Special Care Tutorials Flashcards
what is aspirin used for
- antiplatelet
- analgesic
what is bisoprolol used for
- treats hypertension
- beta blocker - olol ending drugs
- treat conditions such as heart failure, cardiac arrhythmias and hypertension.
what is entresto used for
- treat long term heart failure
- angiotensin receptor neprilysin inhibitor
what is furosemide used for
- loop diuretc
- treat high blood pressure (hypertension), heart failure and a build up of fluid in the body (oedema)
what is omeprazole used for
- proton pump inhibitor - azole ending drugs
- Proton pumps are enzymes in the lining of your stomach that help it make acid to digest food
- Omeprazole prevents proton pumps working properly which reduces the amount of acid the stomach makes.
what is spironolactone used for
- diuretic
what is tegretol used for
- brand name for carbamezapine
- anticonvulsants
- It works by reducing abnormal electrical activity in the brain.
cochrane review on fluoride toothpaste
- if adult high risk give durphat 2800ppmF toothpaste
- cochrane review said no difference than giving 5000ppmF
potential medical reasons for inability to achieve haemostasis
- bleeding disorders - haemophilia A and B, von willibrands disease
- antiplatelet meds
- anticoagulants - heparin, NOA, coumarin anticoagulants
- other drugs - chemotherapy agents, anti-seizure meds (phenytoin), rifampin
- haematological disease - leukaemia, myeloma, ITP
- infections - HIV, hep C
- liver disease - alcoholic liver disease, liver cirrhosis, herp B or C infection, hepatocellular carcinoma
impaired liver function has an impact on
- hepatis synthesis of clotting factors and proteins involved in fibrinolytic system
- including vitamin K dependant coagulation proteins - II, VII, IX, X
- thrombocytopenia and thrombocuthaemia can also be a feature of liver disease
- alcohol can also have direct effect to suppress bone marrow - impair production of cells
renal disease has an impact on
- abnormalities in platelet funcction
- poorly understood
- may be defects in platelet adhesion, secretion and storage
- as a result uraemia - a buildup of toxins in your blood. It occurs when the kidneys stop filtering toxins out through your urine
how would you manage pt with failure to achieve haemostasis
- apply pressure to socket - could use LA soaked gauze
- La around socket
- pack socket with oxidised cellulose or a collagen sponge - surgical mesh helps clotting as framework to allow clot to latch onto
- suture the surgical site
- re-evaluate MH
- if availbale consider tranexamic mouth wash - tranexamic acid works by stopping blood clots from being broken down, reducing unwanted bleeding
- cautery - burning
- bone wax
* if unable to arrest haemorrhage phone local oral orgery or maxfax department - A&E if there is no OMFS unit
if patient asks specific medical questions
- encourage to attend medical assessment
- ensure GDP kept informed of updates so dental tx can be planned appropriately
- if MH still ungoing and any doubt do not provide any operative care until fully assessed
what is a UKELD score and significance
- united kingdom model for end stage liver disease
- score of 49 is very high and 49+ can go on waiting list for liver transplant - also equates to >9% mortality rate within 12 months
- if score >49 may interfere in how we provide any dental tx
features of pt with high UKELD score
- jauncide
- clubbing
- spider naevi
- palmar erythema - palms of hands red
- leukonychia - white nails
- other signs of advancing liver disease - bleeding, oesophageal varices, ascites, peritonitis
- alcohol related - tremors, cognitive impairment
causes of liver disease
- infective - hepatitis viruses B, C and D, rarely A
- autoimmune - primary biliary cirrhosis
- alcohol related
- non-alcoholic fatty liver disease
- drug induced
- hepatocellular carcinoma
- haemochomatosis - iron levels build up
stages of liver disease
- hepatitis - inflammation of liver which may or may not be reversible
- liver cirrhosis - irreversible liver necrosis and fibrosis
- liver failure - failure of normal liver function
to manage pt with liver disease safely what special investigations are required
- liase with hepatology unit
- blood tests - FBC, coagulation/clotting screen, INR, LFTS, Us and Es
- coagulation screen - PT + ration, APPT + ratio, thrombin time
- appropriate radiographs
what does reduced RCC, Hb and haematocrit with increased MCV mean
- macrocytic anaemia
- vit B12/folate deficiency
drugs in dentistry which may have an impact on the liver
- local anaesthetic - lidocaine metabolised in liver
- articaine advantageous as only 5-10% processed in liver
- NSAIDs can increase bleeding risk and risk of hepatorenal syndrome
- paracetamol risk as can be hepatotoxic
- consultation with hepatology if in doubt
- consideration with antibiotics - amoxicillin should be safe, metranidazole dose may be altered, erythromycin contraindicated
- IV sedation with midazolam not appropriate
legal framework which exists to enable access and provision of care for all individuals and groups of people
- equality act 2010 protects those from discrimination - protected charcteristics
- brings together multiple different acts including disability discrimination act 1995 to make the law simpler and clearer
define and explain reasonable adjustment
