Special Care Overview Flashcards
What is the definition of an impairment?
Any loss or abnormality of psychological, physiological, or anatomical structure or function
(occurs at the level of organ/system function
What is the definition of disability?
Any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human
(concerned with functional performance)
What is the definition of a handicap?
A disadvantage for a given individual, resulting from impairment or disability, that limits or prevents the fulfilment of a role that is normal
What are some barriers to care that special care patients may experience?
- physical
- attitudinal
- people centred
- professional centred
What legislation discusses equality in dental care?
The Equality Act 2010
- protects people from discrimination in the workplace & in wider society
Give examples of protected characteristics:
- age
- disability
- gender reassignment
- marriage or civil partnership
- pregnancy and maternity
- race
- religion or belief
- sex
- sexual orientation
What are the different types of discrimination?
- direct
- indirect
- harassment
- victimisation
What is direct discrimination?
treating someone with a protected characteristic less favourably than others
What is indirect discrimination?
putting rules or arrangements in place that apply to everyone, but that put someone with a protected characteristic at an unfair disadvantage
What is harassment?
unwanted behaviour linked to a protected characteristic that violates someones dignity or creates an offensive environment for them
what is victimisation?
treating someone unfairly because they’ve complained about discrimination or harassment
What are the 5 domains of overcoming barriers to healthcare?
- accessibility
- accommodation
- affordability
- acceptability
- availability
How can an upstream approach improve access to healthcare for those with special care needs?
- policies aimed at social inclusion & better access to education/employment
- better insurance policies for this group
- eligibility for free or subsidised dental care
How can a downstream approach improve access to healthcare for those with special care needs?
design of a regional dental care infrastructure to increase access to dental care for disabled people
What legislation is in place to protect individuals who lack capacity?
Adults with Incapacity (Scotland) Act 2000
A person is unable to make a decision for themselves if they are incapable of …….
- acting
- making decisions
- communicating decisions
- understanding decisions
- retaining memory of the decision
What is a bariatric patient defined as?
An individual of any age who has limitations in health and social care due to physical size, health, mobility and environmental access
What does the World Health Organisation define an obese person as in relation to BMI?
> /= 30kg/m2
What are some limitations of the BMI system?
- does not assess body fat distribution
- does not account for age, sex, ethnicity and muscle mass
What is the role of the dental team in relation to bariatric care?
- identify and diagnose health issues associated with bariatric patient
- signpost patients to appropriate services
- be aware of comorbidities or predisposition to dental disease
- referral onto secondary/tertiary care
- may have to provide emergency care
- raise health concerns with patient, parents or carers of vulnerable adults/children
How can obesity affect dental treatment?
- pt does not fit in regular dental chair
- pt may not be able to lie supine
- airway management compromised
- longer needles may be required
- reduced mobility may need longer appt times
- difficult access to oral cavity due to excess weight
- higher risk of MI occurring in practise
- loss of anatomical landmarks
- difficulty taking radiographs
How might obesity affect a pts periodontal disease risk?
Pt at higher risk of diabetes, diabetes is a direct risk factor for periodontal disease development
What are some dental implications of obesity?
- high caries risk
- poor wound healing (bariatric pts tend to have reduced immune function)
- tooth wear risk (GORD prevalence increased)
Why might IV sedation undertaken in a primary care setting be contraindicated in bariatric patients?
- difficulty placing cannula
- compromised airway
- at risk of sleep apnoea
When you are assessing for capacity, what key factors must you always consider?
- presume capacity
- not an all or nothing event
- capacity may fluctuate
- consider residual capacity
- always record your assessment
In reference to consulting with relevant others when making decisions on behalf of adults with incapacity, who should you contact?
- nearest relative / primary carer
- a welfare attorney
What are the 5 principles of treatment decision making under the Adults With Incapacity Act?
- benefit
- minimum necessary intervention
- take account of the wishes of the adult
- consultation with relevant others
- encourage the adult to exercise residual capacity
Who can consent for dental treatment?
- patients with capacity
- wellfare powers of attorney
- welfare guardians
- medical & dental practitioners under Section 47 of AWI Act
Why can aging lead to poor dental health?
- polypharmacy
- OH difficulties
- lack of capacity
- deteriorating immune system
What does a good quality of life look like for the older generation?
- good social relationships
- maintaining social activities
- retaining a role in society
- positive psychological outlook
- good health and mobility
- enjoy life
- retain independence
What are the characteristics of dementia?
