Special Care Dentistry

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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:

Answer 3

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

Question 4

What is the adults with incapacity act?

Answer 4

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.

Question 5

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

Answer 5

2005

Question 6

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?

Answer 6

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.

Question 7

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?

Answer 7

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”.

Question 8

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?

Answer 8

(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.

Question 9

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?

Answer 9

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

Question 10

An IQ less than 70 indicates what?

Answer 10

Learning disability

Question 11

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?

Answer 11

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

Question 12

What are the causes of learning disability?

Answer 12

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

Question 13

What is the most frequent genetic cause of learning impairment?

Answer 13

Down syndrome

Question 14

Which chromosome is responsible for down syndrome?

Answer 14

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

Question 15

Down syndrome is present in how many live births?

Answer 15

1 in 800

Question 16

What increases the chances of having an extra chromosome 21?

Answer 16

Increases with mother’s age.

Question 17

What are the physical features of down syndrome?

Answer 17

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

Question 18

Which image shows atlantoaxial instability?

image missing

Answer 18

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.

Question 19

What is Brachycephaly?

image missing

Answer 19

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.

Question 20

What are brushfield spots?

image x

Answer 20

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.

Question 21

What are the associated health conditions of down syndrome?

Answer 21

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

Question 22

What are the oral features of down syndrome?

Answer 22

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

Question 23

What is fragile x syndrome?

image x

Answer 23

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.

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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.

Question 26

What are the features of Cri du chat syndrome?

Answer 26

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

Question 27

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?

Answer 27

National Autistic Society

Question 28

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

Answer 28

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

Question 29

What are the characteristics of autism?

Answer 29

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

Question 30

What are the clinical presentation of autism?

Answer 30

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

Question 31

Some suspected risk factors for ASD include:

Answer 31

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)

Question 32

what are the oral findings in autistic patients?

Answer 32

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

Question 33

What are dental management of autistic patients

Answer 33

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

Question 34

What is sensory impairment?

Answer 34

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

Question 35

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

Answer 35

358,000

Question 36

Symptoms of visual impairment are?

Answer 36

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

Question 37

What is glaucoma? image x

Answer 37

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.

Question 38

What is the normal intraocular pressure?

Answer 38

15-20mmHg

Question 39

What is cataract? image x

Answer 39

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.

Question 40

What is macular degeneration? image x

Answer 40

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.

Question 41

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

Answer 41

Wet macular degeneration.

Question 42

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

Answer 42

Dry macular degeneration.

Question 43

What is diabetic retinopathy? image x

Answer 43

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.

Question 44

What is hemianopia? image x

Answer 44

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.

Question 45

What is trachoma?

Answer 45

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.

Question 46

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

Answer 46

11 million approx. 75% are > 60 years old

Question 47

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

Answer 47

Excessive noise (prolonged loud noise/industrial deafness)

Question 48

What are the symptoms of hearing impairment in children?

Answer 48

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

Question 49

What are the signs and symptoms of hearing loss?

Answer 49

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

Question 50

What are the three types of hearing aids available? image x

Answer 50

1. Behind the ear hearing aids 2. In the ear hearing aids 3. In the canal hearing aids

Question 51

What are the 4 types of hearing implants?

Answer 51

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

Question 52

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 –

Answer 52

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

Question 53

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

Answer 53

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

Question 54

What is a physical disability?

Answer 54

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

Question 55

What are the causes of physical disabilities?

Answer 55

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

Question 56

What is osteogenesis imperfecta?

Answer 56

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

Question 57

What is dentinogenesis imperfecta?

Answer 57

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

Question 58

What is spina bifida? image x

Answer 58

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.

Question 59

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

Answer 59

1st month of intrauterine life.

Question 60

What is the cause of spina bifida?

Answer 60

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

Question 61

What are the complications of spina bifida?

Answer 61

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

Question 62

What is cerebral palsy?

Answer 62

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)

Question 63

What are the early detection signs for cerebral palsy?

Answer 63

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

Question 64

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

Answer 64

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

Question 65

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

Answer 65

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

Question 66

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

Answer 66

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

Question 67

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

Answer 67

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

Question 68

What are the clinical features of a CVA – stroke?

Answer 68

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

Question 69

What are the implications of stroke on dental health?

Answer 69

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

Question 70

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

Answer 70

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

Question 71

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: -

Answer 71

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

Question 72

What is domiciliary care?

