Special Care Dentistry Flashcards
give four reasons why people with severe mental disorders are more susceptible to oral disease
poor oral hygiene
dental phobia
dental costs
xerostomia from anti-psychotic or anti-depressant drugs
name three impacts of good mental health
improved educational attainment
greater productivity
reduced mortality
name four examples of people who might be at risk of poor mental health
parental use of alcohol, drugs, tobacco during pregnancy
low birth weight
poor parental mental health
adverse childhood experiences
what are the three aspects of neurosis
anxiety
panic
phobia
what scale quantifies levels of anxiety
MDAS
what are the treatments available for anxiety disorders
CBT
medications
what could help overcome dental phobias
CBT
tell show do
acclimatisation
stop signals
needle desensitisation
name five dental implications of depression
chronic facial pain
burning mouth syndrome
TMD
dry mouth
halitosis
name two drugs anti-depressants interact with
benzodiazepines
codeine
what is tardive dyskinesia and what causes it
involuntary movement of tongue, lips, face, trunk and extremities
occurs in 15% patients who have been receiving antipsychotic therapy for years
what disorders is psychosis an umbrella term for
schizophrenia
bipolar disorder
what is hallucination
people see and hear things that don’t exist
what are delusions
where person has strong beliefs that are not shared by others
name four possible causes of psychosis
traumatic experience
stress
alcohol or drug misuse
side effects from prescribed medicines
name four dental effects of bipolar disorder
decline in oral hygiene
increased caries rate
increased periodontal disease
over use of oral hygiene aids during manic episodes = abrasion NCTSL
what is schizophrenia
disorder causing psychological symptoms like hallucinations and delusions
what effects may schizophrenic patients on haloperidol and phenothiazines experience
orthostatic hypotension - take care when raising patients from dental chair
what is schizoaffective disorder (SAD)
disorder that sits in the middle of the bipolar and schizophrenia spectrum
experiences symptoms from both
name four dental implications of eating disorders
dental erosion on lingual, palatal and occlusal surfaces
oral ulceration
xerostomia
sialosis
what is SCOFF
sick, control, one stone, fat, food questionnaire
if patient answers yes to 2 or more questions they are likely to have an eating disorder
what dental prevention aids should you take care with when providing prevention to people with mental health problems
mouthwash (alcohol)
floss (can be sinister)
wooden sticks for interdental cleaning (can be sharpened)
how does the pilocarpine HCl solution work for dry mouth
enhances salivary secretions in patients who have some salivary gland function
what is the prescription for pilocarpine HCl
5mg TID
why should you take caution when prescribing acidic pastilles for saliva stimulants (Salivix or Glandosane)
they can cause tooth erosion and sensitivity in dentate patients
what is the definition of a drug
a medicine or other substance that has a physiological effect when ingested or otherwise introduced to the body
what is the age group most likely to use drugs
young adults between 16-24
give five risk factors for drug misuse
genetic
socioeconomic
co-existing mental problems
peer pressure
trauma
what system has an important role in transition from occasional drug user to addiction
brain reward systems
what two effects can drugs have on neurotransmitters
increased levels of dopamine = euphoria
decreased levels of serotonin = decreased levels of contentment
what is the traditional theory of addiction (opioids)
Intense initial intoxication
development of profound tolerance
escalation in intake
profound dysphoria, physical discomfort with withdrawal
what is the alcohol pattern of addiction
initial intoxication less than opioids
pattern characterised by binges
severe emotional and somatic withdrawal syndrome
intense craving for drug
what happens with the sensitivity of reward system through chronic exposure to drugs
reduces the sensitivity
give three classifications of drugs
behavioural classification
pharmacodynamic classifications
legal classification
what drugs are involved in the behavioural drug classification
stimulants
opioids, antipsychotics, antidepressants
what drugs are involved in pharmacodynamic classification
psychedelics
sedative hypnotics
name three infections you are at an increased risk of after using illicit drugs
TB
STI
BBV
name three complications related to injecting drugs
cellulitis
abscess
thrombophlebitis
what is the term used now to describe IV drug users
people who inject drugs
PWID
name three social implications of drug use
suicides
assaults
death
name four effects of cannabis
euphoria
slow thinking and reaction time
confusion
impaired balance and coordination
name three effects of alcohol
CNS depressant
ataxia and motor coordination
aggressiveness
name five signs of addiction
loss of reliability
mood changes
isolation
impaired driving
constricted or dilated pupils
name four barriers of drug addicts accessing dental care
they have chaotic lifestyles
fear of dentists
poor attendance and compliance
cost
name four medical implications drug misuse may have
increased infection rate
chronic liver disease
infective endocarditis
venous thromboses
In the dental setting, what do you have to be careful with when treating a person who abuses drugs
consent - if under the influence they cannot consent
what can occur when patients are taking cannabis and need LA
LA with adrenaline can prolong tachycardia
name a consideration for a patient with alcohol addiction that requires LA
LA is metabolised in the liver - keep dosage low as can trigger CNS toxicity
name three dental implications of substance misuse
rampant caries
periodontal disease
NCTSL
why is oral cancer more common in drug misusers
smoking
alcohol
direct application of drug to mucosa
poor nutritional and immune status
name five effects of alcohol abuse on the dentition
advanced caries and periodontal disease
glossitis
NCTSL
leukoplakia
recurrent aphthous stomatitis
give three pieces of dental advice for methadone users
use a straw
drink water after consumption
dont brush teeth immediately after
what are the two main oral bacteria that can cause IE in susceptible patients
step viridans
staph aureus
how long should patients refrain from cannabis before dental treatment
72 hours
why should you avoid adrenaline containing LA for patients on cocaine, ecstasy and methamphetamines
