Special Care Dentistry Flashcards
Diagnosis tools for dementia
Blessed dementia scale
Detailed cognitive testing
Mini mental state
Dementia screen to treat causes - FBC, U&E’s, kidney, thyroid, folate, calcium, protein, urainylis, serum
Early stages of dementia
short term mermory loss
confusion
poor judgement
unwilling to make decisions
communication issues
inability to manage everyday tasks
Middle stages of dementia
reminders to eat
fail to recognise people
increase forgetfulness
distress
aggression
anger
wandering
getting lost
hallicinations
throw backs
behave inappropraitely
Late stages of dementia
symptoms progressive and irreversible
unable to recognise objects, surrounding, people
incontinence and loss of speech
physical fraility
difficulty in eating, swallowing, weight loss
Treatment for dementia
counselling
NSAIDs
Aspirin and reducing cardiac risks
Vit E
Multi disciplinary team for dementia
Demntia nurses
GP
Consultant
Community nurses
Carers
Pharmacy
Nursing home staff
Care home dementia friendly places
walls, floors, skirting boards, different colours
lables on drawers
WC visible from bed
Radiator low temp
furnitiure traditional and domestic
personal pics and items
Healthcare dementia friendly places
natural light
reception desk visible
pictorial elements
avoid non essential signs
signage eye level
simple text and colour
colour and tone of walls distintive form flooring
locked rooms same colour as walls to avoid attention
What is dementia
deteriorination in cognitive function beyond whay is expected from normal ageing
What does dementia affect
memory
thinking
communication
learning
comprehension
language
calculation
orientation
Alzheimer’s
reduction in size of cortex, severe in hippocampus
Caused by protein fragments that build up in the spaces between nerve cells
Features of alzheimers
short term memory loss
loss of confidence
communication probs
withdrawn
mood swings
aphasia
Factors for alzheimer’s
age
women > men
head injury
lifestyle - smoking, hypertension, low folate
Vascualr dementia
reduced blood flow to the brain which damages and kills brian cells
Due to narrowing and blockage of small blood vessels in brain
Underlying conditions causing vascualr dementia
high blood pressure
smoking
overweight
diabetes
Features of vascular dementia
delusion
seizures
vispatial difficulties
anxiety
memory loss
Dementia with lewy bodies
desposits of abnormal proteins inside the brain cells, build up in areas responsible for memory and muscle movement
Features of dementia with lewy bodies
short term memory loss
sleep disorders
delusions
motor disorders
speech and swaollowing
cognitive issues
Frontotemporal
protein TDP-43 - abiqitin associated with clumps of protein
Younger age, changes in personaility, difficulties with language
Features of frontotemporal dementia
personality changes
mutism
reptition in words
decline in personal and social conduct
Incapable means
acting
making decisions
commnuicating decision
understanding decisions
retaining memory of decisions
Assessing capacity
capable of making and communicating choice
memory abilites
understand nature of what is being asked
asare of alterantives/risks/benefits
aware of personal revlance to them
not under influence from anyones
Who can you consultant with if erson has incapacity
nearest relative and primary care of adult
guardian, continuing attorney, welfare attorney
person sheriff decides
medical and dental practioners under 47 AWI act`
Who can supply certificates of incapity
medical practioner responsible for pt care
registered nurses
optometirsts
consultant in charge of pt care
dental practioners if specialised training
Welfare power of attorney
powers only come into effect when person incapable of making decisions
matters relating to health and personal
registered with office of public guardian
Continuing power of attorney
only covers finicial affairs and properties
Guardianship orders
court appointed
requires 2 medical reports
deals with property, finiance, martial affiars
appointed for 3 years
(person has no capacity)
Aim of adults with incapacity act 2000
to protct people who lack capcity to make decisons and support involvemtn in making decisions
Principles of AWI act
benefit
minimium intervention
take account wishes of adult
consultation with revelvant others
encourage adult to exercise resiudual capacity
Recognising substance abuse
tremors
less reliable
mood and behavioural changes
puncture marks, scars over veins
impacted ability to drive
