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BDS3 > Special Care Dentistry > Flashcards

Special Care Dentistry Flashcards

1
Q

4 barriers to care

A

Physical, attitudinal, professional-centred, people-centred

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2
Q

Define:

ICIDH 1980

  1. Impairment
  2. Disability
  3. Handicap
  4. WHO definition of disabilities
A
  1. Any loss/abnormality of psychological, physiological or anatomical structure or function
  2. Restriction/lack of ability to perform an activity in a manner/within the range considered normal for a human being
  3. a. Disadvantages for a given individual, resulting from an impairment or disability, that limits/prevents normal role fulfilment for that individual
  4. Umbrella term covering impairments, activity limitation and participation restriction
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3
Q

3 key pieces of legislation for special care

A

Equality Act 2010
Adults with Incapacity (Scotland) Act 2000
Mental Health (Care and Treatment) (Scotland) Act 2003
Disability Discrimination Act 1995/2005
Mental Capacity Act 2005

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4
Q

Sensory impairment

  1. Definition
  2. 2 types
  3. How dentist can make communication easier
A
  1. When one/more of a person’s senses is no longer normal
  2. Visually-impaired, hearing-impaired
  3. Visual - identify yourself, use names, say what you’re doing before doing it, avoid non-verbals
    Hearing - have loop system, face person when speaking, use clear speech, use written aids, reduce background noise, use name badges
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5
Q

Cancer

  1. Define dentally fit (3 components)
  2. Define MDT (and 4 people of MDT)
  3. Describe chemotherapy and 4 side effects
  4. Describe radiotherapy and 4 side effects
A
  1. Free from active disease (removal of infection foci), prevent/inhibit the potential for future disease development (consider/remove teeth of poor prognosis), establish preventative regime
  2. Group of individuals from multiple medical specialties working together to provide holistic care for an individual.
    Surgeon, pathologist, radiologist, clinical nurse specialist, oncologist (medical/clinical)
  3. Systemic drugs used to target rapidly dividing cells.
    Mucositis, hair loss, tiredness, immunocompromised
  4. Ionising radiation damage to cellular DNA delivered in fractioned doses
    Mucositis, tiredness, burns, dry mouth, taste loss, ORN, trismus, radiation caries
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6
Q

Mucositis

  1. Define
  2. Scale
A
  1. Acute inflammation of (oral) mucosa
  2. Grade 0 - normal oral mucosa
    Grade 1 - mild - soreness and erythema
    Grade 2 - moderate - erythema ulcers (can swallow solids)
    Grade 3 - severe - ulcers with extensive erythema (can swallow liquids)
    Grade 4 - life-threatening - extensive mucositis (oral alimentation not possible
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7
Q

Parkinson’s

  1. Define
  2. 5 features
  3. Difference in presentation between Parkinson’s and cerebellar disease
  4. 3 dental issues
  5. Dry mouth why
A
  1. Progressive degeneration of dopaminergic neurons in substantia nigra
  2. Resting tremor, bradykinesia, mask-like/expressionless face, impaired balance and gait, rigidity
  3. Parkinson’s - resting tremor
    Cerebellar disease - intention tremor
  4. Xerostomia, swallowing problems, access issues, limited self-care, drooling (forward tip)
  5. Anticholinergic effect of dopaminergic drugs, forward tip leads to saliva pooling at front of mouth
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8
Q

Dementia

  1. Define
  2. 3 risk factors
  3. 4 types
  4. 4 symptoms of early/middle/late-stage
  5. 4 diagnostic tools
  6. 3 features of treatment plan
  7. 3 features of dementia-friendly dentist/healthcare environment
  8. 5 methods of assisted brushing in care homes
A
  1. Deterioration in cognitive function beyond what might be expected from normal ageing
  2. Age, sex, genes
  3. Alzheimer’s, vascular, with Lewy bodies, frontotemporal
  4. Early - STML, indecisive, poor judgement, confusion
    Middle - increasingly forgetful, angry, distress, mood changes, may fail to recognise people
    Late - increasing frailty, fail to recognise familiar people/objects/places, swallowing difficulties, gradual loss of speech
  5. MMSE, Blessed dementia scale, Montreal cognitive assessment, single neuropsychological tests (delayed word recall)
  6. Plan for the future, establish preventative regime, aim to retain key teeth, provide complex treatment first, atraumatic restoration technique (ART - partial caries removal with instrument, GIC restoration)
  7. Reception desk visible from front door, good level of natural light, signs at eye level, no unnecessary signs, signs contain simple test and colour/pictures, walls/floor/furniture distinctively different colours and tones
  8. Rescuing, bridging, chaining, hand-over-hand, distraction
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9
Q

Name and describe the 2 models of disability

A
  1. Medical model - people are disabled by their impairments/differences and as such should be fixed/changed
  2. Social model - people are disabled by the way society is organised rather than by their impairments/differences
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10
Q

