Special care - revision notes Flashcards

1
Q

What is warfarin

A

warfarin is a Vit K antagonsit that works by blocking the clottiginfactors essential for forming a clot.
These are clotting factors , 2, 7, 9, 10 and protein C and S

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2
Q

INR

A

international normalised ratio - measures the time for the blood to form a clot

Prothrombin time/referecne partial thromboplasatin time

PT is esseintial for forming a clot

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3
Q

INR for healhty people

A

= 1

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4
Q

INR for people on warfarin recienving tx

A

INR <4 and stable

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5
Q

Stable INR

A

<4 and has been for the last 2 months
does not require weekly monitoring

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6
Q

Stable INR

A

tests 72 hrs before the procedure

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7
Q

Why are people on warfarin

A

Atriral fibrilliation
MI
Blood clots in veins (venous thrombosis)
Blood clots in lungs (pulmonary embolism)

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8
Q

Low risk dental procedures

A

6PPC
examination
radiographs
simple XLA
RSD
direct resotrations

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9
Q

High risk dental procedures

A

Biopsies
Rasing flaps
Gingivectomy
Extensive or complicated XLA’s

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10
Q

Apixiban

A

a direct noval oral anticogulatn that works by inhibting factor Xa which works by blocking the action of activated factor xwhich is needed for forming a clot
taken x2 daily

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11
Q

Dabagratran

A

a direct inhibotr of the factor thrombin
taken x2 daily

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12
Q

Rivaroxaban

A

taken once daily

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13
Q

Apixaiban and dabagratran

A

delay morning does till haemostasis has been achied >4hrs after tx

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14
Q

Treatment if on warfarin

A

> 4 then delay treatment
early morning and week appts
haemostasiis agents ready
XLA no more than 3 teeth at one time
paracetamol instead of NSAIDs

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15
Q

Thrombin

A

convereted from prothrombin
serine protease
thrombin then converts fibrnogen to fibrin

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16
Q

Cogualtion casacade

A

for a clot to form need to activate proteins called clotting factos

  1. intrinsic - activated by factors in the blood (factor VII)
  2. extrinsic - activated by factors in the tissues
    common - both theses pathways results in the activation of the common and facto X which converts fibrnogen to fibirn to form a clot
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17
Q

MDT for head and neck cancer

A

oncologist
chemo nurse
speech and language therapsit
physio
patholoigist
surgeon
speacial care dentist

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18
Q

Risk factors for oral cancer

A

smoking
acohol
betal quid
nutrtion - low in antioxidantes
Socieconmic factors
poor OH and dental health
HPV

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19
Q

High risk sites for oral cancer

A

ventral and lateral borders of tongue
buccal mucosa
floor of mouth
hard and soft palate
orpharynx

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20
Q

Signs and sympomts

A

horseness in voice
persient ulcer with unknown casues for >3wks
red or white patches in mouth >3weeks
ear pain with no ear abnormalities >3wks
persistent soreness
unexpailed lump >3wks

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21
Q

Clinical signs of oral cancer

A

solitary ulcer
raised with rolled margins
firm base and hard
erythema

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22
Q

Pre malgingant conditions

A

Leukoplakia
erythroplakia
lichen planus
palatal keratosis
squamous cell carcinoma
submucosous fibrosis

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23
Q

Mucosistis

A

inflammation and ulceration leading to pain
7-14 days after drug therapy

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24
Q

tx for mucositis

A

avoid spicy acidic food, spirits and tea
smoking avoid
soidium bicarb, tea tree oil , honey, CHX, gelclair, saline
chew on ice cubes
oral cooling ice
morphine/;laser light therapy