requesting specific drugs
constricted or dilated pupils
detoriation in appearance and hyg
Medical issues relating to substance abuse
increased infection risk
general health neglect and OH
IE
Venous thrombosis
chronic liver disease in alcohol abuse
Cannabis and LA
Prolonged acute tachycardia
Alcohol and LA
LA metabolised in liver - 2 cartridges max of articaine
What is a drug
med or other substance which has physiological effect when injected into the body
Why do you avoid IV sedation
as alcohol/opoids synergestic effect
collapse of veins
Dental implications of substance abuse
ramptant caries
perio disease
NCTSL
trauma
infection
poor OH and denture hyg
oral cancer
hyposalivation
masseteric hypertrophy - bruxism
Alcohol issues and dental
early appts
glossitis
sialosis
erosion
dry mouth
bone marrow suppresion
impaired wound healing
avoid NSAID and aspirin
caries
perio
NCTSL
Avoid GA as increases vomiting
Rhirophygma - thickening of skin around nose
Why avoid metro with alcohol issues
inhibits breakdown of acid aldehyde causing vasodilation, nausea, headaches
Opiates
immediate effect of euphoria
analgesics may be ineffective
Methadone
high sugar so increased caries risk
prescribed by pharmacy
Cocaine
palatal and nasal septum perforation due to acidic nature of vasconstrictor
interaction with LA - delay tx 6-24hrs after adminstration
Signs of liver disease
jaudnice
ascites
clubbing
bleeding
spider naevi
oesophagela varices
palmer erythema
Casues of liver disease
infective - Hep A,B,C,D
non infective - alcohol related, drug induced, non alcoholic fatty liver disease, autoimmune, carcinoma
Stages of liver disease
Hepatitis - inflammation of liver which is reversible
Cirrhosis - irreversible liver necrosis and fibrosis
Failure - failure of normal function
Blood tests for liver disease
FBC
LFT
U&E’s
cogulation screening
What clotting factors is the liver responsible for
I, II, VII, IX, X, XI
Liver disease and thrmocytopenia
reduced roduction of thrombopoetin
anti cancer agents
bone marrow suppersion by hep C
antiviral tx with inteferon blind therapy
Why avoid IV sedation with liver disease
induces coma
What drugs to avoid with liver disease
avoid NSAIDs - as unable to metablosie, increase bleeding risk
What antibiotics do you avoid with liver disease
metro
erythromycin
Anticogulants for pt requiring renal analysis
heparin
Water leaves by osmosis at
loop of henle
Surplus of waste ion and molceues flow out as urine at
collecting tububles
Actively resorbs glucose, amino acids and salts
promximal convulated tubule
Na is redeemed by active transport and water loss at
distal convulated tubulue
Side effects of chemo
nasuea
vomiting
diarrhea
fatigue
loss of apeptite
fever
hair loss
mouth sores
dry mouth
tooth decay
infeciton
oral mucositis
reproduction function damaged
Chemo blood tests
WBC
RBC
Platelets
leuopenia
neutropenia
Side effects of radiotherapy
occurs only in area being irradiated
trismus
loss of taste (hypogeusia) - radiation of taste buds
Mucisitis
inflammation and ulceration leading to pain
7-14 days after drug therapy
Tx for mucosistis
morphine/ low laser light therapy
aloe vera, CHX
Honey
Na Bicarb
tea tree oil, topical ligno
gelclair
saline
cooling ice
Grading scale for mucositits
0 = none
1= mild - oral soreness and erythema
2 = moderate - erythema, ulcers
3 = severe - oral ulcers, liquid diet
4 = life theratening
Sign and symptoms of oral cancer
unexplained lump >3wks
persisitent pain in throat > 3wks
persisiten hoarseness > 3wks
red or mixed patches on oral mucosa > 3wks
ulceration or unexplained swelling in mucosa >3wks
deep ulcer
rolled margins
firm and hard
erythema
dysphagia and odynophagria > 3wks
Risk factors for oral cancer
smoking
alcohol
betel quid
nutrition
HPV
sociecominic factors
poor OH and dental health
Multi disciplnary team for cancer
Oncologist
chemo nurse
pathologist
surgeon
High risk sites for oral cancer
FOM
oropharynx
palate
labial and buccal mucosa
lateral and venetral surface of tongue
Pre malginant conditions
leaukoplakia
erythroplakia
lichen planus
submucous fibrosis
palatal keratosis
SCC arising in pre exisitng actininc keratosis
Post tx for oral cancer
diet
OH
High fluoride
stop smoking
trismus
fluoride trays
tooth mousse
Osteoradionecorsis
damage of bone and jaw
>60 Gy
Prevention of osteoradionecrosis
remove teeth of doubtful prognosis
liase with oncologist
XLA’s 10-14days prior to radio
Saline irrigation
antibiotics
antimicrobials
Why might you have the inability to achieve heamostasis?