- amnesia
- inability to concentrate
- disorientation in time, place or person
- intellectual impairment
What is Alzheimer’s?
- most common type of dementia
- reduction size of the cortex
- plaques build up in the spaces between nerve cells
What are some different types of dementia?
- Alzheimer’s
- Vascular
- Dementia with Lewy Bodies
What are some early stage symptoms of dementia?
- loss of short-term memory
- confusion
- poor judgement
- anxiety, agitation or distress
- communication problems
What condition is pictured here?
Fibroepithelial polyp
What condition is pictured here?
Geographical tongue
What condition is pictured here?
Atrophic Glossitis
How should xerostomia be managed?
- alter medication regime
- salivary replacement
- frequent sips of water
- salivary stimulants (eg chewing gum/lemon)
What can cause lichenoid tissue reactions?
- NSAIDs
- beta blockers
- amalgam
- diuretics
- statins
- antimalarials
What pathology is pictured here?
MRONJ
Give some uses of bisphosphonates:
- osteoporosis
- paget’s disease
- multiple myeloma
- breast cancer
- prostate cancer
- fibrous dysplasia
What are some risk factors of development of MRONJ while taking bisphosphonate medication?
- extremes of age
- concurrent use of corticosteroids
- systemic conditions affecting bone turnover
- malignancy
- long duration of therapy
- previous MRONJ diagnosis
- invasive dental procedures
What patient advice can you give to reduce risk of MRONJ development after dental procedures?
- regular dental checks
- maintain good OH
- limit alcohol & stop smoking
- report any problems [eg loose teeth, pain, swelling]
What pathology is pictured here?
Herpes Zoster (shingles)
What is post herpetic neuralgia?
- will have had a previous episode of shingles
- constant burning sensation in dermatomal distribution
- resolves within 2 months [50%]
- high suicide risk
How is post herpetic neuralgia treated?
- antidepressants
- gabapentin
- carbamazepine
- topical capsaicin 0.035%
- TENS machine
How can trigeminal neuralgia be managed with medications?
- carbamazepine
- gabapentin
- pregabalin
- lamotrigine
- sodium valproate
- phenytoin
What surgical management is available for trigeminal neuralgia treatment?
- avulsion of nerve
- microvascular decompression
- cryotherapy
- alcohol or glycerol injection
Who is more likely to experience burning mouth syndrome?
Females (F:M = 3:1)
What are some causes of burning mouth syndrome?
- idiopathic in 50% of cases
- drugs
- xerostomia
- candidosis
- haematinic deficiencies
- parafunctional habits
- hypothyroidism
What is frailty?
A state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic & immune systems
What are aspects of the frailty phenotype?
- unintentional weight loss (4.5kg in last year)
- self-reported exhaustion
- weakness
- slow walking speed
- low physical activity
What is an example of an oral health promotion programme for elderly?
Caring for Smiles
How do you report concerns you may have for vulnerable adults?
Recognise
Record
Report
- if immediate danger = call 999
- speak to line manager
- refer to adult protection procedures
- complete AP1 and send to social care directly
What is intellectual impairment?
Affected functioning in:
- intellectual functioning (learning, problem solving, judgement)
- adaptive functioning (communication, independent living)
How do the social and medical models of disability differ?
Social Model:
- disability is caused by the way society is organised, rather than by a person’s impairment or difference
Medical Model:
- people are disabled by their impairments or differences
What are some syndromes that are associated with learning disability?
- downs
- prader willi
- autism
What causes Down’s Syndrome?
Genetic mutation of chromosome 21
- trisomy of chromosome (95%)
- mosaicism (2-4%)
Why are Down’s Syndrome patients at a higher risk of periodontal disease?
- impaired neutrophil chemotaxis (migration of neutrophils to sites of inflammation)
- upregulated production of inflammatory mediators
In those that cannot communicate pain, what are some signs and symptoms that suggest a person may be in pain?
- unprovoked aggression
- altered facial expressions
- changes to mobility/balance
- changes in behaviour (irritability, withdrawal, tearfulness)
- changes to appetite or vocalisation
- altered sleep pattern
What are some adjuncts that can be used to aid communication?
- makaton
- picture boards
- letter boards
- talking mats
- drawing
- writing
What can be used to aid access to the mouth in special care patients?
- bedi shield
- bite blocks