- any step whcih can be reasonably taken to prevent putting a disabled person at a disadvantage in comparison with a non-disabled person
- factors to determine reasonableness are - effectiveness of adjustment, how practical it is, cost, potential disruption, time effort and resources
if pt unable to transfer to dentla chair what are feasible options to aid transfer
- hoist - can be used for non-weight bearing individuals
- reclining wheelchair - no need to transfer
- turn table or stand aid - promotes involvement of pt
signs of dry mouth
- tendency of mucosa to stick to dental mirror or tongue spatula
- food residues within the oral cavity
- frothiness of saliva
- absence of frank salivation from major salivary gland duct orifices
briefly describe rheumaoid arthritis
- RA is an autoimune disease - immune cells attacks healthy cells in your body causing inflammation in affected parts of body
- RA mainly atacks joints - commonly in hands, wrists and knees
- lining of the join becomes inflamed causing damage to joint tissue
- can also affect other tissues in body and cause problems in lungs, heart and eyes etc
signs and symptoms of RA
- pain or aching in more than one joint
- stiffness in more than one joint
- tenderness and swelling in more than one joint
- weight loss
- fever
- fatigue or tiredness
- weakness
name a non-biologic disease modifying anti-rheumatic drug
- methotrexate
- has antiinflammatory and immunosuppressive effects
treatment plan layout
- acute management - manage pain and swelling, emergent or urgent problems
- prevention - OHI, Fluoride “delivering better oral health” useful
- stabilisation - main areas you want to stabilise are caries, perio, pulpal or periapical and extractions of hopeless teeth with immediate gap replacement if needed
- definitive/restorative - you’re looking to carry out any direct restorations which were previously stabilised with GIC, any indirect restorations like onlays or crowns and you’ll also treat any missing spaces with bridges, dentures or implants
- maintenance - reinforcing oral hygiene instructions and diet advice, rep-prescribing fluoride toothpaste if necessary, re-checking BPE or redoing 6 point pocket charts if they were a perio patient, giving a scale and polish if they need it and taking updated bitewings according to the FGDP guidelines
if pt unable to hold toothbrush
any modifications or advice to give pt
- discuss modes to make this easier
- electric TB
- collis curve TB
- foam handles
- ball handles
how long to people with alzheimers tend to live
after diagnosis
5-10years
if pt unable to communicate pain symptoms
signs that may show pt in pain
- behaviour change
- change in eating
- sleeping pattern change
- touching face more
angular chelitis causes
- fungal infection causing crusting
- OVD too small and moisture trapped
- opportunistic infection
causes of mouth ulcer
- trauma
- B12 deficiency
- iron deficiency
- folate deficiency
- stress
- cancer
dry mouth causes
- polypharmacy
- dehydration
- mouth breather
- sjrogens syndrome
name of antifungal gel and tablet
- gel - nystatin
- tablet - fluconazole
what moutwash cannot be used for CoCr dentures and why
- chlorhexidine gluconate
- causes staining
dry mouth tx
- regular sips of water
- glandosane synthetic saliva - acidic
- biotene moisturising gel
- bioXtra moisturising gel
steps taken when pt no capacity and in pain
- supply certificate of incapacity
- pain dental emergency so can XLA theeth causing pain as emergency tx
- try call PoA or welfare guardian and keep up to date on decisions - if not emergency their consent will be required
if pt gets MRONJ
- review 4 weeks to check healing
- if still there then refer
- refer to oral surgery or max fax
what is diagnosis if white patch which extends from hard palate to soft palate & leaves a bleeding base when removed
what are risk fators for this
- pseudomembranous candidiases
- local corticosteroid use
- xerostomia
- antibiotic use
- dentures
- endocrine disorders
- immunodeficiency
- iron deficiency
- smoking
describe atrial fibrillation
- happens when electric impulses in atria of the heart fire irregularly/chaotically instead of steady and regular
- causing the heart to quiver or twitch (fibrillation)
- symptoms include irregular and sometimes fast heartbeat or pulse, heart palpitations
- not life threatening but considered serious as it could create blood clots in the heart that may lead to stroke
complications of diabetes
- risk of hypoglycaemic episode - medical emergency
- increased prevalence, progression and severity of periodontal disease
- xerostomia
- oral dysesthesia (burning mouth syndrome)
- impaired wound healing
- increased risk of infections and severity - including candidosis
- parotid gland enlargement
high blood pressure can result in
- heart and circulatory disease - heart attack or stroke
- kidney failure
- heart failure
- diabetic retinopathy
- vascular dementia
physiological response to high BP
- arteries are stretchy to cope with BP going up and down
- if high BP - arteries lose their stretchiness and become stiff or narrow
- narrowing makes it easier for atheroma (fatty material) to clog them up
risk factors for high BP
- drinking too much alcohol
- smoking
- being overweight
- not enough exercise
- eating too much salt
what is simvastatin used for
- treat hypercholesterolemia