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25
Radiotherapy
dose and field of tx side effects - trismus, loss of taste, dry mouth, oral ulcers, incrseased risk of candiodsis, burning mouth, caries, osteoradnecrosis
26
Side effects of chemo
naseua vomiting, diarrhea mucossitis mouth sores dry mouth, tooth decay, bleeding infection risk incrseaed hair loss fever loss of apeptite
27
Chemo blood tests
white blood cells decrseased, RBC Platelets Neturopenia leukopenia
28
Radiation induced caries
caries that occurs at the neck of teeth due to the radiation damage casued by the radiotherapy tx - primary rothograde surgery and decorniate
29
Osteoradionecrosis
damage of bone jaw
30
Post radio and chemo
mainitain regular dental exams OHI and maintain good OH High lfurodie toothpaste Fluoride varnish tooth mousse saliva stimulants to help with dry mouth stop smoking
31
CT vs MRI
CT - shows soft tissue and bone, quick and no claustrophibia for pt, however need blood tests to check kidneys before commening as iodine die can cause issues with kidney probs in people, small radiation risk MRI - shows only soft tissues, non invasive, no radiation exposure, no iodine die causing issues However - expensive, claustrophibia, takes time to do, difficult if have metal devices in body
32
Osteoradionecrosis
can hapen to a person after recieving radiotherapy for oral cacner >60 grays Signs and symptoms - pain, ulcers, sores, trismus, exposed bone, sharp pieces of bone, swelling, infection, sequestrum Dentists before radio - remove all teeth with poor prognosis, liase with oncologist, commence all tx 10-14 days pre radio Post radio and need tx - mayrequire hyberpbaric oxygen befroe tx Osteroradnecrosis occurs - remove necrotic tissues, irrigation with saline, CHX mw and remove and smooth shrap edges, only prescribe antibiotics if secondary infection occurs
33
Signs of oral cacern
solitary ulcer firm and hard raised rolled margins erythema
34
Incapable means
acting making decsion retaining decion understanding decision communicaigndecsion
35
Who can issue a certificate of incapcity
medical practioner incharge of persons care registered nurse consultant in charge of pt care dentist if specilaist training
36
Guardianship orders
when the person has no capacity if have joint guardianship just need consent form 1 court appointed requires 2medical reports appoitned for 3years deals with finance, proterty and martia affairs
37
Adults with incapacity act 2000 0or mental health act 2004 (england)
to protect people who lack capacity to make decsions and support involement in making decsions
38
Principles of adults with incapcity 2000 act
Beenfit minimal intervention takes into the wishes of the the adult consultation with relvant others enourages the audult to exercise residual capacity
39
Power of attornery
granted by the adult when thet still have capacity certified by lawyer or by medical practioner (proxy) Welfare - comes into affect when person incapable of making decision, realating to health and personal Continuing power - fincial and property affairs only
40
Local casues of pseudomembraous candidosis
dentures - ill fitting dentures antibiotcs xerostomia cortocisteriod use
41
General casues of psedomembranous candidosis
smoking diabetes cushings iron deifiency drugs HIV immunoompromised
42
Diseases that causes xerstomia
diabetes radio/chemo sjogren's syndrome RA cystic fibrosis parkinson's disease hyperpathyroidsm
43
Drugs casuing xertstome
beta blockers antircylic antidepressants anti convulsants anti pysiochitoics NSADS - diclofenac direuetics protein pump inhibitors antohistamines
44
Casues of ulcers
trauam - chemical, mechanical, thermal carcinoma vesicubullous diseases - pemphgoid, pemipgisu viral infections - HIV GI diseases - crohns, UC, coliac autoimmune diseases - OFG meds - iron tabs, ,aspirn
45
Xerostomia
unstimulated salvia flow <0.3ml/min
46
Risks of xerostomia
increased caries and perio risk difficult swallowing difficlut with speaking difficult eating and chewing food bad taste burning mouth candidosis ulcerations angular chelitis sialodentitis (infection of salivary gland)
47
Reasons for hypersalivation
meds -prilocarpine disabilites - cerbral palsy anxiety or stress psycholocial stroke parkinsons Preganant
48
MDT for dementia
hospice staff care home nurses GP consultant pharmacy community nurses
