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FINALS > Special Care Dentistry > Flashcards

Special Care Dentistry Flashcards

1
Q

give four reasons why people with severe mental disorders are more susceptible to oral disease

A

poor oral hygiene
dental phobia
dental costs
xerostomia from anti-psychotic or anti-depressant drugs

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2
Q

name three impacts of good mental health

A

improved educational attainment
greater productivity
reduced mortality

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3
Q

name four examples of people who might be at risk of poor mental health

A

parental use of alcohol, drugs, tobacco during pregnancy
low birth weight
poor parental mental health
adverse childhood experiences

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4
Q

what are the three aspects of neurosis

A

anxiety
panic
phobia

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5
Q

what scale quantifies levels of anxiety

A

MDAS

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6
Q

what are the treatments available for anxiety disorders

A

CBT
medications

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7
Q

what could help overcome dental phobias

A

CBT
tell show do
acclimatisation
stop signals
needle desensitisation

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8
Q

name five dental implications of depression

A

chronic facial pain
burning mouth syndrome
TMD
dry mouth
halitosis

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9
Q

name two drugs anti-depressants interact with

A

benzodiazepines
codeine

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10
Q

what is tardive dyskinesia and what causes it

A

involuntary movement of tongue, lips, face, trunk and extremities
occurs in 15% patients who have been receiving antipsychotic therapy for years

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11
Q

what disorders is psychosis an umbrella term for

A

schizophrenia
bipolar disorder

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12
Q

what is hallucination

A

people see and hear things that don’t exist

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13
Q

what are delusions

A

where person has strong beliefs that are not shared by others

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14
Q

name four possible causes of psychosis

A

traumatic experience
stress
alcohol or drug misuse
side effects from prescribed medicines

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15
Q

name four dental effects of bipolar disorder

A

decline in oral hygiene
increased caries rate
increased periodontal disease
over use of oral hygiene aids during manic episodes = abrasion NCTSL

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16
Q

what is schizophrenia

A

disorder causing psychological symptoms like hallucinations and delusions

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17
Q

what effects may schizophrenic patients on haloperidol and phenothiazines experience

A

orthostatic hypotension - take care when raising patients from dental chair

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18
Q

what is schizoaffective disorder (SAD)

A

disorder that sits in the middle of the bipolar and schizophrenia spectrum
experiences symptoms from both

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19
Q

name four dental implications of eating disorders

A

dental erosion on lingual, palatal and occlusal surfaces
oral ulceration
xerostomia
sialosis

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20
Q

what is SCOFF

A

sick, control, one stone, fat, food questionnaire
if patient answers yes to 2 or more questions they are likely to have an eating disorder

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21
Q

what dental prevention aids should you take care with when providing prevention to people with mental health problems

A

mouthwash (alcohol)
floss (can be sinister)
wooden sticks for interdental cleaning (can be sharpened)

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22
Q

how does the pilocarpine HCl solution work for dry mouth

A

enhances salivary secretions in patients who have some salivary gland function

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23
Q

what is the prescription for pilocarpine HCl

A

5mg TID

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24
Q

why should you take caution when prescribing acidic pastilles for saliva stimulants (Salivix or Glandosane)

A

they can cause tooth erosion and sensitivity in dentate patients

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25
Q

what is the definition of a drug

A

a medicine or other substance that has a physiological effect when ingested or otherwise introduced to the body

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26
Q

what is the age group most likely to use drugs

A

young adults between 16-24

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27
Q

give five risk factors for drug misuse

A

genetic
socioeconomic
co-existing mental problems
peer pressure
trauma

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28
Q

what system has an important role in transition from occasional drug user to addiction

A

brain reward systems

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29
Q

what two effects can drugs have on neurotransmitters

A

increased levels of dopamine = euphoria
decreased levels of serotonin = decreased levels of contentment

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30
Q

what is the traditional theory of addiction (opioids)

A

Intense initial intoxication
development of profound tolerance
escalation in intake
profound dysphoria, physical discomfort with withdrawal

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31
Q

what is the alcohol pattern of addiction

A

initial intoxication less than opioids
pattern characterised by binges
severe emotional and somatic withdrawal syndrome
intense craving for drug

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32
Q

what happens with the sensitivity of reward system through chronic exposure to drugs

