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FINALS!!! > Special care - revision notes > Flashcards

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
Q

Radiotherapy

A

dose and field of tx
side effects - trismus, loss of taste, dry mouth, oral ulcers, incrseased risk of candiodsis, burning mouth, caries, osteoradnecrosis

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26
Q

Side effects of chemo

A

naseua vomiting, diarrhea
mucossitis
mouth sores dry mouth, tooth decay, bleeding
infection risk incrseaed
hair loss
fever
loss of apeptite

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27
Q

Chemo blood tests

A

white blood cells decrseased,
RBC
Platelets
Neturopenia
leukopenia

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28
Q

Radiation induced caries

A

caries that occurs at the neck of teeth due to the radiation damage casued by the radiotherapy

tx - primary rothograde surgery and decorniate

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29
Q

Osteoradionecrosis

A

damage of bone jaw

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30
Q

Post radio and chemo

A

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

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31
Q

CT vs MRI

A

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

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32
Q

Osteoradionecrosis

A

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

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33
Q

Signs of oral cacern

A

solitary ulcer
firm and hard
raised rolled margins
erythema

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34
Q

Incapable means

A

acting
making decsion
retaining decion
understanding decision
communicaigndecsion

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35
Q

Who can issue a certificate of incapcity

A

medical practioner incharge of persons care
registered nurse
consultant in charge of pt care
dentist if specilaist training

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36
Q

Guardianship orders

A

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

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37
Q

Adults with incapacity act 2000 0or mental health act 2004 (england)

A

to protect people who lack capacity to make decsions and support involement in making decsions

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38
Q

Principles of adults with incapcity 2000 act

A

Beenfit
minimal intervention
takes into the wishes of the the adult
consultation with relvant others
enourages the audult to exercise residual capacity

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39
Q

Power of attornery

A

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

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40
Q

Local casues of pseudomembraous candidosis

A

dentures - ill fitting dentures
antibiotcs
xerostomia
cortocisteriod use

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41
Q

General casues of psedomembranous candidosis

A

smoking
diabetes
cushings
iron deifiency
drugs
HIV
immunoompromised

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42
Q

Diseases that causes xerstomia

A

diabetes
radio/chemo
sjogren’s syndrome
RA
cystic fibrosis
parkinson’s disease
hyperpathyroidsm

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43
Q

Drugs casuing xertstome

A

beta blockers
antircylic antidepressants
anti convulsants
anti pysiochitoics
NSADS - diclofenac
direuetics
protein pump inhibitors
antohistamines

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44
Q

Casues of ulcers

A

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
Q

Xerostomia

A

unstimulated salvia flow <0.3ml/min

46
Q

Risks of xerostomia

A

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
Q

Reasons for hypersalivation

A

meds -prilocarpine
disabilites - cerbral palsy
anxiety or stress
psycholocial
stroke
parkinsons
Preganant

48
Q

MDT for dementia

A

hospice staff
care home nurses
GP
consultant
pharmacy
community nurses

49
Q

Dementia friendly care homes

A

toilet visible from bed
walls, floor and sceiling different colours
labelled cupboards and drawers
radiator low temp
personal pics
furniture tradiotional and domestic

50
Q

Dementia friendl in dental setting

A

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
Q

Diseases casues xerostomia

A

Diabetes
Hyperpathyrodism
HIV
Cushings syndrome
sjoren’s syndrome
RA
parkinson’s
cystic fibrosis
radio and chemo

52
Q

Drugs causing xerostomia

A

duretics
antihistamines
anti cyclic depressants
protein pump inhibiors
beta blockers
anti-covulsants
anti-psychiotics
NSAIDS -diclofenac

53
Q

Dementia

A

detoriation in cognitivie function beyond what is normal for aging

54
Q

Dementia affects

A

memory
thinking
oritentation
calculation
lanuguage
comprehension
learning capacity

55
Q

Frontal tmeporoal dementia

A

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
Q

Dementia with lewy bodies

A

when desposits of prteins (lewy bodies) are abnormal inside the brain

57
Q

Vascualr dementia

A

reduced blood flow to the brain
tends to occur in people who are overwegith, diabetes, smoker, high BP

58
Q

Alzehermier dementia

A

reduction in size of the cortex - deposists of plq in the brain cells - amyloid plqs

59
Q

Testing for demetnia

A

detailed cognitive testing
mini mental state exam
blessed dementia scale
FBC, U&E’s, urinalysis, liver, kidney, glucose, serum, folate, calcium, protein

60
Q

Heamophillia acquired or inhertitied

A

acquired bleeding disorder

61
Q

Name types of acquired bleeding disorders

A

protein cdefiecnecy
protein s deificency
von willebrand
Haemophillia A
Haemophillia B

62
Q

Inhertited bleeding disorders

A

trauma
preganancy
cancer
surgery
OCP

63
Q

Haemophillia A

A

X lineked recissive acquired bleeding disorder
defieicnecy in VII

64
Q

Haemophillia B

A

x linked reciessve acquired bleeding disorder
defeicney in factor IX

65
Q

Von willebrand

A

autosomal dominant (both affected)
factor VII levels are reduced
reduced platelet aggregation

