special care dentistry need to know Flashcards
what is a multidisciplinary team?
group of healthcare professionals from different disciplines/specialities who share their expertise and work together in a team to provide the best and most holistic care possible for the patient
list possible members of a cancer MDT
surgeon
clinical oncologist
chemotherapy nurse
special care dentist
pathologist
what features of cerebral palsy would impair your access to the mouth?
muscle stiffness (hypotonia)
muscle weakness
random and uncontrolled body movements
give two ways you can aid a patient who struggles to open their mouth
mouth rests for opening
bedi shield
give methods of tilting a patient for access
wheelchair recliner
hoist
portable turntable
stand aid
banana board
what can you use for communicating if a patient cannot speal or write?
makaton
picture boards
talking mats
electrical tablet
what are the differences n medical models and social models related to disability?
social models- disability caused by how society is organised rather than a person’s impairment or difference
medical models - disability caused by a person’s impairment/differences and should be ‘fixed’ or ‘changed’ by other medical/other treatments
name 4 types of dementia
alzheimers
vascular
frontotemporal
dementia with lewy bodies
what is the most common form of dementia?
alzheimers
how does alzhemiers affect the brain?
reduction in size of cortex
severely affects hippocampus
what causes alzhemiers?
abnormal protein fragments (beta-amyloid) build up in spaces between nerve cells forming plaques and disrupting brain function
what are the features of alzheimers?
short term memory loss
aphasia
communication difficulties
muddled over everyday activities
mood swings
withdrawn
loss of confidence
what are the risk factors of alzheimers?
age
gender
head injury
genetic- abnormalities of chromosomes 1,14,21
lifestyle- smoking, hypertention, low folate, high cholesterol
what is the cause of vascular dementia?
reduced blood flow to the brain
damages and eventually kills the brain cells
what causes vascular dementia to develop?
narrowing/blockage of small blood vessels into the brain
single large stroke
lots of mini-strokes that cause small, but widespread damage
underlying health conditions
what are the features of vascular dementia?
memory problems of sudden onset
visuospatial difficulties
anxiety
delusions
seizures
what causes dementia with lewy bodies?
deposits of abnormal proteins called lewy bodies inside brain cells
what are the features of dementia with lewy bodies?
short term memory loss
cognitive ability fluctuates
visuospatial difficulties
attentional difficulties
overlapping motor disorders
speech and swallowing problems
sleep disorders and delusions
lewy bodies can be found in patients with what cerebellular disease?
Parkinson’s disease
what are the features of frontotemporal dementia?
uncontrollable repition of words
short term memory loss (sometimes)
personality changes
decline in personal and social conduct
what are the symptoms of late stage dementia?
inability to recognise familiar objects, surroundings or people
difficulty eating and swallowing
incontinence
gradual loss of speech
what is the most common way to test for dementia?
the mini mental state examination (MMSE)
name 3 cognitive testing methods for dementia
MMSE
blessed dementia scale
the montreal cognitive assessment (MoCA)
what are the advantages of the mini mental state examination?
well known
easy to administer
what are the advantages of the mini mental state examination?
well known
easy to administer
what are the cons of of the mini-mental state examination?
not sensitive to mild impairment
not sensitive in testing frontal lobe
non-standardised time between registration and recall
what is the treatment for dementia?
councelling can delay residential care up to 1 year
aspirin/reducing cardiac risks can halt deterioration of vascular dementia
NSAIDs may slow progression
vitamin E can slow progression
anticholinesterases for mild/moderate alzheimers
cerebrolysin improves cognitive function for vascular dementia
when would treatment for a patient with dementia be stopped?
when it is deemed that treatment is no longer working
the MMSE score falls below 10
what can care homes do to be more dementia friendly?
make walls, flooring, skirting different colours
add labels/images to drawers etc. to help pts find things
bedroom WC should be visible from bed
position personal pics/items with personal relevance
how can healthcare environments be made more dementia friendly?
reception desk visible from front door
no non-essential signs
staff only doors same colour as walls
colour of walls different from floor/celing
signs should be simple, colourful;, eye level
What are risk factors of oral cancer ?