Answer 72

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

Question 73

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

Answer 73

Valid consent

Question 74

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?

Answer 74

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

Question 75

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

Answer 75

1. Open questions 2. Chunk and check 3. Teach back

Question 76

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

Answer 76

Adults with incapacity act applies.

Question 77

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?

Answer 77

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

Question 78

What is a proxy?

Answer 78

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

Question 79

What is power of attorney?

Answer 79

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

Question 80

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

Answer 80

Embossed seal.

Question 81

do you need to check each PoA document?

Answer 81

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

Question 82

When can Power of Attorney be granted?

Answer 82

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

Question 83

When do Power of Attorneys expire?

Answer 83

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

Question 84

When are guardians granted? Granted when an adult either:

Answer 84

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

Question 85

How does a person get a guardian?

Answer 85

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

Question 86

What are the types of guardian powers?

Answer 86

1. Financial/property 2. Welfare 3. Both

Question 87

What is an intervener?

Answer 87

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

Question 88

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

Answer 88

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

Question 89

Who can consent for dental treatment?

Answer 89

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.

Question 90

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

Answer 90

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

Question 91

What is the definition of dementia?

Answer 91

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.

Question 92

What is the incidence of dementia in UK 2019?

Answer 92

900,00

Question 93

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

Answer 93

1.6 million

Question 94

What is the incidence rate of dementia around the globe

Answer 94

57.4 million

Question 95

1 in 3 people will develop dementia by what age?

Answer 95

65

Question 96

1 in 6 people will have dementia by what age?

Answer 96

80

Question 97

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

Answer 97

The rise in dementia

Question 98

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

Answer 98

Just over 25K

Question 99

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

Answer 99

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

Question 100

What are the risk factors for dementia?

Answer 100

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

Question 101

What are the medical risk factors for dementia?

Answer 101

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

Question 102

What are the lifestyle risk factors for dementia?

Answer 102

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

Question 103

Which sports have the highest incident of head injuries?

Answer 103

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

Question 104

What is chronic traumatic encephalopathy?

Answer 104

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.

Question 105

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?

Answer 105

3.5x

Question 106

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?

Answer 106

5x

Question 107

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

Answer 107

Under 12

Question 108

How can you reduce the risk factors of developing dementia?

Answer 108

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

Question 109

There are 5 types of dementia, what are they?

Answer 109

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

Question 110

Alzheimer’s disease accounts for what percentage of dementia?

Answer 110

62%

Question 111

How does Alzheimer’s disease present with?

Answer 111

Short-term memory loss and word-finding difficulties

Question 112

As Alzheimer’s progresses how does it present?

Answer 112

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

Question 113

What are amyloid plaques?

Answer 113

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

Question 114

What are tangles – tau protein?

Answer 114

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.

Question 115

What is acetylcholine?

Answer 115

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

Question 116

Which neurotransmitter is decreased In Alzheimer’s?

Answer 116

acetylcholine

Question 117

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

Answer 117

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).

Question 118

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

Answer 118

gingivitis and periodontal disease.

Question 119

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

Answer 119

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

Question 120

Vascular dementia accounts for how many patients with dementia?

Answer 120

17% of cases

Question 121

What causes vascular dementia?

Answer 121

Caused by a reduced blood flow to the brain

Question 122

When is vascular dementia usually diagnosed?

Answer 122

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

Question 123

What percentage of dementia is mixed dementia?

Answer 123

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

Question 124

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

Answer 124

Alzheimer’s

Question 125

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

Answer 125

4% cases

Question 126

What are Lewy Bodies?

Answer 126

Are small deposits of protein in nerve cells

Question 127

Lewy-Body dementia is associated with which disease?

Answer 127

Parkinson’s disease

Question 128

Presentation of Lewy-Body dementia is dependant on what? image x

Answer 128

Presentation on which part of the brain is affected.

Question 129

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

Answer 129

Motor problems

Question 130

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

Answer 130

Cognitive symptoms

Question 131

What is frontotemporal dementia?

Answer 131

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).

Question 132

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

Answer 132

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

Question 133

How do you diagnose dementia?

Answer 133

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.

Question 134

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

Answer 134

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

Question 135

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

Answer 135

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

Question 136

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

Answer 136

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

Question 137

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

Answer 137

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

Question 138

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

Answer 138

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

Question 139

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

Answer 139

Targets amyloid

Question 140

Why do people experience dementia differently?

