at serious risk, or if information about a patient could be important in preventing or detecting a serious crime.

264
Q

In any circumstance where you decide to release confidential information, you must do what?

A

Document your reasons and be prepared to explain and justify your decision and actions.

265
Q

The adult support and protection act 2007 protects adults falling under what type of categories?

A
  1. Risk of harm
  2. 16 years or older
  3. Dementia
  4. Learning disability
  5. Physical impairment
266
Q

What is harm?

A

Harm can take many forms and could be due to another person taking advantage of the adult, could also be the adult unintentionally putting themselves at risk.

267
Q

The following list falls under which type of harm category.

  1. Theft
  2. Fraud
  3. Misuse of money, property or resources without informed consent
  4. Unexplained or sudden withdrawal of money from accounts
  5. Personal possessions or valuables going missing from the home
  6. Bills not being paid
  7. Pressure from family members or carers to decline care services
  8. Unusual purchases unrelated to the known interests of the adult at risk
A

Financial harm

268
Q

The following list falls under which type of harm category.

  1. Physical assault
  2. Bruising
  3. Abrasions
  4. Bites
  5. Burns
  6. Scalds
  7. Scars
  8. Fractures
A

Physical harm

269
Q

The following list falls under which type of harm category.

  1. Excessive shouting
  2. Bullying
  3. Humiliation
  4. Rejection
  5. Scapegoating
  6. Denigration of culture/religion/gender/sexuality/disability
  7. Demonstration of fear
  8. Denial of opportunities for appropriate socialisation
  9. Unrealistic expectations of the adult at risk of harm
A

Emotional/psychological harm

270
Q

The following list falls under which type of harm category.

  1. Incest/rape/acts of gross indecency
  2. Exploitation through prostitution
  3. FGM
  4. Recurrent STD’s
  5. Unexpected pregnancy
A

Sexual harm

271
Q

The following list falls under which type of harm category.

  1. Incest/rape/acts of gross indecency
  2. Exploitation through prostitution
  3. FGM
  4. Recurrent STD’s
  5. Unexpected pregnancy
A

Sexual harm

272
Q

The following list falls under which type of harm category.

  1. Failure to provide access to appropriate health care
  2. Withholding necessities such as nutrition, appropriate heating
  3. Lack of appropriate food or clothing
  4. Unhygienic home conditions
  5. Lack of protection or exposure to dangers
  6. Unnecessary delay in staff responses to resident’s requests
  7. Serious or persistent failure to meet the needs of the adult at risk
  8. Isolation and withdrawal from social activities
A

Neglect

273
Q

What are the three-point criteria which the legislation supports and protect.

A
  1. Adults who are at risk of harm
  2. More at risk because that are affected by disability, mental disorder, illness or physical or mental infirmity
  3. Unable to safeguard their own wellbeing, property rights or other interests
274
Q

Intervention is an adult’s affairs should only occur when?

A
  1. It will provide benefit to the adult, which could not reasonably be provided without intervention
  2. The chosen intervention is likely to succeed and is the least restrictive of the adults freedom
275
Q

When intervention is required, it is important to clarify your concerns?

A
  1. Why do I think this person is at risk of harm?
  2. What is the barrier to their safety?
  3. What do I know about the person’s history that causes concern?
  4. What factors indicate a risk of harm and in my opinion, are they severe enough to warrant immediate action?
  5. Are they at higher risk because they are affected by disability, mental disorder or illness?
276
Q

Patients who are vulnerable and do not ask for help, it is our duty to recognise signs, what are they?

A
  1. Injuries
  2. Explanations
  3. Behaviours
  4. Tone of voice
  5. Eye contact
277
Q

What are the three R’s reporting concerns?

A
  1. Recognise – signs of harm
  2. Record – believe. Listen. Take notes
  3. Report – tell someone*
278
Q

When your recording concerns what should be recorded?

A
  1. Was the adult with anyone? Who? Role/relationship?
  2. Observe behaviour(s) and physical signs
  3. Summary of discussions
  4. Record/draw/photograph injuries and reasons given for them
  5. Recognise historical patterns
  6. Distinguish historical patterns
  7. Distinguish between facts and opinion
279
Q

What should you never do when reporting concerns?