A

reduces the sensitivity

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33
Q

give three classifications of drugs

A

behavioural classification
pharmacodynamic classifications
legal classification

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34
Q

what drugs are involved in the behavioural drug classification

A

stimulants
opioids, antipsychotics, antidepressants

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35
Q

what drugs are involved in pharmacodynamic classification

A

psychedelics
sedative hypnotics

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36
Q

name three infections you are at an increased risk of after using illicit drugs

A

TB
STI
BBV

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37
Q

name three complications related to injecting drugs

A

cellulitis
abscess
thrombophlebitis

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38
Q

what is the term used now to describe IV drug users

A

people who inject drugs
PWID

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39
Q

name three social implications of drug use

A

suicides
assaults
death

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40
Q

name four effects of cannabis

A

euphoria
slow thinking and reaction time
confusion
impaired balance and coordination

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41
Q

name three effects of alcohol

A

CNS depressant
ataxia and motor coordination
aggressiveness

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42
Q

name five signs of addiction

A

loss of reliability
mood changes
isolation
impaired driving
constricted or dilated pupils

43
Q

name four barriers of drug addicts accessing dental care

A

they have chaotic lifestyles
fear of dentists
poor attendance and compliance
cost

44
Q

name four medical implications drug misuse may have

A

increased infection rate
chronic liver disease
infective endocarditis
venous thromboses

45
Q

In the dental setting, what do you have to be careful with when treating a person who abuses drugs

A

consent - if under the influence they cannot consent

46
Q

what can occur when patients are taking cannabis and need LA

A

LA with adrenaline can prolong tachycardia

47
Q

name a consideration for a patient with alcohol addiction that requires LA

A

LA is metabolised in the liver - keep dosage low as can trigger CNS toxicity

48
Q

name three dental implications of substance misuse

A

rampant caries
periodontal disease
NCTSL

49
Q

why is oral cancer more common in drug misusers

A

smoking
alcohol
direct application of drug to mucosa
poor nutritional and immune status

50
Q

name five effects of alcohol abuse on the dentition

A

advanced caries and periodontal disease
glossitis
NCTSL
leukoplakia
recurrent aphthous stomatitis

51
Q

give three pieces of dental advice for methadone users

A

use a straw
drink water after consumption
dont brush teeth immediately after

52
Q

what are the two main oral bacteria that can cause IE in susceptible patients

A

step viridans
staph aureus

53
Q

how long should patients refrain from cannabis before dental treatment

A

72 hours

54
Q

why should you avoid adrenaline containing LA for patients on cocaine, ecstasy and methamphetamines

A

risk of systemic increase in blood pressure

55
Q

name four factors that increase change of developing oral cancer

A

smoking
alcohol
HPV
previous SCC

56
Q

name three features of presenting oral cancer

A

ulcerated
uneven surface
rolled edges

57
Q

how is performance status graded when evaluating cancer patients

A

ECOG performance status

58
Q

what is CT scan used for when investigating cancer in head and neck

A

assess primary tumours
assess for regional spread

59
Q

what is the use of MRI scan when investigating head and neck cancer

A

extent of bone and nerve involvement
surgical planning

60
Q

name four people in the MDT for head and neck cancer

A

OMFS surgeons
ENT surgeons
speech and language therapist
dietician

61
Q

how is head and neck cancer graded

A

T - tumour size and depth of invasion
N - nodal involvement
M - metastases present

62
Q

give three reasons why tumour staging is important

A

treatment planning
prognostic
research purposes

63
Q

give three treatment options for primary site head and neck cancer

A

resection and packing
resection and primary closure
resection and reconstruction

64
Q

how much tissue should be removed when removing a head and neck cancer

A

1cm margin of normal tissue around the margins of the cancer

65
Q

how would oral cancer with bony involvement appear on an OPT

A

moth eaten bone
pathological fractures
generalised widening of PDL space
unusual periodontal bone loss

66
Q

name four warning signs seen on an ultrasound that would make you consider head and neck cancer

A

rounded shaped lymph nodes (instead of oval)
enlarged lymph nodes (more than 10mm diameter)
necrosis of nodes
internal calcification

67
Q

name two post treatment complications of radiotherapy for head and neck cancer

A

infection
osteoradionecrosis

68
Q

what does incidence of ORN in head and neck cancer patients depend on

A

dosage used (more than 50rN)
field of view

69
Q

what is impairment

A

loss or abnormality of psychological, physiological or anatomical structure or function

70
Q

what is disability

A

any restriction or lack of ability to perform an activity in the manner or within the range to be considered normal

71
Q

what is handicap

A

a disadvantage for a given individual resulting from an impairment or a disability