66
Q

Grading severity of heamophillia

A

mild = 6-40% factor present
mod = >2.5% factor present
severe <1% factor present

67
Q

Safe procedures for heamophillia

A

supra ging scaling
exams and radiographs
LA inf
articaine INF
supra ging restorations

68
Q

Risky dental procedures for heamophillia

A

sub ging scaling
XLAs and surgicals
biopsies
IDB or lingual inf or superior nerve block

69
Q

MOD and severe grading heamophillia

A

carried out in haemophillia clinic

70
Q

Thrombophillia

A

incsread risk of clots developing due to lack of protein causing the body to be unable to clot
acquired

71
Q

Tx for heamophillia

A

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
Q

Throbocytopenia

A

reduced number of platelets in the blood
due to failure of proteins numbers - anemia, vit defiency
or
platelet destruction - splenogemegaly viral, drugs, autoimmune

73
Q

Thrombocytopenia

A

normal = 150 x10^9l-400x10^9/l
dental tx in GDP - >100x10^9/l
consult and liase with heamtolgist <100 x10^9/l

74
Q

Tests for bleeding disorders

A

LFT
FBC
Haemophillia and factor screen
Cogualtion screening - prothrombin and activated partial thrmoboplastin time

75
Q

How to help people with physical disability

A

electric toothbrush
putty handles
foam handles
ball handles
collis curve toothbrush

76
Q

Adaptions to dental practice for people with disabilites

A

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
Q

Equality act 2010

A

protects people from discrimination within the workplace
age, sex, religion, disability, sexual oriteitatin

78
Q

Disability discrimination act 2004

A

rights in employment access to goods and facilites

79
Q

tx for nctsl

A

flurodie mw’s
flurodie varnish
dentine bonding agents
chew sugar free gum
reduce carbonated drinks and acidic fruits
flurodie varnish

80
Q

Social model

A

disbaility caused by how socity is organsied rather than a person’s impairment

81
Q

Medical model

A

disability cuased by a persons impairment and differnces should be fixed/changed my medical tx

82
Q

ways to gain access to mouth

A

open wide mouth rsts
bedi shields
mirror
good light
toothbrush
clincial holding

83
Q

Options to aid transfer to chair

A

hoist
stand aid
wheelchair reclininer
turn table
wheelchair tipper
banaana board

84
Q

Cerebral palasy

A

a neurodevelopment conditin affective movement and co-ordination

Dyskinetic - involutanty movements
spastic - muscles tight and stiff
ataxia - shaky movements affects balance
mixed

85
Q

Dental issues with cebral palsy

A

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
Q

Prader willi

A

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
Q

Down syndrome

A

fall trisomy of 21 - extra copy of 21 chromomsome

88
Q

Features of down syndrome

A

flat face
short back of neck
abnormal eara
short brad nose adn hands
round oval face
flat back of head
diminsed muscle tone

89
Q

Dental features of down syndrome

A

class 3 malocclusion
AOB
hypodontia
supernumerary teeth
small and arched palate
posterior cross bite
fissure tongue
small lips and opening of mouth

90
Q

Medical features of down sndyndrome

A

congential heart defects
alzehmer’s/dementia
eye probles
epilspy
leaukameia
tyrhoid disorder
hearing impairment
colaic disease
depression
sexual health issues

91
Q

Signs of liver diseases

A

jaudnince
finger clubbing
aascites
bleeding
spider naevi
oesophageal varices

92
Q

Casues of liver diseases

A

infective - hep a,b,c,d,
non finective - primary billiary circihosis, alcohol , non alcoholic fatty liver disease, drug induced, hetocellular carcinoma

93
Q

Dentistry and liver

A

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
Q

why do liver diseases pts get thrombocytopenia

A

due to anti cancer agents
reduction in platelets due to reduction in thrmobopoietin which regulates platelet production
bone marrow suppersion by hep C

95
Q

Dental implications of an eating disorder

A

NCTSL
xertostomia
senstivity
hostile acidic environment
loss of vertical dimension

96
Q

Depression dental aspect

A

TMD problems
poor OH
dry mouth
spots or lumps
chronic facial pain
burning muoth
disturbed taste sensation

97
Q

Tardive dyskinesia

A

involuntary movements of the tongue, lip face and trunk
happens in people who recieve antipsychitocis for mainy years

98
Q

Bipolar disorder

A

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
Q

Pysychosis

A

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
Q

Psychosis trigger by

A

stress
meds
alocohl
drug misue
physical condition - eg brain tumour

101
Q

antipysichiotic mieds

A

olanzapine
quetiapine
clozapine

102
Q

Psychosis types

A

Bipolar
schizophrenia
schizoeffective disroder

103
Q

Bipolar

A

mood disorder and swings
1.mainc
2.depressive
3. hypomanic

104
Q

Schizophernia

A

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
Q

Extra pyramidal effects

A

inability to sit still
involuntary muscle contractions
involuntary facial movements
stiff/tremor of muscles

106
Q

Schizoeffective disorder

A

bipolar and psychiotic
1. manic - psychiotic and mania
2. depressive - psychotics and depressive
3. mixed

107
Q

Neurosis

A

a mild netal health disroder not from organic disease but from stress and anxiety
can be anxiety, depression OCD

108
Q

Psychosis

A

a major personality disorder with mental and emtional disruptions

FINALS!!! (20 decks)

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