49
Dementia friendly care homes
toilet visible from bed walls, floor and sceiling different colours labelled cupboards and drawers radiator low temp personal pics furniture tradiotional and domestic
50
Dementia friendl in dental setting
natural light reception desk visible from entrance avoid non essential signs locks rooms same colour as walls to direct attention away from them pictorial elements simple text and colour singange eye level
51
Diseases casues xerostomia
Diabetes Hyperpathyrodism HIV Cushings syndrome sjoren's syndrome RA parkinson's cystic fibrosis radio and chemo
52
Drugs causing xerostomia
duretics antihistamines anti cyclic depressants protein pump inhibiors beta blockers anti-covulsants anti-psychiotics NSAIDS -diclofenac
53
Dementia
detoriation in cognitivie function beyond what is normal for aging
54
Dementia affects
memory thinking oritentation calculation lanuguage comprehension learning capacity
55
Frontal tmeporoal dementia
Dementia of prtein TDP-43 associated with clumps of protein tends to occurs in younger pts with change of personailiyt and difficult with language
56
Dementia with lewy bodies
when desposits of prteins (lewy bodies) are abnormal inside the brain
57
Vascualr dementia
reduced blood flow to the brain tends to occur in people who are overwegith, diabetes, smoker, high BP
58
Alzehermier dementia
reduction in size of the cortex - deposists of plq in the brain cells - amyloid plqs
59
Testing for demetnia
detailed cognitive testing mini mental state exam blessed dementia scale FBC, U&E's, urinalysis, liver, kidney, glucose, serum, folate, calcium, protein
60
Heamophillia acquired or inhertitied
acquired bleeding disorder
61
Name types of acquired bleeding disorders
protein cdefiecnecy protein s deificency von willebrand Haemophillia A Haemophillia B
62
Inhertited bleeding disorders
trauma preganancy cancer surgery OCP
63
Haemophillia A
X lineked recissive acquired bleeding disorder defieicnecy in VII
64
Haemophillia B
x linked reciessve acquired bleeding disorder defeicney in factor IX
65
Von willebrand
autosomal dominant (both affected) factor VII levels are reduced reduced platelet aggregation
66
Grading severity of heamophillia
mild = 6-40% factor present mod = >2.5% factor present severe <1% factor present
67
Safe procedures for heamophillia
supra ging scaling exams and radiographs LA inf articaine INF supra ging restorations
68
Risky dental procedures for heamophillia
sub ging scaling XLAs and surgicals biopsies IDB or lingual inf or superior nerve block
69
MOD and severe grading heamophillia
carried out in haemophillia clinic
70
Thrombophillia
incsread risk of clots developing due to lack of protein causing the body to be unable to clot acquired
71
Tx for heamophillia
mild Haemophillia A and von willebrand - tx with DDAVP which release factor 8 (do not use for heamophilllia B need a recombineent facotr IX) severe = tranxiamic acid which is an anti-fbronolytic agent or factor replacement
72
Throbocytopenia
reduced number of platelets in the blood due to failure of proteins numbers - anemia, vit defiency or platelet destruction - splenogemegaly viral, drugs, autoimmune
73
Thrombocytopenia
normal = 150 x10^9l-400x10^9/l dental tx in GDP - >100x10^9/l consult and liase with heamtolgist <100 x10^9/l
74
Tests for bleeding disorders
LFT FBC Haemophillia and factor screen Cogualtion screening - prothrombin and activated partial thrmoboplastin time
75
How to help people with physical disability
electric toothbrush putty handles foam handles ball handles collis curve toothbrush
76
Adaptions to dental practice for people with disabilites
designated parking spaces signposting for sensory impairment ground level access designated disable toilets wheelchair turning circle hearing loops handrails for support wide dorrs and corrodrs
77
Equality act 2010
protects people from discrimination within the workplace age, sex, religion, disability, sexual oriteitatin
78
Disability discrimination act 2004
rights in employment access to goods and facilites
79
tx for nctsl
flurodie mw's flurodie varnish dentine bonding agents chew sugar free gum reduce carbonated drinks and acidic fruits flurodie varnish
80
Social model
disbaility caused by how socity is organsied rather than a person's impairment
81
Medical model
disability cuased by a persons impairment and differnces should be fixed/changed my medical tx