A
smoking
Alcohol intake
HPV
sunlight
nutritional deficiencies
candida infections
What are causes of liver cirrhosis
Alcohol
Hepatitis virus
fatty liver disease
autoimmune causes:primary billary cirrhosis
haemochromatosis
hepatocellular carcinoma
drug induced
why should a patient be dentally fit before a transplant
the patient will be immunosuppressed for the rest of their life so must reduce the risk of further dental intervention in the future
what teeth can be justified to extract when making a patient dentally fit
teeth with periapical periodontitis or other pathology
teeth with poor prognosis - highly restored and secondary caries
what causes thrombocytopenia to occur
splenic sequestration
impaired hepatic synthesis
increased degredation of thrombopoeitin by platelets sequestered in the congested spleen
drug related - alcohol, penecillin based drugs or heparin
what platelet level is considered safe to treat in general practise
> 100 x 10^9 / L
why might patients with advanced alcoholic liver disease have increased risk of bleeding
thrombocytopenia
medication induced, patient may be taking heparin
liver disease may have been caused by hepatitis or HIV which both affect bleeding
clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
why might patients with advanced alcoholic liver disease have increased risk of bleeding
thrombocytopenia
medication induced, patient may be taking heparin
liver disease may have been caused by hepatitis or HIV which both affect bleeding
clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
who can provide section 47 AWI certificate for dental treatment
dentist who has done additional training
general medical practicioners
consultants in-charge of patient care
What are risk factors of stroke?
hypertension
smoking
alcohol
diabetes mellitus
age
DVT
What are the protected characteristics from the Equality Act 2010?
Age
Disability
Gender
Marriage and Civil Partnership
Pregnancy and Maternity
Race
Religion
Sex
Sexual orientation
What is the definition on impairment?
any loss or abnormality of psychological, physiological or anatomical structure or function
What is the definition of disability ?
a physical or mental impairment that has substantial long term negative effect on ability to do normal daily activities
What is aim of the Equality Act 2010 ?
provide a legal framework to protect the rights of individuals and advance equality of opportunity for all
places a legal duty on organisations to make reasonable adjustments to remove barriers that affect people accessing care
What is the inverse care law
the people who need health care the most are least likely to receive it
What are the 5 domains to overcoming barriers to healthcare
Accessibility
Accommodation
Affordability
Acceptability
Availability
What is the function of the Adults with Incapacity Act 2000 (Scotland)
to protect welfare and manage finances of individuals (16 and over) who lack capacity due to mental illness, learning disabilities
aim to support their involvement in making decisions as far as they are able to do so
what are difficulties associated with treating a bariatric patient?
loss of anatomical landmarks
ID blocks may be difficult
may have to be treated semi-supine or sitting upright
access may be more difficult due to excess soft tissue
long procedures can cause acute leg oedema, cellulitis and pressure sores
How do you assess capacity ?
being incapable of:
- Acting
- Making a decision
- Communicating decision
- Understanding decision
- Retaining the memory of a decision
AMCUR
Q
What are the principles of the AWI Act?
decisions made on behalf of another must be:
- benefit the patient
- minimum necessary intervention
- Take into account the wishes of the adult
- Consult with relevant others
- Encourage the adult to exercise residual capacity
What are the types of power of attorney
Continuing power of attorney - makes financial and property decisions
Welfare power of attorney - makes decisions on healthcare and dental treatment
Combined power of attorney - both financial and welfare decisions
What are the types of guardianship?
Welfare guardian- can consent to dental treatment
Financial guardian - cannot consent to dental treatment
What is sensory impairment ?
When one or more of a person’s senses are no longer normal
What is cataract ?
Clouding of the lens of the eye which prevents clear vision
What are the two types of macular degeneration ?
wet - causes severe sight loss in a matter of months
dry - gradual loss of central vision
What causes wet macular degeneration ?
growth of new vessels under the retina which break and leak into the macula causing scarring
What causes dry macular degeneration?
Layers of the macula become progressively thinner causing it to function less effectively
What does macular degeneration look like visually?
loss of the central field of vision
patients may be sensitive to light
What causes glaucoma?
fluid build up in the front part of the eye which increases pressure inside the eye
what does glaucoma look like visually?
tunnel vision - dark black surrounding outside
What causes diabetic retinopathy
vascular changes in the retinal circulation due to diabetes
what does diabetic retinopathy look like visually ?