Answer 140

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

Question 141

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

Answer 141

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

Question 142

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

Answer 142

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

Question 143

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

Answer 143

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

Question 144

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

Answer 144

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

Question 145

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

Answer 145

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

Question 146

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

Answer 146

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

Question 147

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

Answer 147

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

Question 148

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

Answer 148

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

Question 149

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

Answer 149

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

Question 150

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

Answer 150

Behavioural management

Question 151

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

Answer 151

GA

Question 152

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?

Answer 152

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

Question 153

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

Answer 153

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

Question 154

What can help dementia patients reduce their need for medication?

Answer 154

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

Question 155

Which sense is the last to go for dementia patients?

Answer 155

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

Question 156

What are the best tips to help cope with dementia?

Answer 156

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

Question 157

What can you do to male your home dementia friendly?

Answer 157

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

Question 158

What are the 4 stages of normal haemostasis?

Answer 158

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

Question 159

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

Answer 159

1. Failed platelet production 2. Excessive platelet destruction 3. Abnormal platelet function

Question 160

What is thrombocytopenia?

Answer 160

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

Question 161

What is the normal platelet level?

Answer 161

150 – 300 x10 9/l

Question 162

What can cause thrombocytopenia?

Answer 162

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

Question 163

What is Idiopathic thrombocytopenic purpura?

Answer 163

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

Question 164

What is Glanzmann?

Answer 164

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

Question 165

What does Glanzmann affect?

Answer 165

Platelet aggregation

Question 166

What is epistaxis?

Answer 166

Nose bleeds

Question 167

What is menorrhagia?

Answer 167

Heavy menstrual bleeding

Question 168

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

Answer 168

Haematology, a full FBC prior to procedure

Question 169

What is the required platelet level before for an extraction?

Answer 169

50x10 9/l

Question 170

What is the required platelet level for major surgery?

Answer 170

70x10 9/l

Question 171

How do steroids regulate bleeding?

Answer 171

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.

Question 172

What is eltrombopag?

Answer 172

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

Question 173

What is tranexamic acid?

Answer 173

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.

Question 174

How many clotting factors are there?

Answer 174

12 clotting factors

Question 175

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

Answer 175

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

Question 176

What autosomal disease is VWD?

Answer 176

Autosomal dominant

Question 177

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

Answer 177

Tranexamic acid and desmopressin

Question 178

What is desmopressin?

Answer 178

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

Question 179

How can desmopressin be delivered?

Answer 179

1. Intravenous 2. Intramuscular 3. Subcutaneous 4. Intranasal

Question 180

What is haemophilia?

Answer 180

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.

Question 181

Who are affected with haemophilia?

Answer 181

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

Question 182

Which factor is deficient in Haemophilia A?

Answer 182

factor VIII 1/5000 live male births

Question 183

Which factor is deficient in Haemophilia B?

Answer 183

factor IX 1/20000 live male births

Question 184

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

Answer 184

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

Question 185

What are the symptoms of haemophilia?

Answer 185

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

Question 186

What is a haematoma?

Answer 186

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

Question 187

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

Answer 187

Administer factor concentrate which helps them to be independent.

Question 188

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

Answer 188

factor concentrates

Question 189

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

Answer 189

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

Question 190

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

Answer 190

Liaise with haemophilia centre to organise factor replacement therapy.

Question 191

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

Answer 191

Use of buccal Articaine

Question 192

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

Answer 192

No

Question 193

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

Answer 193

TA mouthwash

Question 194

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

Answer 194

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

Question 195

What are the challenges of patients with bleeding disorders?

Answer 195

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

Question 196

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

Answer 196

1. Leukaemia 2. Lymphoma 3. Myeloma

Question 197

Name the 7 types of cells of the blood?

Answer 197

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

Question 198

What is myeloma? image x

Answer 198

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.

Question 199

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

Answer 199

Myeloma

Question 200

What age does myeloma affect people?

Answer 200

Mainly affects people aged over 60 Multiple myeloma usually presents many years before symptoms.

Question 201

The cause of multiple myeloma can be related to what?

Answer 201

Radiotherapy or petroleum products

Question 202

What is the function of plasma cells?

Answer 202

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.

Question 203

How does multiple myeloma affect the bone?

Answer 203

Bone infiltration and destruction

Question 204

What are the presentations of multiple myeloma?

Answer 204

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

Question 205

How does multiple myeloma affect the renal system?

Answer 205

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

Question 206

Dental aspects of multiple myeloma include?