82
ways to gain access to mouth
open wide mouth rsts bedi shields mirror good light toothbrush clincial holding
83
Options to aid transfer to chair
hoist stand aid wheelchair reclininer turn table wheelchair tipper banaana board
84
Cerebral palasy
a neurodevelopment conditin affective movement and co-ordination Dyskinetic - involutanty movements spastic - muscles tight and stiff ataxia - shaky movements affects balance mixed
85
Dental issues with cebral palsy
difficuty gaining access to the mouth - random uncontrolled movments sotre food in the mouth drooling and hypersalivation increased caries risk high surgar meds can't hold toothbrush in mouth
86
Prader willi
chromosmoe 15 does not function or not present constant desire to eat food restricted growth reduced muscle tone lack of sexual devlopment learning difficuties behavioural issues
87
Down syndrome
fall trisomy of 21 - extra copy of 21 chromomsome
88
Features of down syndrome
flat face short back of neck abnormal eara short brad nose adn hands round oval face flat back of head diminsed muscle tone
89
Dental features of down syndrome
class 3 malocclusion AOB hypodontia supernumerary teeth small and arched palate posterior cross bite fissure tongue small lips and opening of mouth
90
Medical features of down sndyndrome
congential heart defects alzehmer's/dementia eye probles epilspy leaukameia tyrhoid disorder hearing impairment colaic disease depression sexual health issues
91
Signs of liver diseases
jaudnince finger clubbing aascites bleeding spider naevi oesophageal varices
92
Casues of liver diseases
infective - hep a,b,c,d, non finective - primary billiary circihosis, alcohol , non alcoholic fatty liver disease, drug induced, hetocellular carcinoma
93
Dentistry and liver
do not give lignocaine as metabolised in the liver, use articaine and not blocks as increased risk of heamatoma avoid IV sedation as prolongs effects and can induce coma increased bleeding tendeies due to clotting facotrs made in liver more prone to infection antibiotics - avoid metro and erythromycin avoid NSAIDs as unable to metabolise Bone marrow suppression by hep c
94
why do liver diseases pts get thrombocytopenia
due to anti cancer agents reduction in platelets due to reduction in thrmobopoietin which regulates platelet production bone marrow suppersion by hep C
95
Dental implications of an eating disorder
NCTSL xertostomia senstivity hostile acidic environment loss of vertical dimension
96
Depression dental aspect
TMD problems poor OH dry mouth spots or lumps chronic facial pain burning muoth disturbed taste sensation
97
Tardive dyskinesia
involuntary movements of the tongue, lip face and trunk happens in people who recieve antipsychitocis for mainy years
98
Bipolar disorder
a disorder which affects you rmood swings manic, depressive, hypomanic depression - increased decline in oh, incrseased perio and caries risk mania - overdose use of OH aids and can cause abrasion NCTSL
99
Pysychosis
lose contact with reality - percieve things differntly to those around them hallicnations and delusion types schizophernia - affects how you think feel and behave, hallicinations, delusions, muddled thoughts, losing interest tx - talking therapies, CBT antipsyhciotic meds, Bioplar
100
Psychosis trigger by
stress meds alocohl drug misue physical condition - eg brain tumour
101
antipysichiotic mieds
olanzapine quetiapine clozapine
102
Psychosis types
Bipolar schizophrenia schizoeffective disroder
103
Bipolar
mood disorder and swings 1.mainc 2.depressive 3. hypomanic
104
Schizophernia
hallicinations and delusions paronoid illusions muddle thoughts losinginterest tx - CBT, antipsyhchotic meds, counselling and psychotherapy Dental antipsychitoics can casue facial dsykiensia, hypotension, hypersalivation , dry mouth oral pigmentation and extra pyradaminal effects
105
Extra pyramidal effects
inability to sit still involuntary muscle contractions involuntary facial movements stiff/tremor of muscles
106
Schizoeffective disorder
bipolar and psychiotic 1. manic - psychiotic and mania 2. depressive - psychotics and depressive 3. mixed
107
Neurosis
a mild netal health disroder not from organic disease but from stress and anxiety can be anxiety, depression OCD
108
Psychosis
a major personality disorder with mental and emtional disruptions