A
  1. Put yourself/team at risk of harm
  2. Attempt to confront an abuser
  3. Promise you will keep secrets for the victim
280
Q

It is NOT your responsibility to do when reporting concerns?

A
  1. Assess legislative criteria
  2. Investigate harm
  3. Seek proof
281
Q

Who do you report to when in immediate danger?

A

999

282
Q

Who do you report to when not in immediate danger?

A
  1. Speak to line manager/colleague/principle
  2. Follow workplace adult protection policy
  3. Speak to defence union/society for advice and support
  4. Preferable to get consent from patient but not always possible
  5. Call local health & social care partnership – Adult protection team
283
Q

What are the concerns about proxies?

A
  1. Welfare powers: contact social work
  2. Financial powers: OPG
  3. Advice: Mental Welfare Commission
284
Q

What are the six principles of adult safeguarding?

A
  1. Empowerment
  2. Prevention
  3. Proportionality
  4. Protection
  5. Partnership
  6. Accountability
285
Q

Domestic abuse (Scotland) act 2018 say that abuse comes in the form of:

A
  1. Physical
  2. Verbal
  3. Sexual
  4. Psychological
  5. Financial
286
Q

Statistics for domestic abuse indicate that of 5 domestic abuse incidents, of which were female victim?

A

4/5

287
Q

What is the age bracket that has the highest incident rate for both victims and accused?

A

26-30 years

288
Q

What percentage of all domestic abuse incidents occurred in the home or dwelling?

A

88%

289
Q

Coercive controlling behaviour designed to make a person’s dependent include?

A
  1. Isolation from support
  2. Exploiting them
  3. Depriving them of independence
  4. Regulating behaviour
290
Q

Coercive control creates a sense of fear that pervades all elements of a victims life
How does coercive control work?

A

It works to limit the victim’s human rights by depriving them of their liberty and reducing their ability for action.

291
Q

Human trafficking and exploitation act 2015 includes the following exploitation?

A
  1. Slavery
  2. Forced labour
  3. Prostitution
  4. Removal of organs
  5. Securing services and benefits
292
Q

What is the role of the dental team before a person undergoes cancer treatment?

A

Remove potential sources of infection so that cancer treatment can proceed without delay and to prevent future flareups.

293
Q

What are the complications that may affect receiving dental treatment after you have had head and neck surgery?

A
  1. Altered anatomy
  2. Altered appearance
  3. Difficult access for OH
  4. Trismus
  5. Fistula
294
Q

What are adjunctive cancer treatment if surgery was the primary treatment?

A
  1. Radiotherapy
  2. Chemotherapy
  3. Chemo-radiotherapy
295
Q

How does radiotherapy work?

A
  1. Uses ionizing radiation
  2. Radiation kills DNA of cancer cells
  3. Blunt tool
  4. Healthy cells destroyed too
  5. Salivary glands very sensitive
296
Q

What are the general side effects of radiotherapy?

A
  1. Fatigue
  2. Nausea
  3. Burns
  4. Pain
297
Q

What are the oral side effects of radiotherapy?

A
  1. Mucositis - in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth
  2. Xerostomia
  3. Radiation caries
  4. Periodontal disease
  5. Dysgeusia/ageusia – taste disorder all foods taste a specific way/ complete loss of taste function on tongue
  6. Trismus
  7. Osteoradionecrosis
298
Q

What is dysgeusia/ageusia?

A

Loss of one or more taste sensations, may recover after 9-18 months or may be permanent.

299
Q

What dental interventions can we do for some before they receive any form of cancer treatment?

A

Prevention is better than cure so the following is advised:

  1. Extraction of hopeless teeth
  2. Duraphat toothpaste and varnish
  3. Fluoride trays
  4. HPT (hygiene phase therapy)
  5. Therabite – handheld device to open and stretch your jaw
  6. Pharmaceuticals
  7. LLLT (low level laser therapy) – reduce inflammation and encourage bone and tissue growth.
300
Q

What qualifies for extraction of hopeless teeth?

A
  1. Gross caries
  2. Mobile teeth (grade 2 or >)
  3. Pockets 5mm and greater
  4. Periapical pathology
  5. Furcation involvement
301
Q

Use of Duraphat toothpaste and varnish is essential in the interventions for cancer treatment, what are the guidelines for them?