Answer 206

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

Question 207

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

Answer 207

1. Steroids 2. Bisphosphonates 3. Biological therapies

Question 208

What is leukemia?

Answer 208

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.

Question 209

What are the four types of leukemia?

Answer 209

1. Acute lymphoblastic leukaemia 2. Acute myeloid leukaemia 3. Chronic lymphocytic leukaemia 4. Chronic myeloid leukaemia

Question 210

Which of the acute leukaemia is commonest in children?

Answer 210

Acute lymphoblastic leukaemia

Question 211

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

Answer 211

Poor

Question 212

which chronic or acute leukaemia have a better prognosis?

Answer 212

chronic.

Question 213

Which cells proliferate in chronic leukaemia?

Answer 213

Proliferation of more mature cells.

Question 214

Chronic leukaemia is otherwise asymptomatic however patients may present with?

Answer 214

Splenomegaly and lymph node enlargement.

Question 215

What are the dental aspects of leukaemia?

Answer 215

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

Question 216

What is lymphoma? image x

Answer 216

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

Question 217

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

Answer 217

Hodgkins and non hodgkins

Question 218

What are the symptoms of lymphoma?

Answer 218

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

Question 219

Which lymphoma develops from B lymphocytes?

Answer 219

Hodgkin’s lymphoma

Question 220

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

Answer 220

Characterised by reed-sternberg cells

Question 221

Hodgkin’s lymphoma affect which category of adults?

Answer 221

Young adults and people over 75.

Question 222

How is Hodgkin’s lymphoma treated?

Answer 222

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

Question 223

Non-Hodgkin’s lymphoma affects which lymphocytes?

Answer 223

B lymphocytes or T lymphocytes

Question 224

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

Answer 224

More than 30 types

Question 225

Non-Hodgkin’s lymphoma affects which age group?

Answer 225

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

Question 226

Treatment of lymphoma depends on what?

Answer 226

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

Question 227

What is the treatment plan for low grade lymphoma?

Answer 227

Watch and wait

Question 228

What is the treatment option for high grade lymphoma?

Answer 228

Chemotherapy, radiotherapy, monoclonal antibody therapy – rituximab

Question 229

What is myelodysplasia?

Answer 229

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.

Question 230

Myelodysplasia is most common in adults over the age of?

Answer 230

70

Question 231

Myelodysplasia can develop in which type of cancer?

Answer 231

Acute myeloid leukaemia

Question 232

What are the symptoms of myelodysplasia?

Answer 232

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

Question 233

What are the treatment options for myelodysplasia?

Answer 233

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

Question 234

What is advised before treating patients with blood cancers?

Answer 234

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

Question 235

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

Answer 235

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

Question 236

What is MRONJ?

Answer 236

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.

Question 237

What qualifies as MRONJ?

Answer 237

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.

Question 238

What are the symptoms of MRONJ?

Answer 238

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

Question 239

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

Answer 239

1% (1 case per 100)

Question 240

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

Answer 240

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

Question 241

What are the risk factors for MRONJ?

Answer 241

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

Question 242

What drugs increase the risk of MRONJ?

Answer 242

1. Bisphosphonates 2. RANKL inhibitors 3. Anti-angiogenic drugs

Question 243

Bisphosphonates affect osteoclasts or osteoblasts?

Answer 243

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

Question 244

Bisphosphonates most commonly used for?

Answer 244

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

Question 245

What is the positive effect of bisphosphonates?

Answer 245

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

Question 246

Bisphosphonates have a high affinity to what?

Answer 246

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

Question 247

What is the half life of alendronate?

Answer 247

10 years

Question 248

How does bisphosphonates affect the blood supply of bone?

Answer 248

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

Question 249

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

Answer 249

Orally

Question 250

Bisphosphonates such as pamidronate, zolendronic acid are administered how?

Answer 250

IV

Question 251

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

Answer 251

Inhibits osteoclast function and bone resorption.

Question 252

What is the function of RANKL inhibitors?

Answer 252

Reduce risk of fracture and chronic pain in osteoporosis

Question 253

How often is Denosumab administered for osteoporosis?

Answer 253

Given 6 monthly for osteoporosis

Question 254

How often is Denosumab administered for cancer treatment?

Answer 254

Given every month

Question 255

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

Answer 255

9 months

Question 256

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

Answer 256

Anti-angiogenic restrict the growth of tumour blood vessels

Question 257

Lenalidomide, aflibercept, sunitinib are examples of which drugs?