Down’s syndrome and autism

  1. Down’s genetic tests results
  2. 4 physical/dental features of Down’s
  3. 4 associated health conditions of Down’s
  4. Why can’t consent/why no capacity (Down’s)
  5. Define autism
  6. 3 signs/symptoms of autism
  7. Dental management of autism
A
  1. Trisomy 21
  2. Atlanto-axial instability, macroglossia, hypo/microdontia, class III, maxillary hypoplasia, caries risk, perio. disease
  3. CHD, haematological malignancy (leukaemia), epilepsy, (early-onset) Alzheimer’s, coeliac disease, learning disability
  4. Unable to make a reasoned decision, understand a decision, communicate a decision, retain memory of a decision
  5. Lifelong developmental spectrum disorder affecting areas of the brain responsible for language, social interaction and abstract/creative thinking
  6. Isolated, withdrawn, literal interpretation of language. difficulty relating to people, socially awkward and naive
  7. Pre-visit, social story, quiet time, allow more time, consider patient sensory issues, communication aids, hide non-essential items/equipment
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11
Q

Diabetes

  1. What to measure to evaluate control
  2. Ideal value
  3. 3 dental features if poorly controlled
A
  1. Hb1Ac - better indication of LT control compared to GTT
  2. 6.5%/48mmol/mol (Diabetes UK). Want to be slightly higher before dental treament. Book earlier appointment, advise patient to eat breakfast
  3. Increased risk of perio disease, dry mouth, delayed/poorer wound healing, fungal/candida infection
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12
Q

Antiplatelets/anticoagulants

  1. 2 types of anticoagulants
  2. Warfarin - what inhibits, what to check and when, acceptable values, normal values if not on warfarin
  3. 3 types of DOAC and what they inhibit
  4. High risk procedures
  5. How to manage high-risk procedure for DOAC patient
  6. Antiplatelets – what to do if on 1/2/3
  7. 3 types of inherited bleeding disorders and treatment
A
  1. Vitamin K-dependent anticoagulants (coumarins - warfarin, heparin), direct oral anticoagulants
  2. Extrinsic coagulation pathway. Inhibits production of clotting factors 2, 7, 9 and 10. Check INR 24hrs before extraction, ideally stable for 72hrs pre-extraction. Acceptable if <4.0 (SDCEP) or <3.5 (NHS GGC) - ideal is 1.5-3, depending on ‘normal’ limit. Normal INR for individual not on warfarin is 1.0
  3. Dabigatran (dTi - FIIa), Apixaban (FXa), rivaroxiban (FXa)
  4. 3+ extractions, flap-raising procedures (surgical extractions, perio surgery), gingival recontouring, biopsies
  5. Apixaban and dabigatran - miss morning dose
    Rivaroxiban - delay morning dose
  6. 1 - fine, 2 - grey area, 3 - avoid
7. Haemophilia A (FVIII deficient). Tranexamic acid, DDAVP, recombinant factor
Haemophilia B (FIX deficient). Tranexamic acid, DDAVP, recombinant factor
Von Willebrand disease (vWF deficient). Tranexamic acid, DDAVP
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13
Q

Liver disease

  1. 3 causes of jaundice
  2. Effect of dental treatment
  3. Alcohol - recommended maximum weekly units
  4. How can excessive alcohol intake be a risk of bleeding
  5. 3 key blood tests for bleeding problems
  6. Platelet level for extractions and what transfusion required
A
  1. Alcoholic liver disease, non-alcoholic fatty liver disease, infective liver disease (hepatitis)
  2. Increased bleeding risk
  3. 14 units/week over 3+ days with 2+ alcohol-free days
  4. Damages liver, inhibiting production of clotting factors. Also suppresses bone marrow - combined with liver disease, this can lead to thrombocytopenia (as platelets are produced in the bone marrow and require the protein thrombopoietin to be produced, which is produced in the liver)
  5. FBC, LFT, coagulation screen
  6. > 100^9 for GDP, 50-100^9 for secondary care. <50^9 - FFP/platelet transfusion
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14
Q

AWI

  1. Define incapacity
  2. What law and list 5 principles of act
  3. 2 types of PoA
  4. Difference between PoA and WG
  5. What required for dental/medical treatment
  6. Who can provide consent
  7. What doesn’t require consent
  8. What defines emergency treatment
  9. 2 types of dental emergency
A
  1. Inability to enter into legally binding contracts
  2. Adults with Incapacity (Scotland) Act 2000
    Benefit, minimum necessary intervention, take account of the wishes of the adult, consultation with relevant others, encourage adult to exercise residual capacity
  3. Continuing (financial), welfare (health)
  4. PoA - appointed by individual before they lose capacity
    WG - court-appointed when an individual who has never had capacity turns 16 or when an adult without a PoA loses capacity
  5. Section 47 certificate, specific to proposed treatment
  6. Adult (with capacity), parent (if child <16yrs and lacks capacity), welfare PoA, welfare guardian, nearest relative, carer, GP/GDP (with Section 47 certificate)
  7. Emergency treatment
  8. Preservation of life/to prevent serious deterioration
  9. Bleeding, spreading infection (associated with abscess)
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15
Q

Oral ulceration

  1. 4 causes
  2. 2 OC guidelines
  3. 4 modifiable OC risk factors
A
  1. Oral cancer, trauma, medication side effect, nutritional deficiency
  2. Scottish referral guidelines for suspected cancer
    NICE guideline 12
  3. Smoking, alcohol, poor OH, sun exposure (lip cancer)
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16
Q

3 diseases bisphosphonates are used to treat/manage

A
  1. Osteoporosis
  2. Multiple myeloma (and metastatic cancer)
  3. Paget’s disease

BDS3 (16 decks)

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