A
  1. 2 strengths: 2800ppm & 5000ppm
  2. Advice use x2 daily
  3. Supplement with varnish and mouthwash
  4. Caution if children in household
302
Q

What is a fluoride tray?

A

A custom made tray for the upper and lower dentition. The tray is filled with duraphat toothpaste or fluoride mousse and applied for a minimum 5min daily wear

303
Q

Hygiene phase therapy is essential and may lessen the severity of mucositis and should be tied in with duraphat varnish application. Hygiene phase therapy should be done before and after end of radiotherapy treatment.

A
304
Q

What does pentofooxifylline do?

A

Pentoxifylline improves the flow of blood through blood vessels. It is used to reduce leg pain caused by poor blood circulation. Pentoxifylline makes it possible to walk farther before having to rest because of leg cramps

305
Q

What can hyperbaric oxygen therapy help with?

A
  1. Hypoxia theory of ORN
  2. Increases oxygen to damaged bone
  3. Promotes healing?
306
Q

What is the downside to hyperbaric oxygen therapy?

A
  1. Not much evidence of effectiveness
  2. Not widely available
  3. Cost
  4. Compliance
307
Q

What can you consider if a patient is at risk of Osteoradionecrosis before radiotherapy?

A

Consider preventive prophylaxis

308
Q

What is a neoadjuvant?

A

chemotherapy is a neoadjuvant, its purpose is to first shrink a tumour before the main treatment, which is usually surgery.

309
Q

What is palliative chemotherapy?

A

palliative chemotherapy is defined as chemotherapy that is given in the non-curative setting to optimize symptom control, improve quality of life

310
Q

How does chemotherapy work?

A
  1. Using drugs to kill rapidly dividing cells
  2. Interferes with mitosis
  3. Interferes with apoptosis
  4. Interferes with tumour cell DNA
311
Q

What are the three chemotherapy drugs?

A
  1. Cisplatin - binds to the N7 reactive center on purine residues and as such can cause deoxyribonucleic acid (DNA) damage in cancer cells.
  2. Cetuximab - It works by blocking the function of a protein called the epidermal growth factor receptor
  3. TPF – combination of cancer drugs Taxotere, platinol, fluorouracil
312
Q

What are the general side effects of chemotherapy?

A
  1. Fatigue
  2. Nausea
  3. Vomiting and diarrhoea
  4. Skin rash
  5. Hair loss
  6. Thrombocytopenia
  7. Neutropenia
313
Q

What are the oral side effects of chemotherapy?

A
  1. Mucositis
  2. Infection
  3. Bleeding
  4. Temporary xerostomia?
314
Q

What is fear?

A

Fear is the physiological reaction to actual threat/danger

315
Q

What is anxiety?

A

Anxiety is the physiological reaction to perceived threat/danger

316
Q

What is phobia?

A

A phobia is a persistent and excessive fear of an object or situation that is not in fact dangerous.

317
Q

What are the types of anxiety disorders?

A
  1. Phobic anxiety disorders
  2. Panic disorder
  3. Generalised anxiety disorder (GAD)
  4. Post-traumatic stress disorder (PTSD)
  5. Adjustment Disorders
  6. Hypochondrial Disorders
318
Q

Patients who suffer from gagging have been loosely divided into 2 groups:

A
  1. Somatogenic group- those in whom physical stimulation produces the gagging reflex.
    What is the other group?
  2. Psychogenic group- those in whom the stimulation appears to be psychological in origin.
319
Q

What are the triggers to gagging?

A
  1. Tactile – exam, radiographs, imps, wearing dentures
  2. Gustatory – taste of impression material
  3. Olfactory – smell of the surgery
  4. Visual – sound of the handpiece
  5. Cognitions – memories of past events
320
Q

What are the contributing factors to gagging?

A
  1. Anatomical
  2. Medical
  3. Psychological
  4. Dental/iatrogenic
321
Q

Give an example of how anatomical factors can contribute to gagging?

A
  1. Variations in soft palate anatomy
  2. Resorption of the maxillary alveolar bone causing a shift in the upper denture base and loss of retention.
322
Q

Give an example of medical factors contributing to gagging?