Answer 257

Anti-angiogenic drugs

Question 258

Is there a drug holiday for bisphosphonates?

Answer 258

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

Question 259

What is the guidance for drug holiday for denosumab?

Answer 259

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

Question 260

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?

Answer 260

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

Question 261

Which act helps identify adults at risk?

Answer 261

Adults support and protection act 2007

Question 262

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?

Answer 262

the appropriate social care agencies or the police.

Question 263

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?

Answer 263

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.

Question 264

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

Answer 264

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

Question 265

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

Answer 265

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

Question 266

What is harm?

Answer 266

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.

Question 267

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

Answer 267

Financial harm

Question 268

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

Answer 268

Physical harm

Question 269

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

Answer 269

Emotional/psychological harm

Question 270

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

Answer 270

Sexual harm

Question 271

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

Answer 271

Sexual harm

Question 272

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

Answer 272

Neglect

Question 273

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

Answer 273

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

Question 274

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

Answer 274

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

Question 275

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

Answer 275

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?

Question 276

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

Answer 276

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

Question 277

What are the three R’s reporting concerns?

Answer 277

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

Question 278

When your recording concerns what should be recorded?

Answer 278

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

Question 279

What should you never do when reporting concerns?

Answer 279

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

Question 280

It is NOT your responsibility to do when reporting concerns?

Answer 280

1. Assess legislative criteria 2. Investigate harm 3. Seek proof

Question 281

Who do you report to when in immediate danger?

Answer 281

999

Question 282

Who do you report to when not in immediate danger?

Answer 282

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

Question 283

What are the concerns about proxies?

Answer 283

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

Question 284

What are the six principles of adult safeguarding?

Answer 284

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

Question 285

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

Answer 285

1. Physical 2. Verbal 3. Sexual 4. Psychological 5. Financial

Question 286

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

Answer 286

4/5

Question 287

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

Answer 287

26-30 years

Question 288

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

Answer 288

88%

Question 289

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

Answer 289

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

Question 290

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

Answer 290

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

Question 291

Human trafficking and exploitation act 2015 includes the following exploitation?

Answer 291

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

Question 292

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

Answer 292

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

Question 293

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

Answer 293

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

Question 294

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

Answer 294

1. Radiotherapy 2. Chemotherapy 3. Chemo-radiotherapy

Question 295

How does radiotherapy work?

Answer 295

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

Question 296

What are the general side effects of radiotherapy?

Answer 296

1. Fatigue 2. Nausea 3. Burns 4. Pain

Question 297

What are the oral side effects of radiotherapy?

Answer 297

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

Question 298

What is dysgeusia/ageusia?

Answer 298

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

Question 299

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

Answer 299

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.

Question 300

What qualifies for extraction of hopeless teeth?

Answer 300

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

Question 301

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

Answer 301

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

Question 302

What is a fluoride tray?

Answer 302

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

Question 303

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.

Question 304

What does pentofooxifylline do?

Answer 304

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

Question 305

What can hyperbaric oxygen therapy help with?

Answer 305

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

Question 306

What is the downside to hyperbaric oxygen therapy?

Answer 306

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

Question 307

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

Answer 307

Consider preventive prophylaxis

Question 308

What is a neoadjuvant?

Answer 308

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

Question 309

What is palliative chemotherapy?

Answer 309

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

Question 310

How does chemotherapy work?

Answer 310

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

Question 311

What are the three chemotherapy drugs?

Answer 311

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

Question 312

What are the general side effects of chemotherapy?

Answer 312

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

Question 313

What are the oral side effects of chemotherapy?

Answer 313

1. Mucositis 2. Infection 3. Bleeding 4. Temporary xerostomia?

Question 314

What is fear?

Answer 314

Fear is the physiological reaction to actual threat/danger

Question 315

What is anxiety?

Answer 315

Anxiety is the physiological reaction to perceived threat/danger

Question 316

What is phobia?

Answer 316

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

Question 317

What are the types of anxiety disorders?

Answer 317

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

Question 318

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

Answer 318

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.

Question 319

What are the triggers to gagging?

Answer 319

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

Question 320

What are the contributing factors to gagging?

Answer 320

1. Anatomical 2. Medical 3. Psychological 4. Dental/iatrogenic

Question 321

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

Answer 321

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.

Question 322

Give an example of medical factors contributing to gagging?

