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4th Yr- CCD2- Special Needs > special needs 3 > Flashcards

special needs 3 Flashcards

1
Q

What should children with a medical condition be considered to be

A

High risk for dental caries

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2
Q

List the stages of a full preventive programme

A
  1. Diet
  2. OHI
  3. Fluoride
  4. Fissure sealants
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3
Q

Give examples of common medical conditions children may present with

A
  1. Congenital heart disease
  2. Angina
  3. Cystic fibrosis
  4. Inherited heart disorders
  5. oncology
  6. diabetes
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4
Q

how many children are affected by congenital heart diseases

A

7-8/ 1000 children are born with a heart defect

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5
Q

How do we classify congenital heart disease

A
  1. Acyanotic

2. Cyanotic

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6
Q

Describe acyanotic congenital heart disease

A

Blood does not bypass the lungs

there is a left to right shunt

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7
Q

Describe cyanotic congenital heart disease

A

Deoxygenated blood is found in the systemic circulation leading to lack of oxygen in the body

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8
Q

Which is more common cyanotic or acyanotic congenital heart defects

A

Acyanotic (80%)

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9
Q

Give examples of acyanotic congenital heart defects

A
  1. Ventricular septal defect
  2. Patent Ductus Arteriosus
  3. Pulmonary Stenosis
  4. Atrial Septal Defect
  5. Coarctation Aorta
  6. Aortic Stenosis
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10
Q

give examples of cyanotic defects

A

Tetralogy Fallot 6%

Transposition of the Great Arteries 5%

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11
Q

Give examples of teratology Fallot

A

VSD- ventricular septal defect
Right Ventricular Hypertrophy
Pulmonary Stenosis
Over-riding Aorta

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12
Q

Is there a link between caries levels and congenital heart disease

A

Caries levels are seen to be the same for patients with and without CHD
BUT
In patients with CHD there is an increase in UNTREATED caries and enamel defects

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13
Q

Why might patients with CHD have an increase in untreated caries

A

Due to difficulty scheduling appointments and carrying out treatment

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14
Q

What is infective endocarditis

A

A multi system disease that results from infection usually bacterial of the endocardial surface of the heart (heart lining, heart valve or blood vessel)

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15
Q

What is paediatric infective endocarditis caused by

A

40% paediatric IE cases are caused by oral streptococci

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16
Q

What can predispose a patient to infective endocarditis

A

congenital heart disease

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17
Q

what is the link between oral disease and infective endocarditis

A

Oral disease is Riley to be associated with increased frequency and size of bacteraemias

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18
Q

Name the only CHD that do not predispose you to infective endocarditis

A

Isolated atrial septal defect
Fully corrected atrial septal defect
Fully corrected ventricular septal defect
Patent ductus arterioles

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19
Q

The guidelines state healthcare professionals should regard people with which cardiac conditions as having an increased risk of developing infective endocarditis

A
  1. Acquired calculator heart disease with stenosis or regurgitation
  2. Valve replacement
  3. Structural congenital heart disease
  4. Previous infective endocarditis
  5. Hypertrophic cardiomyopathy
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20
Q

Which oral bacteria can cause infective endocarditis

A
  1. Viridans streptococci (48%)
  2. Staphylococci (30%)
  3. Enterococci (10%)
  4. Haemolytic streptococci
  5. Pneumococci
  6. Other
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21
Q

Describe viridian’s streptococci

A

Is a commensal gram positive bacteria that is found in the oral cavity

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22
Q

Should we provide antibiotic cover to patients at high risk of infective endocarditis prior to dental treatment

A

Antibiotic prophylaxis against infective endocarditis is no longer recommended for people undergoing dental procedures

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23
Q

Who should we contact with if we are unsure if a patient at high risk of infective endocarditis would benefit from antibiotics

A

Lisa with GP as cases of IE are increasing slightly and it is a very serious condition

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24
Q

In which patients should we take extra precautions before carrying out dental treatment due to risk of infective endocarditis

A

Patients with prosthetic valves including:

  1. previous infective endocarditis patients
  2. Any type of cyanotic CHD
  3. Any type of CHD repaired with a prosthetic material
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25
What treatment is contraindicated in patients with CHD
1. Pulp therapy in primary teeth 2. Be cautious with intraligamental local anaesthetic 3. Beware of anticoagulant therapy
26
what is asthma
A chronic inflammatory condition
27
What is asthma associated with
Associated with airway hyper-responsiveness | Recurrent episodes of wheezing, breathlessness, chest tightness and coughin
28
How common Is asthma in children
10-15% of school children affected
29
Is asthma fatal
Causes 15-20 deaths a year in the uk
30
List soem symptoms of asthma
1. Coughing 2. Wheezing 3. Breathlessness 4. Chest tightness 5. Chest pain 6. Seasonal symptoms
31
What can asthma be triggered by
1. Environmental factors | 2. Genetic predisposition
32
Talk through the pathophysciolgy of asthma
1. Trigger 2. Bronchial inflammation 3. Bronchial hyperactivity and trigger factors 4. Oedema leading to bronchoconstriction and increased mucous production 5. Airways narrow 6. Symptoms present
33
List some common triggers of asthma
1. Upper respiratory tract infections 2. Allergens 3. Smoking (active or passive) 4. Cold air 5. Exercise 6. Emotional upset or excitement 7. Chemical irritants
34
List some of the oral manifestations of asthma
1. Erosion 2. Thrush 3. Caries
35
What are some of the dental considerations we make for patients with asthma
1. Avoid GA in severe asthmatics 2. May be taking systemic steroids 3. Advise asthmatics to bring inhalers for dental appointment 4. 3-5% of asthmatic patients experience ADRs with NSAIDs 5. Allergy to penicillin is more common 6. Anxiety can precipitate an asthmatic attack 7. AVOID COLOPHONY CONTAINING FLUORIDE VARNISH
36
What should we avoid in giving to asthmatic patients
colophony-containing fluoride varnish eg duraphat
37
What can steroids put asthmatics at risk of
Adrenal suppression meaning they are unable to produce enough cortisol
38
What is the significance of cortisol
this maintains: 1. BP and CV function, 2. slows immune system inflammatory response, 3. balances effects of insulin, 4. aids metabolism
39
give an alternative to duraphat that we can Give to asthmatic patients
flur-protect
40
In whom is cystic fibrosis most common
Caucasians (1 in 2500 live birth)
41
What is cystic fibrosis
An autosomal recessive inheritance disorder
42
what does cystic fibrosis cause
results in failure to produce protein which regulates electrolyte and water transport across cell membranes
43
What can cystic fibrosis result in
Secretions which are viscous and prone to respiratory infection
44
Which body systems are most affected by cystic fibrosis
1. Respiratory system | 2. Gastrointestinal system
45
How is the respiratory system affected by cystic fibrosis
1. Patient may be more prone to infection 2. Patient requires intensive physiotherapy 3. Patient may be on long term antibiotics
46
How can cystic fibrosis affect the gastrointestinal system
Pancreatic enzymes are affected
47
As children with cystic fibrosis get older what may they develop
Liver disease and diabetes
48
What are some of the oral manifestation of cystic fibrosis
1. Salivary gland dysfunction 2. Dental caries is decreased 3. Lower levels of plaque induced gingivitis but higher levels of calculus 4. Enamel defects seen in 25% of patient 5. Delayed dental development and eruption
49
How can saliva be affected in cystic fibrosis patients
``` Alterations in: 1. flow 2. Viscosity 3. Sodium 4, Calcium 5. Lipid concentration 6. pH 7. Buffering capacity ```
50
Why might patients with cystic fibrosis have a lower incidence of dental caries
1. Antibiotics 2. Raised salivary calcium levels 3. Raised salivary pH
51
How do we manage dental treatment of cystic fibrosis patietns
1. GA is avoided 2. Narcotics and sedatives are avoided due to risk of respiratory depression 3. Diet assessment and advice 4. universal infection prevention measures
52
Give examples of bleeding Disorders
1. Haemophilia A 2. Haemophilia B 3. Haemophilia C 4. Von Willebrand disease
53
What can inherited blood disorders be split into
1. Bleeding disorders | 2. Sickle cell anaemia
54
What is haemophilia A
Factor VIII deficiency | impairs bloods ability to clot
55
Is haemophilia A seen more commonly in men or women
Men as it is x linked recessive
56
What is haemophilia B also known as
The Christmas disease
57
What is haemophilia b
Factor IX deficiency
58