A
  1. Nasal obstruction
  2. Post-nasal drip
  3. chronic catarrh
  4. heavy smoking
  5. gastric disorders
  6. MND
323
Q

Give an example of psychological factors contributing gagging?

A
  1. Influencing factors such as fear
  2. Stress
  3. Phobia
  4. Alcoholism
  5. In some patients the sight and sounds of clinical dentistry could trigger gagging
324
Q

Give an example of dental/iatrogenic factors contributing to gagging?

A
  1. Overloaded impression tray
  2. Denture design faults
  3. Gagging when manipulation of oral tissues
  4. Instruments
  5. Equipment
  6. Water spray/ water accumulation – in sensitive areas
325
Q

There are 5 intra-oral areas known as the trigger zone, what are they?

A
  1. Palatoglossal and palatopharyngeal folds
  2. Base of tongue
  3. Palate
  4. Uvula
  5. Posterior pharyngeal wall
326
Q

Although exact cause of phobia and anxiety are not known, they are generally considered to be learned fears, acquired through direct conditioning, what are those conditioning?

A
  1. Classic conditioning
  2. Operant conditioning
327
Q

Remember avoidance is a short term solution with long term consequences.

Our patients are often cognitively
aware of the problem with avoiding the dentist.

But they are up against these powerful biological and behavioural systems.

What are the emotions people with anxiety show?

A
  1. Dread
  2. Fear
  3. Shame
  4. Embarrassment
  5. Nervous
328
Q

What are the body reactions you expect to see with a patient with anxiety?

A
  1. Increased heart rate
  2. Dizziness
  3. Feeling sick/being sick
  4. Needing the loo
  5. Going pale/blushing
  6. Struggling to breathe/shortness of breath
  7. Tremor/shaking/shivering
  8. Sweating
  9. Cold to touch
  10. Dry mouth
329
Q

What are the behaviours you expect to see with a patient with anxiety?

A
  1. Fidgeting/Restlessness
  2. Speaking loudly/quietly
  3. Hesitating/avoidance
  4. Shaking
  5. Aggression
  6. Sitting on edge of chair, leaning forwards
  7. Leaving the surgery
  8. Pacing
  9. Frequent visits to bathroom
  10. Verbal abuse
  11. Excessive talking/making jokes
  12. Shutting down
  13. Not talking
  14. Making self look small
330
Q

What are the behaviours that you might not see directly with a patient with anxiety?

A
  1. Frequent cancellations
  2. Forgetting or missing appointments
  3. Avoiding periodic check-ups
  4. Arriving late
  5. Multiple trips to the bathroom whilst in waiting room
  6. Abnormal number of telephone calls
  7. Frequent questioning
  8. Numerous different excuses
  9. Unreasonable demands
  10. Multiple complaints
331
Q

50% of dentally fearful individuals said fear developed in?

A

childhood

332
Q

What are the features of phobic patients?

A
  1. 10% of the population
  2. Not unusual to seek help from their doctor
  3. Many will only seek an appointment when in severe or chronic pain
  4. Some forced by friend or relative
  5. Not unusual for them to flee from the waiting room.
333
Q

What is the vicious cycle of dental fear?

IMAGE X

A

DENTAL FEAR -> DELAYED VISITING -> DENTAL PROBLEMS -> SYMPTOM-DRIVEN TREATMENT

334
Q

Link Between Mental Health and Physical Health Outcomes

A
  1. Social inequality linked with poorer mental health
  2. Social inequality linked with poorer physical health
  3. Poorer mental health is linked with poorer physical health
  4. How does this apply in our population?
335
Q

Behavioural model proposes that anxiety is a behaviour that is learned, so therefore it can be?

A

Unlearned

336
Q

What is the treatment plan for anxiety?

A
  1. Assessment
  2. Psychoeducation
  3. Rationale for treatment
  4. Provide basic behavioural coping strategies
  5. Exposure
337
Q

The treatment plan for anxiety begins with assessment of their anxiety, what is assessed during this stage?

A
  1. Is it likely that they will be able to engage with treatment?
     Do they want to?
     Do they understand what it involves?
     Do they have time?
     Are they cognitively/developmentally able to?
  2. Motivation levels
  3. Who should provide the treatment?
338
Q

What is the range for the MIDS (modified dental anxiety scale)?