Black spots in the vision
what is the most common because of hemianopia ?
stroke
What does hemianopia look like visually?
vision from only half of the eye
What are the impacts of hearing impairment ?
functional impact - affects ability to communicate with others and can affect academic perdormance of children
Social and emotional impact - isolation and exclusion from communication with others
financial impact - higher unemployment rate
causes of hearing loss ?
congenital - low birth weight, infections during pregnancy, jaundice in neonatal period
acquired - infectious diseases (meningitis) , chronic ear infection, injury to head, recreational exposure to loud sounds
What causes down’s syndrome?
trisomy of chromosome 21
co morbidities associated with Down’s syndrome
congenital heart defects
alzheimers dementia
epilepsy
leukaemia
diabetes mellitus
coeliac disease
intellectual impairment
what are dental implications of downs syndrome ?
reduced oral hygiene
increased risk of periodontal disease
immunocompromised
saliva quality is altered
what are physical features of cerebral palsy
muscle stiffness
muscle weakness
random uncontrolled body movements
balance and co-ordination problems
What are the different types of dementia
Alzheimers
Vascular dementia
Dementia with lewie bodies
what are questions to ask if you suspect a non verbal patient with dementia is in pain?
has their behaviour changes
has sleep been disturbed
has their eating behaviour changed
have they been holding or touching their face
what infections are more common during cancer treatment ?
candida - treat with fluconazole (systemic), miconazole (topical) or nystatin
herpes simplex virus - treat with acyclovir
What is schizophrenia ?
psychological condition affecting neurotransmitters in the brain which affects the way people interpret reality
What are the 2 types of symptoms in schizophrenia?
positive symptoms - things something is there that isn’t (e.g. hallucinations)
Negative symptoms - affects emotions and communication
what level of neutrophils would because concern?
<1 means have greater risk of infection
what LA is used in patients with advanced liver disease?
Articaine as it is not metabolism in the liver
what clotting factors does the liver produce?
1, 2, 7, 9 ,10 and 11
Apart from clotting factors what other product essential for achieving haemostasis is produced in the liver?
Thrombopoietin
What does low white blood cells indicate?
immunosuppression or autoimmune disease
what is the normal range for WBC?
4.5 - 10 x10^9/L
what does a high white blood cell count indicate?
current infection
What can low haemoglobin indicate?
Thalassaemia
What is the range of platelets for a patient to be treated in general practice?
> 100
What does low red blood cell and low haemoglobin mean?
anaemia
what does low haemoglobin with reduced MCV indicate?
microcytic anaemia
caused by iron deficiency or Thalassemia
what does low haemoglobin with increased MCV indicate?
Macrocytic anaemia
caused by liver damage and b12 and folate deficiency
What does low haemoglobin with normal MCV indicate>
Normocytic anaemia
What are oral complications of radiotherapy?
osteoradionecrosis
radiation caries
hypogeusia - loss of taste due to radiation affecting taste buds
xerostomia - may be due to damage of salivary glands
difficulty wearing dentures
more prone to fungal infections
trismus may occur due to replacement fibrosis of muscles of mastication
what sites of the teeth are affected by radiation caries?
gingival margins and incisor edges
what are causes of radiation caries?
dry mouth
loss of taste
change in diet
hypersensitivity of teeth makes OH difficult
What do you need to know about patients who have had radiotherapy?
what dose of radiation was given
what area of the body was exposed to the radiation
duration of treatment
hat are preventative measures used for patients who have had radiotherapy?
OHI
higher concentration of fluoride toothpaste
fluoride varnish
how do you treat osteoradionecrosis?
irrigation of necrotic debris
remove loose sequestra
What methods help prevent risk of osteoradionecrosis?
scale teeth near extraction site and use chlorohexidine mouthwash
careful extraction technique
antibiotics, chlorhexidine mouthwash and review
hyperbaric oxygen before and after extraction to increase local tissue oxygenation
close soft tissues
what are the causes of congestive heart disease?
Coronary artery disease
- Cardiomyopathy
- Heart attack
- alcohol abuse
- hypertension
- valve disease
- diabetes
- MI
idiopathiccauses
what are the symptoms of congestive heart disease?
- rapid irregular heart beat
- fatique and weakness
- swelling of abdomen
- oedema in leg/ankle/feet
- nausea
- shortness of breath
- cough, wheezing
- chest pain when breathing
what is the treatment of congestive heart failure?
lifestyle changes
ACE inhibitor
beta blockers
diuretics
digoxin
pace maker
what microbe is the ain cause of infective endocarditis?
streptococcus viridians
give features of parkinsons disease
bradykinesia- slow movement
rigidity- increase motor tone
mask like face
resting tremors
posture instability, impaired use of upper limbs
how does parkinsons differ from other cerebellular diseases?
resting tremors as apposed to intentional active tremors
how does parkinsons cause dry mouth?
anticolinergic effects of drugs e.g. benztropine
how can you prevent dentures being lost in a care home?
initials during process
store in a labelled container