72
Q

what is a legislation passed in 2010 that is relevant to dental care

A

equality act 2010

73
Q

what are the 9 protected characteristics

A

age
disability
gender reassignment
marriage or civil partnership
pregnancy
race
religion or belief
sex
sexual orientation

74
Q

what are the 5 domains to overcoming barriers (5As)

A

accessibility
accommodation
affordability
acceptability
availability

75
Q

what was introduced to protect individuals 16 and over who lack capacity to make some or all decisions for themselves

A

adults with incapacity act 2000

76
Q

how is a person decided they are unable to make decisions for themselves (AMCUR)

A

they are unable to:
act
make
communicate
understand
retain memory

77
Q

what is a cataract

A

clouding of the lens of the eye - prevents clear vision

78
Q

what is age-related macular degeneration

A

loss of person’s central field of vision

79
Q

what is glaucoma

A

fluid building up in the front part of the eye increasing the pressure
can lead to vision loss
makes periphery of sight appear darker

80
Q

what are the two types of glaucoma

A

primary open angle - slow onset and caused by drainage channels being gradually blocked
angle closure - acute as the drainage system is blocked suddenly

81
Q

what is diabetic retinopathy

A

occurs in diabetic patients and causes there to be dark spots in their vision

82
Q

what is hemianopia

A

blindness in one half of the visual field

83
Q

what are the two causes of hearing loss

A

congenital - maternal rubella, syphilis, low birth weight
acquired - age, chronic ear infection, meningitis, mumps, measles

84
Q

what are the 3Rs when reporting an incident to do with

A

recognise
report
record

85
Q

what is four dental implications of obesity

A

periodontitis
caries
tooth wear
impaired wound healing

86
Q

what are examples of aids to get patients from wheelchairs to the dental chair

A

.hoist
banana board
reclining wheelchair
turn table
wheelchair recliner
stand aid

87
Q

what are ways in which you can prevent osteoporosis

A

stay physically active
drink alcohol in moderation
not smoking
take prescribed medications
eat nutritious diet in calcium and vitamin D

88
Q

suggest modifications for oral hygiene for a patient who has disability in their hands

A

electric toothbrush
foam handles
ball handles
suction brush to stick on the wall to clean dentures

89
Q

what are local causes of pseudomembranous candidiasis

A

antibiotic use
dentures
local corticosteroid use
xerostomia

90
Q

what are systemic causes of pseudomembranous candidiasis

A

drugs
extremes of age
endocrine - cushing’s
iron deficiency
smoking

91
Q

how should pseudomembranous candidiasis be managed

A

use toothbrush to clean palate
use of chlorhexidine 0.2% m/w
remove denture at night
appropriate cleaning of denture
miconazole/ fluconazole/ nystatin

92
Q

what is INR

A

ratio of prothrombin time to thrombin time

93
Q

what value should the INR be before you would consider extraction of a tooth

A

below 4

94
Q

how can you achieve local haemostasis

A

sockets packed with surgicel
sutures
pressure applied
atraumatic technique
tranexamic acid mouthwash

95
Q

all of the DOACs are Factor Xa inhibitors except one - which one is it

A

dabigatran - direct thrombin inhibitor

96
Q

how should a patient be treated if taking apixaban or dabigatran for procedures with higher risk of bleeding

A

miss their morning dose and take evening dose as usual

97
Q

how should patients be treated if they are on rivaroxaban or edoxaban and require a dental procedure with a higher risk of bleeding

A

delay morning dose until 4 hours after haemostasis has been achieved

98
Q

name the four dental procedures that are risk of causing bleeding but the risk is low

A

simple extractions
incisions and drainage of swellings
detailed 6PPC
RSD
direct or indirect restorations with subgingival margins

99
Q

when should patients with haemophilia be seen at a special haemeophilia centre

A

dental extractions
surgical procedures
subgingival scaling
anaesthesia requiring IDBs or lingual infiltrations

100
Q

give some reasons why haemostasis may not be able to be achieved in some patients

A

inherited bleeding disorders (haemophilia)
medication induced (warfarin/ antiplatelets)
haematological disease (leukaemia)
infections - HIV or HepC
liver disease - alcoholic liver disease/ cirrhosis

101
Q

what is the safe platelet level to achieve haemostasis in secondary care

A

50 x 10 to the 9 per litre

102
Q

what is UKELD

A

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

103
Q

what are the stages of liver disease

A

hepatitis
liver cirrhosis
liver failure

FINALS (25 decks)

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