A

5-25

339
Q

What are the scales for the MIDAS?

A
  1. 5-9: no anxiety – low anxiety
  2. 10-18: moderate anxiety
  3. 19 or above significant dental anxiety/phobia
340
Q

What is the mean MIDAS score of a GDP population?

A

10.79

341
Q

For the psychoeducation for the anxiety treatment plan, what are you wanting to get through to patients?

A
  1. Underlying their anxiety or phobia
  2. Fight/flight/freeze, evolutionary theories, behavioural learning theories
  3. Try to communicate key messages
    - Anxiety is normal
    - There is treatment
  4. Rationale for treatment
  5. Use handouts
342
Q

What are three good coping strategies you can instil in your patient?

A
  1. Deep breathing
  2. Progressive muscular relaxation (PMR)
  3. Grounding
343
Q

What is grounding?

A

When we are anxious our minds tend to be in the past or future. Grounding refers to any technique that brings us to the present moment. Examples:
1. Grounding in the body
2. Name five things that are blue
3. Drink cold drink
4. Self-soothing exercises
5. Name where you are
6. Three things you can see, hear, touch…

344
Q

What is graded exposure?

A
  1. Establish feared situations
  2. Get patient to rank these from least anxiety provoking to most
  3. Start with those that provoke least anxiety and work up to those that provoke the most anxiety (keep in mind subclinical levels of anxiety)
  4. Expose patient to situation until their anxiety has reduced
  5. Move on to next feared situation
345
Q

What are other useful cognitive strategies?

A
  1. Distraction
  2. Modelling
  3. Assertiveness
  4. Self-reward
346
Q

What conditions must the medical history meet?

A
  1. MH must be taken in writing and signed by the patient
  2. MH must be checked at each visit
347
Q

When assessing the risk of a cardiac patient in dentistry what must you assess?

A
  1. Stable or unstable condition
  2. Take into account any and all co-morbidities
  3. Consider the ‘functional’ capacity
  4. Consider anxiety
  5. Consider procedure complexity and duration
348
Q

Ventricular septal defect (acyanotic) and tetralogy of fallout (cyanotic) are examples of what cardiac condition?

image x

A

Congenital

349
Q

What are the oral findings in patient with congenital cardiac conditions?

A
  1. Delayed eruption of both abnormalities
  2. Increased positional abnormalities
  3. Enamel hypoplasia
  4. Vasodilation of pulp
  5. Increased periodontal disease
  6. Increased caries
350
Q

What should we consider before treating someone with cardiac conditions?

A
  1. Anticoagulated
  2. Risk of infective endocarditis
  3. Hypertension with adrenaline containing products
351
Q

NICE 2016 guidelines stated that “antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental treatment” what does the SDCEP 2018 guideline state?

A

If unsure get advice

352
Q

What is ischaemic heart disease?

A

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

353
Q

What are the causes of atherosclerosis and hypertension?

A
  1. Smoking
  2. Lack of exercise
  3. Obesity
354
Q

What are the oral findings with cardiac conditions?

A
  1. More severe caries
  2. More severe periodontal disease
  3. Angina is a rare cause of pain in mandible/teeth
  4. Drugs used to manage may cause oral adverse effects
    - Lichenoid reactions
    - Gingival swelling
    - Angioedema
    - Ulcers
355
Q

Unstable angina patients should be treated where?

A

In an acute hospital setting

356
Q

Be aware of interaction between B blockers and?

A

Adrenaline in LA

357
Q

Defer treatment post myocardial infarction?

A

Min 6/12

358
Q

What is hypertension?

A

“BP consistently over 140/90mmHg”

359
Q

What are the treatment options for hypertension?

A
  1. Lifestyle changes
  2. Diuretic
  3. B blocker
  4. Ca channel blockers
  5. Statins
  6. Aspirin/clopidogrel
360
Q

Dental considerations: side effects of medications can impact upon oral health?

A
  1. Xerostomia
  2. Salivary gland pain/swelling
  3. Lichenoid reactions
  4. Angio-oedema
  5. Gingival hyperplasia
  6. Sore mouth
  7. Paraesthesia
361
Q

which medication is responsible for causing gingival hyperplasia?

A

Amlodipine

362
Q

what is orthostatic hypotension?