- HMG CoA reductase inhibitor
what is metformin used for
- anti-hyperglycaemic effect so used for type II diabetes
- can also reduce vitB12 levels - resulting in B12 deficiency anaemia
triple therapy in the management of diabetes
- metformin
- dapaglifloin
- sulfonylurea
how to manage pseudomembranous candidiosis
- assess risk factors and reasons for presence
- observe denture hygiene if applicable - encourage to remove at night
- use toothbrush or some gauze to clean the palate or short term use of corsodyl
- if first line management fails consider medication - nystatin or oral antifungal
where INR should sit for different tx on warfarin
- 2.5 - DVT treatment or pulmonary embolism, AF, mitral stenosis, myocardial infarction
- 3.5 - recurrent DVT, mechanical prosthetic heart valves
requirements prior to XLA pt on warfarin
- plan appt early in day and early in week - allows appropriate time for review
- check INR preferably 24h before XLA but acceptable up to 72 hours where the INR is table
nama factor Xa inhibitors
and how to reverse effect
- apixaban
- edoxiban
- rivoroxiban
- activated charcol pay prevent if administered with 1-2 hours of ingestion
benefits of new oral anticoagulants
- predictable pharmacokinetics and pharmacodynamics
- rapid onset and offset - short half life
- low drug and food interactions
- generally no need for lab monitoring
weaknesses of new oral anticoagulants
- no standardised test for monitoring
- currently lack of antidote
- high cost
- not enough experience
dental procedures unlikely to cause bleeding
- LA by infiltration, mental nerve block, intraligamentary, IDB
- BPE
- supragingival scaling
- direct or indirect restorations with supragingival margins
- impressions and pros
- ortho fitting and adjustment
dental procedures that are likely to cause bleeding
low risk
- simple extractions 1-3 teeth with restricted wound size
- incision and drainage
- detailed 6PPC
- RSD
- direct or indirect restorations with subgingival margins
dental procedures that are likely to cause bleeding
high risk
- complex extractions - cause large wound or more than 3 XLA at once
- flap raising procedures - surgical XLA, periodontal surgery, preprosthetic surgery, periradicular surgery, dental implant surgery
- gingival contouring
- biopsies
NOAC guidance for dental procedures with higher risk of bleeding
- apixaban usually taken twice a day - miss morning dose and after tx take usual time in evening
- rivaroxiban taken once a day in morning - delay morning dose and take 4 hours after haemostasis has been achieved
- edoxaban taken once a day in evening - take usual time in evening
- as long as no earlier than 4 hours after haemostasis has been achieved pt should continue with usual drug schedule after tx
what is hemarthrosis
- bleeding into a joint space
- associated with haemophilia
types of hemophilia
- hemophilia A - deficiency in factor VIII (85% cases)
- haemophilia B - deficiency in factor IX
- both are X-linked recessive
different severity of haemophilia
- mild = 6-40% factor present
- moderate = 2-5% factor present
- severe = <1% factor present
What is clozapine used to treat and dental implications
- anti-psychotic drug
- not a first line management so tx has been ongoing for so,e time
- long term use can lead to hypersalivation and cardiomyopathy
- risks = neutropenia so do FBC before tx as increased risk of infection
Which anti-psychotic drug can cause hyoersalivation and neutropenia
Clozapine
What is schizophrenia
Mental health illness affecting how person thinks, feels and behaves
- NT affected
- visual, auditory hallucinations and delusions (disordered thoughts)
What is the cause of schizophrenia
-genetic predisposition
- environmental trigger
- drug use can increase risk
Management for schizophrenia
- drug therapy antipsychotics
- cognitive behaviour therapy
- talking therapy
- life skills development cookout classes etc
- art and music therapy
Differential diagnoses for ulcers
- Trauma - sharp tooth etc
- Nutritional deficiency / med induced
- Oral cancer
Oral features of frequent vomiting
- palatal tooth erosion
- keratinisation of mucosa
- bad breath
- ulcer of nutritional deficiency or trauma from method of vomiting (toothbrush etc)
Dental hard tissue management of erosion due to eating disorder
- prescribe increased fluoride toothpaste
- fluoride varnish
- GI over teeth
what does Childs C mean
- scale for measuring alcohol liver disease cirrhosis
- A, B, C
- C = severe
importance of neutrophils in blood work
- avg 2-7 x 10^9
- if neutrophils below 1 give antibiotic before invasive tx
- due to increased risk of infection
what is ustekinumab and dental significance
- monoclonal antibody
- increases risk of infection
- can rinse with chlorhexidine before XLA
- review appt after extractions - warn pt of signs of infection
rovaroxaban considerations
- factor Xa inhibitor anticoagulant
- follow SDCEP guidance
- delay dose until at least 4 hours after haemostasis achieved
- recommend max 3 XLA at a time and try not to create big wounds
scale for measuring dry mouth
- challacombe scale
- numeric system of 1 to 10
- 1-3mild
- 4-6 moderate
- 7-10 severe
what dose of radiotherapy increases risk of ORN
60+ grays in one area
platelet count blood work significance
- normal range 150-410 x 10^9
- > 100 okay to tx in GDP
- > 50 for hospital setting