What is haemophilia C
Factor XI deficiency
59
What is von Willebrand disease
Problem with quantity or quality of von Willebrand factor
60
What is the significance of von Willebrand factor
Binds to both platelets and endothelium forming an adhesive bridge so essential for platelet adhesion
61
Is haemophilia B more common in men or women
Men as it is x linked recessive
62
Is haemophilia C recessive or dominant
Autosomal recessive
63
Is von willebrands disease recession or dominant
Type I is autosomal dominant
64
Which haemophilia is the most common
A is most common and c is lead common
65
What are the presenting factors of haemophilia
1. Increased bleeding 2. Easy bruising 3. Nose bleeds 4. Family history
66
How can we treat haemophilia
Giving adequate replacement of the deficient factor
67
What should we avoid in haemophilia patients
NSAIDs and aspirin
68
What dental consideration should we make fro a patient with haemophilia
1. Communicate with haematologist/paediatrician 2. LA infiltrations and intraligamentals are unlikely to cause problems 3. IDB/lingual infiltration contraindicated as risk of haematoma 4. Pulp therapy is preferable to extraction 5. Extractions in hospital setting 6. Consider GA if factor replacement required for multiple quadrants
69
What are haemophilia at greater risk of developing
Increased caries risk due to poor oral hygiene and lack of professional care
70
What is sickle cell anaemia
Am autosomal recessive disorder caused by the substation of a single amino acid in the haemoglobin chain
71
In whom is sickle cell anaemia most common
Black African population
72
Which cells are affected in sickle cell anaemia patients
Red blood cells
73
What happens to the RBC in sickle cell anaemia patients
Thet have a shorter life (30-60 days) leading to haemolytic anaemia The RBCs may clump together if there is a lack of oxygen
74
How can children with sickle cell anaemia present
1. May be anaemic, tired, weak and breathless 2. Painful joints, swelling of hands and feet 3. Failure to thrive and delayed growth 4. Increased susceptibility to infection
75
How do we manage patients with sick cell anaemia
1. Avoid GA 2. If need to undergo GA patient must be tested with a Hb electrophoresis test 3. Have a preventative and conservative approach to dentistry 4. Consider preventing infection buys of post op antibiotics
76
What is the opinion on using inhalation sedation on patients with sickle cell anaemia
Inhalation sedation is safe but ensure 100% Oxygen for 4-5 minutes at the end of treatment
77
How common is cancer in children
1 child in 650 develops cancer by 15 years old
78
name the most common cancer children in the uk develop
Leukaemia (32%)
78
name the most common cancer children in the uk develop
Leukaemia (32%)
79
name the most common type of leukaemia
Acute lymphoblastic leukaemia (75% incidence)
80
What is leukaemia
A malignant proliferation of white blood cells
81
What may be the first indication of leukaemia
1. Oral mucosal bleeding 2. Anaemia 3. Thrombocytopenia
82
what may children with cancer also be on
1. Chemotherapy 2. Radiotherapy 3. Surgery 4. Bone marrow transplant
83
How can chemothapty effect oral health
1. Drug methotrexate mucositis 2. Neutropenic ulceration 3. Petechiae and bullae 4. Infection
84
What are some oral problems associated with radiotherapy
1. Oral mucositis and ulceration 2. Hyposalivation and xerostomia 3. Infection esp candida 4. Radiation caries 5. Loss/altered taste 6. Gingivitis/periodontitis 7. Osteoradionecrosis 8. Trismus
85
What should aim to do prior to a paediatric patient starting chemotherapy
1. Removal of infected teeth 2. Dressing of other carious teeth 3 Organise mouth care and mouthwashes
86
How can we support a paediatric oncology patient during chemotherapy
1. Support and encourage maintained mouthcare (via nursing staff) 2. Help/advice with management of specific oral problems
87
How can we support a paediatric oncology patient in remission
1. Treat as normal 2. Poor salivary gland function 3, Caries 4. Poorly formed teeth 5. Psychological
88
When does presentation of type 1 diabetes usually peak
at the age of 5-7
89
What are the key presentations of type one diabetes
1. Polydipsia 2. Polyuria 3. Weight Loss
90
How many children are affected by diabetes
2 in 1000
91
What can poorly controlled diabetes increase a Childs risk of developing
1. Periodontal disease 2. Reduced salivary flow 3. Increased caries

4th Yr- CCD2- Special Needs (3 decks)

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