A

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when standing after sitting or lying down

363
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”

364
Q

what are the likely causes of cardiomyopathy?

A
  1. Genetic
  2. Viral infections
  3. Autoimmune
  4. Medications
365
Q

What are the treatment options for cardiomyopathy?

A
  1. Medications: B Blockers, anticoagulants, diuretics
  2. Pacemakers or ICD’s
  3. Surgery
  4. Transplant
366
Q

What is heart failure?

A

“ When the heart muscle is too weak or too stiff, so unable to pump blood effectively around body”

367
Q

Dental assessment pre-cardiac surgery is essential, under what conditions will you extract teeth?

A
  1. Severe periodontal disease
  2. Gross caries
  3. Apical pathology
368
Q

Patients who are receiving a transplant will be on lifelong what must you consider?

A
  1. Extract grossly carious teeth
  2. Extract severely periodontically involved teeth
  3. Extract any teeth with PA pathology
369
Q

Invasive treatment only after liaison with medical team after how long post transplant surgery?

A

2 years.

370
Q

What hormones does the renal system secrete?

A

Renin, erythropoietin, active vitamin D

371
Q

What are the features of chronic kidney disease?

A
  1. Kidney damage, or a reduction in GFR for 3 or more months.
  2. Increased risk of loss of kidney function
  3. More common in women than men
  4. Higher incidence in South Asian or African heritage
  5. Most common causes- diabetes, hypertension, glomerulonephritis. 75%
372
Q

What are the symptoms for early signs of chronic kidney disease?

A

No symptoms

373
Q

What tests can you do to assess kidney disease?

A

Blood test and urine test

374
Q

Symptoms are present when kidney function is at?

A

25% less than normal

375
Q

What are the stages of chronic kidney disease?

A
  1. Normal
    1 Early CKD
    2 Mild CKD
    3 Moderately severe
    4 Severe CKD
    5 End stage renal failure
376
Q

What are the clinical presentation of renal failure?

A

1 Depression, lethargy
2 Nausea, vomiting, anorexia
3 Weakness, fatigue
4 Peptic ulceration
5 Bruising
6 Diarrhoea
7 Bone pain

377
Q

What are the oral findings of CKD?

A

1 Osseous lesions
2 Dry mouth, metallic taste, halitosis
3 Reduced salivary flow, protein and electrolyte changes
4 Accelerated calculus production
5 Pale oral mucosa
6 Oedema, oral ulceration
7 Paraesthesia

378
Q

What are the two options for renal dialysis?

A
  1. Haemodialysis
  2. Peritoneal dialysis
379
Q

How is haemodialysis performed?

A
  1. Performed in health centres or hospitals
  2. Requires arterio-venous access
  3. Removes excess fluid and uraemic solutes
380
Q

How is peritoneal dialysis performed?

A
  1. Performed at home by patient or carer
  2. A catheter is placed in the peritoneal cavity
  3. Dialysis fluid is exchanged at regular intervals
381
Q

What are the considerations before you carry out any dental treatments undergoing renal dialysis?

A
  1. Bleeding
  2. Infection
  3. Drug interactions
  4. Toxicity and dosage
  5. Consult Renal Physician
  6. ?Antibiotic cover
  7. For extractions- FBC and coagulation screen.
  8. Best time for treatment is day after haemo-dialysis.
  9. Safest treatment is LA.
  10. Avoid aspirin and other NSAIDs
382
Q

What are the conditions once you have had a renal transplant?

A
  1. Lifelong immunosuppression
  2. Gingival hyperplasia
  3. Increased risk of oral tumours
  4. Candidiasis, herpes simplex
383
Q

How long do renal transplants last for?

A
  1. From living donor
  2. How well kidney is matched re blood group and tissue type
  3. Age and overall health of person
  4. 90% success at 1 yr
  5. 70% survival at 5 yrs
  6. Overall mortality of less than 5%
384
Q

Pre-renal transplant, what dental work needs to be carried out?

A
  1. Full dental assessment
  2. Extract teeth of poor prognosis
  3. Preventative regime
385
Q

What must you consider for dental treatment post transplant?

A
  1. Defer elective dental care for 6 months
  2. Consult with renal physician
  3. Delayed wound healing

Dentistry year 4: Module 7 (10 decks)

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