Special Needs III Flashcards
what entails prevention?
diet advice
OHI
fluoride application
fissure sealants
whats the concentration of fluoride for the age categories?
0-3 - 1000ppm
3-6 - 1450ppm
6+ - 1350-1550ppm
whats the concentration of high fluoride toothpaste for the ages?
10+ = 2800ppm
16+ = 5000ppm
fluoride varnish
- concentration
- frequency of application - dependent on risk
22600ppm
low caries risk - every 6 month
high caries risk - every 3-6 month
mouthwash
- concentration - dependent on risk
- what age is recommended to start using
low risk - 0.05%
high risk - 0.2%
recommended 6+ - more reliable to spit and not swallow
describe the passage of blood in the heart
deoxygenated blood
- vena cava
- right atrium
- tricuspid valve
- right ventricle
- pulmonary vein
oxygenated blood
- pulmonary artery
- left atrium
- mitral valve
- left ventricle
- aorta
congenital heart disease
- definition
- types
birth defect affecting the structure of the heart
types
1. acyanotic
- left to right shunt
- so blood still goes to the lungs
- cyanotic
- right to left shunt
- blood bypasses the lungs
- deoxygenated blood enters the circulation
give 8 defects for acyanotic CHD
- ventricular septal defect
- hole between the ventricles - patent ductus ateriosus
- blood vessel connecting pulm artery to aorta - pulmonary stenosis
- pulm vessels are narrow - arterial septal defect
- hole between arteries - coarctation aorta
- aorta is narrow - aortic stenosis
- narrow aortic valve to the aorta
give 2 cyanotic CHD defects
- tetralogy fallot
- 4 key features:
- ventricular septal defect
- right ventricular hypertrophy
- pulmonary stenosis
- over-riding aorta - transposition of the great arteries
- pulmonary artery and aorta are switched
why is infective endocarditis relevant?
- oral disease = ^size of bacteraemia
- need to advise well on OH and prevention
40% paeds cases of IE are caused by oral streptococci
- viridans streptococci
- staphylococci
pt is more predisposed if they have CHD
is antibiotic prophylaxis advised against infective endocarditis when undergoing dental tx?
not anymore
- non evidence that it works
- may be >antibiotic resistance
with CHD, which group of people need special consideration regarding dental tx with the cardiologist?
- any prosthetic materials
- prev IE
- cyanotic CHD
what treatments are indicated in children with CHD?
pulp therapy
intraligamental LA
- be aware of any anticoagulants
dont want to increase risk of IE
asthma
- definition and symptoms
- pathophysiology
chronic inflam conditions
- hyper-responsive airway
symptoms:
- recurrent episodes
- wheezing, breathlessness, tight chest, coughing
pathophysiology
1. environmental factors or genetic
2. bronchial inflammation
3. bronchial hyperactivity + trigger factors
4. bronchoconstriction, mucus production, oedema
5. narrow airway
6. symptoms
how may asthma manifest orally?
erosion - acidic medication
thrush - corticosteroid inhalers, need to rinse after
caries - salivary function, medication
how do you manage asthmatic patients?
- severe asthma - avoid GA
- avoid colophony-containing fluoride varnish
- be aware of systemic steroid medication
- bring inhaler to appt
- can be more anxious and stressed
- more common to have a penicillin allergy
- may have adverse reaction to NSAIDS - ibuprofen
Cystic Fibrosis
- aetiology
- pathophysiology
- treatment
- oral manifestations
aetiology
- autosomal recessive
patho
- failure to produce protein which regulates electrolyte and water transport
= viscous secretions
= more prone to respiratory infection
treatment
- intense physiotherapy
- long term antibiotics
oral manifestations
- salivary gland dysfunction, >Ca+, <pH
- LESS CARIES
- low levels of plaque-induced gingivitis
- higher levels of calculus
-»_space; enamel defects and delayed eruption
how do you manage a pt with cystic fibrosis
- avoid GA
- avoid narcotics and sedatives - due to risk of respiratory depression
- diet advice
Inherited Blood Disorders
- describe Haemophilia A, B, C
- describe VWD
- sickle cell anaemia
Haemophilia A - severe
- < F8
Haemophilia B (xmas disease) - mod
- < F9
Haemophilia C - mild
- <F11
Von Willebrand Disease
- <VWF
Sickle Cell Anaemia
- damaged RBC
Haemophilia
- features
- treatment
> bleeding
< clotting
bruise easy
treatment:
- replace the deficient factor
- DDAVP - desmopressin - simulates release of F8
- antifibrinolytic agents/tranexamic acid
- avoid NSAID and aspirin
how do you manage a pt with haemophilia?
- communicate with their haematologist
- ID block/lingual infiltration = contraindicated - risk of HAEMATOMA
- LA is okay
- prefer pulp therapy>extraction
- xlas will be in hospital
Sickle Cell Anaemia
- aetiology
- pathophysiology
- what happens to the RBC
- what is haemolytic anaemia?
autosomal recessive disorder
a single AA in haemoglobin chain is substituted
- pt needs to be homozygous to be fully affected
- RBC changes shape
- shorter life = 30-60 days rather than 120
- when lack of O2 - sickle cells clump = sickling crisis
- occlusion and ischaemia in the blood vessels
haemolytic anaemia - low number of RBC due to»_space;> haemolytic
Sickle Cell Anaemia
- symptoms
- how do you deal with a pt?
symptoms
- tired, weak, breathless
- painful joints, swelling of hands and feet
- failure to thrive and delayed growth
- more susceptible to infection
pt?
- test O2 levels before GA
- via Hb Electrophoresis test
Leukaemia
- pathophysiology
- most common type
- initial symptoms
- treatment
WBC
= malignant proliferation
- begins in the bone marrow
most common type
Acute Lymphoblastic Leukaemia
initial
- oral mucosal bleeding
- anaemia
- thrombocytopenia - < platelets
treatment
- chemotherapy
- radiotherapy - proton beam therapy
- surgery
- bone marrow transplant
how does chemotherapy affect oral health?
direct
- methotrexate mucositis
indirect
- neutropenic ulceration
- petechiae and bullae
- infection - viral (herpes), fungal (candida) and dental chronic infection
how does radiotherapy affect oral health?
- mucositis and ulceration
- hypo salivation and xerostomia
- infection - candida
- radiation candida
- gingivitis/perio
- loss/altered taste
- osteoradionecrosis
- trismus
dental management of cancer
- frequency of visits
- tx
- management when pt is in remission
- pretreatment - at diagnosis, before they begin tx
- during tx
- post tx - in remission
tx:
- remove infected teeth
- dress carious teeth
- OHI
in remission:
- treat as normal
- will have poor salivary gland function, may have caries, poorly formed teeth and pyschological steps
Type I Diabetes
- how does it present
- how does uncontrolled present orally
- how do u manage the pt
presentations
- polydipsia - excessive thirst
- polyuria - excessive urine
- weight loss
uncontrolled oral presentations:
- perio disease
- «salivary flow
-»_space; increased caries
management
- diet advice
- ensure levels are well controlled
- be aware of hypoglycaemia
- avoid GA
