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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
Q

What treatment is contraindicated in patients with CHD

A
  1. Pulp therapy in primary teeth
  2. Be cautious with intraligamental local anaesthetic
  3. Beware of anticoagulant therapy
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26
Q

what is asthma

A

A chronic inflammatory condition

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27
Q

What is asthma associated with

A

Associated with airway hyper-responsiveness

Recurrent episodes of wheezing, breathlessness, chest tightness and coughin

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28
Q

How common Is asthma in children

A

10-15% of school children affected

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29
Q

Is asthma fatal

A

Causes 15-20 deaths a year in the uk

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30
Q

List soem symptoms of asthma

A
  1. Coughing
  2. Wheezing
  3. Breathlessness
  4. Chest tightness
  5. Chest pain
  6. Seasonal symptoms
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31
Q

What can asthma be triggered by

A
  1. Environmental factors

2. Genetic predisposition

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32
Q

Talk through the pathophysciolgy of asthma

A
  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
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33
Q

List some common triggers of asthma

A
  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
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34
Q

List some of the oral manifestations of asthma

A
  1. Erosion
  2. Thrush
  3. Caries
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35
Q

What are some of the dental considerations we make for patients with asthma

A
  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
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36
Q

What should we avoid in giving to asthmatic patients

A

colophony-containing fluoride varnish eg duraphat

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37
Q

What can steroids put asthmatics at risk of

A

Adrenal suppression meaning they are unable to produce enough cortisol

38
Q

What is the significance of cortisol

A

this maintains:

  1. BP and CV function,
  2. slows immune system inflammatory response,
  3. balances effects of insulin,
  4. aids metabolism
39
Q

give an alternative to duraphat that we can Give to asthmatic patients

A

flur-protect

40
Q

In whom is cystic fibrosis most common

A

Caucasians (1 in 2500 live birth)

41
Q

What is cystic fibrosis

A

An autosomal recessive inheritance disorder

42
Q

what does cystic fibrosis cause

A

results in failure to produce protein which regulates electrolyte and water transport across cell membranes

43
Q

What can cystic fibrosis result in

A

Secretions which are viscous and prone to respiratory infection

44
Q

Which body systems are most affected by cystic fibrosis

A
  1. Respiratory system

2. Gastrointestinal system

45
Q

How is the respiratory system affected by cystic fibrosis

A
  1. Patient may be more prone to infection
  2. Patient requires intensive physiotherapy
  3. Patient may be on long term antibiotics
46
Q

How can cystic fibrosis affect the gastrointestinal system

A

Pancreatic enzymes are affected

47
Q

As children with cystic fibrosis get older what may they develop

A

Liver disease and diabetes

48
Q

What are some of the oral manifestation of cystic fibrosis

A
  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
Q

How can saliva be affected in cystic fibrosis patients

A 
Alterations in:
1. flow
2. Viscosity 
3. Sodium 
4, Calcium 
5. Lipid concentration 
6. pH 
7. Buffering capacity
50
Q

Why might patients with cystic fibrosis have a lower incidence of dental caries

A
  1. Antibiotics
  2. Raised salivary calcium levels
  3. Raised salivary pH
51
Q

How do we manage dental treatment of cystic fibrosis patietns

A
  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
Q

Give examples of bleeding Disorders

A
  1. Haemophilia A
  2. Haemophilia B
  3. Haemophilia C
  4. Von Willebrand disease
53
Q

What can inherited blood disorders be split into

A
  1. Bleeding disorders

2. Sickle cell anaemia

54
Q

What is haemophilia A

A

Factor VIII deficiency

impairs bloods ability to clot

55
Q

Is haemophilia A seen more commonly in men or women

A

Men as it is x linked recessive

56
Q

What is haemophilia B also known as

A

The Christmas disease

57
Q

What is haemophilia b

A

Factor IX deficiency

58
Q

What is haemophilia C

A

Factor XI deficiency

59
Q

What is von Willebrand disease

A

Problem with quantity or quality of von Willebrand factor

60
Q

What is the significance of von Willebrand factor

A

Binds to both platelets and endothelium forming an adhesive bridge
so essential for platelet adhesion

61
Q

Is haemophilia B more common in men or women

A

Men as it is x linked recessive

62
Q

Is haemophilia C recessive or dominant

A

Autosomal recessive

63
Q

Is von willebrands disease recession or dominant

A

Type I is autosomal dominant

64
Q

Which haemophilia is the most common

A

A is most common and c is lead common

65
Q

What are the presenting factors of haemophilia

A
  1. Increased bleeding
  2. Easy bruising
  3. Nose bleeds
  4. Family history
66
Q

How can we treat haemophilia

A

Giving adequate replacement of the deficient factor

67
Q

What should we avoid in haemophilia patients

A

NSAIDs and aspirin

68
Q

What dental consideration should we make fro a patient with haemophilia

A
  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
Q

What are haemophilia at greater risk of developing

A

Increased caries risk due to poor oral hygiene and lack of professional care

70
Q

What is sickle cell anaemia

A

Am autosomal recessive disorder caused by the substation of a single amino acid in the haemoglobin chain

71
Q

In whom is sickle cell anaemia most common

A

Black African population

72
Q

Which cells are affected in sickle cell anaemia patients

A

Red blood cells

73
Q

What happens to the RBC in sickle cell anaemia patients

A

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
Q

How can children with sickle cell anaemia present

A
  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
Q

How do we manage patients with sick cell anaemia

A
  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
Q

What is the opinion on using inhalation sedation on patients with sickle cell anaemia

A

Inhalation sedation is safe but ensure 100% Oxygen for 4-5 minutes at the end of treatment

77
Q

How common is cancer in children

A

1 child in 650 develops cancer by 15 years old

78
Q

name the most common cancer children in the uk develop

A

Leukaemia (32%)

78
Q

name the most common cancer children in the uk develop

A

Leukaemia (32%)

79
Q

name the most common type of leukaemia

A

Acute lymphoblastic leukaemia (75% incidence)

80
Q

What is leukaemia

A

A malignant proliferation of white blood cells

81
Q

What may be the first indication of leukaemia

A
  1. Oral mucosal bleeding
  2. Anaemia
  3. Thrombocytopenia
82
Q

what may children with cancer also be on

A
  1. Chemotherapy
  2. Radiotherapy
  3. Surgery
  4. Bone marrow transplant
83
Q

How can chemothapty effect oral health

A
  1. Drug methotrexate mucositis
  2. Neutropenic ulceration
  3. Petechiae and bullae
  4. Infection
84
Q

What are some oral problems associated with radiotherapy

A
  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
Q

What should aim to do prior to a paediatric patient starting chemotherapy

A
  1. Removal of infected teeth
  2. Dressing of other carious teeth
    3 Organise mouth care and mouthwashes
86
Q

How can we support a paediatric oncology patient during chemotherapy

A
  1. Support and encourage maintained mouthcare (via nursing staff)
  2. Help/advice with management of specific oral problems
87
Q

How can we support a paediatric oncology patient in remission

A
  1. Treat as normal
  2. Poor salivary gland function
    3, Caries
  3. Poorly formed teeth
  4. Psychological
88
Q

When does presentation of type 1 diabetes usually peak

A

at the age of 5-7

89
Q

What are the key presentations of type one diabetes

A
  1. Polydipsia
  2. Polyuria
  3. Weight Loss
90
Q

How many children are affected by diabetes

A

2 in 1000

91
Q

What can poorly controlled diabetes increase a Childs risk of developing

A
  1. Periodontal disease
  2. Reduced salivary flow
  3. Increased caries

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

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