medications
disease - heamophillia, von willebrand
liver disease
infections - HIV, hep C
Chronic renal failure
Chemo
Safe dental procedures for haemophillia
exams
supra ging restorations
crowns/bridges with inf LA
use articaine infs and intraligamental to avoid IDBs
Procedures carried out in haemophillic centre
xlas
surgicals
subging scaling
LA -idb or lingual inf
Mild or von willebrand treatment
DDAVP
consdier antibiotics
Moderate or severe heamophillia treatment
factor replacement - tranexamic acid (inhibits the breakdown of fibrin in blood clots)
Haemophilia A
deficiency in factor 8
Haemophillia B
defiency in factor 9 - x linked recessive
Von willebrand
factor VIII levels reduced
abnormal plasma proteins
Bloods tests for bleeding disorders
FBC
LFT
Thrmobophilli and haemophilli factor screen
Cogualation screening - prothrmobin and activated partial thromboplastin time
The types of severity of haemophilia
mild - 6-40% factor present
moderate = 2.5% factor present
severe = <=1% factor present
Thromobocytopenia
low platelet count <80
Hemarthrosis
bleeding into the joint space and associated with haemophillia pts
Prothrombin time
measures factors VII, X, V, prothrombin and firbronogen I, II
deranged in liver disease or warfarint therapy
Activated partial thrmoboplastin time
measures factors VII, IX, XI, XII, X, V, prothrmobin and fibrnogen
deraanged in heamophillia
INR
prothrobin time/ reference PT plasma
What is warfarin
vit k anticogualant that inhibits Vit K function and decreases clotting factors
inhibits vit K, protein C and S,, II, VII, X, IX
Apixiban
factor xa inhibitor which works by blocking the action of activated factor X which is needed for forming clot
taken twice daily
Dabigatra
direct inhibitor of cugulation factor thrombin
taken x2 daily
Rivaroxaban
taken once daily
Depression dental implications
chronic facial pain
burning mouth/sore tongue
TMD
Dry mouth
spots or lumps
disturbed taste sensation
Eating disorders dental implications
NCTSL
Xerostomia
senstivity
loss of vertical dimension
quality of dentine for bonding
hostile acidic environment
Tardive Dyskiensia
involuntary movements of tongue, lip. face, trunk
happens in people who recieve antipsychiotics for years
Psychosis
lose contact with reality
Schizphernia
affects how you think, feel, behave
Bipolar
affects mood of person
Panic disorder
regular or frequent panic attacks without clear cause or trigger
Phobics
extreme fear or anxiety triggered by a particular situation or object
PTSD
develop anxiety problems after going through something trauamatic
Body dysmorphic disorders
experience obession and compulsions to physical appearance
Reasons people have hypersalivation
Parkinsons
Cerbral palsy
Stroke
Acid reflux
Pregnant
Meds - alzehiemers
Diseases causing xerostomia
radio and chemo
Parkinson’s
Cystic fibrosis
RA
Sjogren’s syndrome
Diabetes
Hyperthyroidism
Why not use glandosane in people with teeth
very acidic
Drugs causing xerostomia
diuretics
beta blockers
anti -depressants
anti psychiotics
anti covulsants
NSAIDs - diclofenac
Causes of pseudomebranous candidiosis
antiobiotcis
dentures
xerostomia
cortocsteirod use
drugs
smoking
iron diefiency
diabetes
Xerosotmia
reduced or absent saliva flow <0.3ml/min of unstimualted saliva flow
viscosity increased, ph decreased
Risks associated with xerostomia
caries
perio
candidosis
dental erosion
sialadentitis (infection of salivary gland)
Management of xerostomia
oral balance
chew on sugar free gum
ice cubes
tooth mousse
water
Causes of ulcers
trauma
meds
oral cancer
viral infection
recurrent apthous stomatitis
Equality act 2010