risk of systemic increase in blood pressure
name four factors that increase change of developing oral cancer
smoking
alcohol
HPV
previous SCC
name three features of presenting oral cancer
ulcerated
uneven surface
rolled edges
how is performance status graded when evaluating cancer patients
ECOG performance status
what is CT scan used for when investigating cancer in head and neck
assess primary tumours
assess for regional spread
what is the use of MRI scan when investigating head and neck cancer
extent of bone and nerve involvement
surgical planning
name four people in the MDT for head and neck cancer
OMFS surgeons
ENT surgeons
speech and language therapist
dietician
how is head and neck cancer graded
T - tumour size and depth of invasion
N - nodal involvement
M - metastases present
give three reasons why tumour staging is important
treatment planning
prognostic
research purposes
give three treatment options for primary site head and neck cancer
resection and packing
resection and primary closure
resection and reconstruction
how much tissue should be removed when removing a head and neck cancer
1cm margin of normal tissue around the margins of the cancer
how would oral cancer with bony involvement appear on an OPT
moth eaten bone
pathological fractures
generalised widening of PDL space
unusual periodontal bone loss
name four warning signs seen on an ultrasound that would make you consider head and neck cancer
rounded shaped lymph nodes (instead of oval)
enlarged lymph nodes (more than 10mm diameter)
necrosis of nodes
internal calcification
name two post treatment complications of radiotherapy for head and neck cancer
infection
osteoradionecrosis
what does incidence of ORN in head and neck cancer patients depend on
dosage used (more than 50rN)
field of view
what is impairment
loss or abnormality of psychological, physiological or anatomical structure or function
what is disability
any restriction or lack of ability to perform an activity in the manner or within the range to be considered normal
what is handicap
a disadvantage for a given individual resulting from an impairment or a disability
what is a legislation passed in 2010 that is relevant to dental care
equality act 2010
what are the 9 protected characteristics
age
disability
gender reassignment
marriage or civil partnership
pregnancy
race
religion or belief
sex
sexual orientation
what are the 5 domains to overcoming barriers (5As)
accessibility
accommodation
affordability
acceptability
availability
what was introduced to protect individuals 16 and over who lack capacity to make some or all decisions for themselves
adults with incapacity act 2000
how is a person decided they are unable to make decisions for themselves (AMCUR)
they are unable to:
act
make
communicate
understand
retain memory
what is a cataract
clouding of the lens of the eye - prevents clear vision
what is age-related macular degeneration
loss of person’s central field of vision
what is glaucoma
fluid building up in the front part of the eye increasing the pressure
can lead to vision loss
makes periphery of sight appear darker
what are the two types of glaucoma
primary open angle - slow onset and caused by drainage channels being gradually blocked
angle closure - acute as the drainage system is blocked suddenly
what is diabetic retinopathy
occurs in diabetic patients and causes there to be dark spots in their vision
what is hemianopia
blindness in one half of the visual field
what are the two causes of hearing loss
congenital - maternal rubella, syphilis, low birth weight
acquired - age, chronic ear infection, meningitis, mumps, measles
what are the 3Rs when reporting an incident to do with
recognise
report
record
what is four dental implications of obesity
periodontitis
caries
tooth wear
impaired wound healing
what are examples of aids to get patients from wheelchairs to the dental chair
.hoist
banana board
reclining wheelchair
turn table
wheelchair recliner
stand aid
what are ways in which you can prevent osteoporosis
stay physically active
drink alcohol in moderation
not smoking
take prescribed medications
eat nutritious diet in calcium and vitamin D
suggest modifications for oral hygiene for a patient who has disability in their hands
electric toothbrush
foam handles
ball handles
suction brush to stick on the wall to clean dentures
what are local causes of pseudomembranous candidiasis
antibiotic use
dentures
local corticosteroid use
xerostomia
what are systemic causes of pseudomembranous candidiasis
drugs
extremes of age
endocrine - cushing’s
iron deficiency
smoking
how should pseudomembranous candidiasis be managed
use toothbrush to clean palate
use of chlorhexidine 0.2% m/w
remove denture at night
appropriate cleaning of denture
miconazole/ fluconazole/ nystatin
what is INR
ratio of prothrombin time to thrombin time
what value should the INR be before you would consider extraction of a tooth
below 4
how can you achieve local haemostasis
sockets packed with surgicel
sutures
pressure applied
atraumatic technique
tranexamic acid mouthwash
all of the DOACs are Factor Xa inhibitors except one - which one is it
dabigatran - direct thrombin inhibitor
how should a patient be treated if taking apixaban or dabigatran for procedures with higher risk of bleeding
miss their morning dose and take evening dose as usual
how should patients be treated if they are on rivaroxaban or edoxaban and require a dental procedure with a higher risk of bleeding
delay morning dose until 4 hours after haemostasis has been achieved
name the four dental procedures that are risk of causing bleeding but the risk is low
simple extractions
incisions and drainage of swellings
detailed 6PPC
RSD
direct or indirect restorations with subgingival margins
when should patients with haemophilia be seen at a special haemeophilia centre
dental extractions
surgical procedures
subgingival scaling
anaesthesia requiring IDBs or lingual infiltrations
give some reasons why haemostasis may not be able to be achieved in some patients
inherited bleeding disorders (haemophilia)
medication induced (warfarin/ antiplatelets)
haematological disease (leukaemia)
infections - HIV or HepC
liver disease - alcoholic liver disease/ cirrhosis
what is the safe platelet level to achieve haemostasis in secondary care
50 x 10 to the 9 per litre
what is UKELD
UK score for Endstage Liver Disease
predicts a patient’s prognosis in chronic liver disease
49 is the minimum score for a patient to be assessed for liver transplant
what are the stages of liver disease
hepatitis
liver cirrhosis
liver failure