Answer 322

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

Question 323

Give an example of psychological factors contributing gagging?

Answer 323

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

Question 324

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

Answer 324

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

Question 325

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

Answer 325

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

Question 326

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?

Answer 326

1. Classic conditioning 2. Operant conditioning

Question 327

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?

Answer 327

1. Dread 2. Fear 3. Shame 4. Embarrassment 5. Nervous

Question 328

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

Answer 328

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

Question 329

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

Answer 329

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

Question 330

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

Answer 330

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

Question 331

50% of dentally fearful individuals said fear developed in?

Answer 331

childhood

Question 332

What are the features of phobic patients?

Answer 332

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.

Question 333

What is the vicious cycle of dental fear? IMAGE X

Answer 333

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

Question 334

Link Between Mental Health and Physical Health Outcomes

Answer 334

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?

Question 335

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

Answer 335

Unlearned

Question 336

What is the treatment plan for anxiety?

Answer 336

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

Question 337

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

Answer 337

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?

Question 338

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

Answer 338

5-25

Question 339

What are the scales for the MIDAS?

Answer 339

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

Question 340

What is the mean MIDAS score of a GDP population?

Answer 340

10.79

Question 341

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

Answer 341

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

Question 342

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

Answer 342

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

Question 343

What is grounding?

Answer 343

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...

Question 344

What is graded exposure?

Answer 344

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

Question 345

What are other useful cognitive strategies?

Answer 345

1. Distraction 2. Modelling 3. Assertiveness 4. Self-reward

Question 346

What conditions must the medical history meet?

Answer 346

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

Question 347

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

Answer 347

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

Question 348

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

Answer 348

Congenital

Question 349

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

Answer 349

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

Question 350

What should we consider before treating someone with cardiac conditions?

Answer 350

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

Question 351

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?

Answer 351

If unsure get advice

Question 352

What is ischaemic heart disease?

Answer 352

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

Question 353

What are the causes of atherosclerosis and hypertension?

Answer 353

1. Smoking 2. Lack of exercise 3. Obesity

Question 354

What are the oral findings with cardiac conditions?

Answer 354

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

Question 355

Unstable angina patients should be treated where?

Answer 355

In an acute hospital setting

Question 356

Be aware of interaction between B blockers and?

Answer 356

Adrenaline in LA

Question 357

Defer treatment post myocardial infarction?

Answer 357

Min 6/12

Question 358

What is hypertension?

Answer 358

“BP consistently over 140/90mmHg”

Question 359

What are the treatment options for hypertension?

Answer 359

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

Question 360

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

Answer 360

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

Question 361

which medication is responsible for causing gingival hyperplasia?

Answer 361

Amlodipine

Question 362

what is orthostatic hypotension?

Answer 362

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

Question 363

what is cardiomyopathy?

Answer 363

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

Question 364

what are the likely causes of cardiomyopathy?

Answer 364

1. Genetic 2. Viral infections 3. Autoimmune 4. Medications

Question 365

What are the treatment options for cardiomyopathy?

Answer 365

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

Question 366

What is heart failure?

Answer 366

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

Question 367

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

Answer 367

1. Severe periodontal disease 2. Gross caries 3. Apical pathology

Question 368

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

Answer 368

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

Question 369

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

Answer 369

2 years.

Question 370

What hormones does the renal system secrete?

Answer 370

Renin, erythropoietin, active vitamin D

Question 371

What are the features of chronic kidney disease?

Answer 371

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%

Question 372

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

Answer 372

No symptoms

Question 373

What tests can you do to assess kidney disease?

Answer 373

Blood test and urine test

Question 374

Symptoms are present when kidney function is at?

Answer 374

25% less than normal

Question 375

What are the stages of chronic kidney disease?

Answer 375

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

Question 376

What are the clinical presentation of renal failure?

Answer 376

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

Question 377

What are the oral findings of CKD?

Answer 377

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

Question 378

What are the two options for renal dialysis?

Answer 378

1. Haemodialysis 2. Peritoneal dialysis

Question 379

How is haemodialysis performed?

Answer 379

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

Question 380

How is peritoneal dialysis performed?

Answer 380

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

Question 381

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

Answer 381

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

Question 382

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

Answer 382

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

Question 383

How long do renal transplants last for?

Answer 383

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%

Question 384

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

Answer 384

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

Question 385

What must you consider for dental treatment post transplant?

Answer 385

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