protects people from discrimniation in workplace and wider society
age, sex, relgion, disability, sexual orientation
Disability discrimination act 2004
rights in employment, access to goods, facilities,
buying or renting land/ property
Adaptation to dental practices for people with disabilites
designated parking
signposting for people with sensory impairment
ground level access
ramps for wheelchairs
wheelchair turing circle
unisex disabled toilets
hearing loops
handrails for support
wide doors and corridors
How to help people with physical disbaility brush
electric toothbrush
putty handles
foam handles
ball handles
collis curve toothbrush
What to do if someone has hearing impairment
face pt
finger spelling
write things down
allow extra time
no echo
speak slowly and clearly
Social model
disbaility casued by how society is organsied rather than a persons impairment
Medical model
disability casued by a persons impairment and differences should be fixed/ changed by medical treatment
Impairment
any loss of abnormality of psychological, physiological or anatomical structure or function
Disability
restriction or lack of ability resulting in impairment to perform an activity in a manner or within the range considered normal
Handicap
disadvantage for a given individual resulting from an impairment or a disability that limits or prevents fulfiment of a role
Drooling
abnormalities in swallowing rather than absence of swallowing
poor mouth closure, tongue thrusting, jaw instability
Tx for bruxism/ NCTSL
flurodie mw’s
toothpastes - low abrasion, low acidity, high flurodie, anti-hypersenstitivty
flurodie varnish
dentine bonding agents
chew sugar free gum
reduce carbonated drinks, acidic fruits
Dentally fit
means the patient is free from all dental disease before they have their tx carried out which makes them immunocompromised and increase infection risk
Multi disciplenary team
incldues professionals from different areas in healthcare who come together to plan, assess and provide care for someone
ways to gain acess to the mouth
bedi shield
toothbrush
mirror
good light
open wide mouth rests
clincial holding
Opitions to aid trasnfr to chair
hoist
stand aid
wheelchair recliner
turn table
wheelchair tipper
banana board
Signs pt in pain but can’t communicate
crying/groaning
refusing to eat
rubbing area
depressions
withdrawn
sleep disturbance
aggressive behaviour
biting
grimacing
Causes of learning disability
infection
injury
nutrition
prematurity
genetics
injury
toxic agents
chromosmoal
materal health
Risk factors for people with learning disability
poor moisutre control
imbrication of teeth
lack of cleansing
pouching and limted food clearnace
meds
rewarding
mouth breathing (reduced salvia)
Down syndrome
a neurodevelopmental disorders of gentic origin affecting chromosome 21
fally trismoy of 21 = extra copy of 21
Down syndrome signs
short neck and flat back of head
growth failure
diminsted muscle tone
abnormal ears
big toes widley spread
cogential heart disease
umblical hernia
small and arched palate
short broad hands
enlarged colon
thryoird disease
hearing impairment
Prader willi
chromsome 15 does not function/ not present
Prader willi symptoms
constant desire to eat food
restricted growth
reduced muscle tone
lack of sexual development
learning difiiculties
behavioural issues
Cerebral Palsy
neuroloigcal condition affecting movement ad co-ordination
3 types of cerebral palsy
sapastic = muscles appear tight and stiff
dyskinetic = involuntary movements
ataxic = sharky movements - affects balanace
mixed
Cerebral palsy and dentistry
impaired access to mouth
store food in mouth
can’t hold toothbrush
meds - high in sugar
