summary Flashcards
What are reasons for non-surgical treatment before surgical?
- To assess patient motivation
- non-surgical therapy may reduce some deep pockets
- stabilising condition will have better outcomes for surgery
Explain the pattern of distribution of decay in nursing bottle caries?
mandibular incisors are spared from decay as they are protected by the tongue
maxillary incisors are first to experience the cariogenic challenge and suffer the longest due to early eruption
teeth are affected in sequence of their eruption
What are causes of nursing bottle caries ?
bottles at night
prolonged breastfeeding
child holding milk in their mouth
sugar in bottles of milk
inappropriate use of bottles and feeding cups
what toothbrushing advice would you give for nursing bottle caries ?
1000ppm fluoride toothpaste
2x day - morning and night
small headed toothbrush with small bristles
brush for 2 minutes
wait at least 30 minutes after consumption of sugary foods
what special investigations are used for carious lower 6s?
bitewings
What indicates the suitable time for extracting 6s ?
bifurcation formation of unerupted 7s
8s present
What is treatment for upper non carious 6s
Fissure sealant
What are 2 advantages of extracting carious 6s at the right time?
gives a carious free permanent dentition
7s will erupt mesially and close the space
What are 2 disadvantages of extracting carious 6s ?
associated risk of GA
extraction of permanent molars can be demanding for a child and may affect future appointments
if extracting lower 6s need to extract caries free uppers to compensate
What is the origin and insertion of the masseter
origin - zygomatic arch
insertion - lateral surface and angle of the mandible
What is the function of the masseter ?
Elevates the mandible
What is the origin and insertion of the temporalis?
origin - floor of the temporal fossa
insertions - coronoid process and anterior border of the ramus
What is the function of the temporalis?
Elevates and retracts the mandible
What is the origin of the lateral pterygoid ?
from the lateral surface of the lateral pterygoid plate
What is the insertion for the anterior belly of the lateral pterygoid?
the anterior border of the condyle
What is the insertion for the superior belly of the lateral ptyergoid?
the anterior fibres of the intra-articular disc
What is the overall function of the lateral ptyerygoid?
protrudes and laterally deviates the mandible
What function does the inferior head of the lateral pterygoid have?
depresses the mandible
What is the insertion of the medial pterygoid?
medial surface of the angle of the mandible
What is the function of the medial pterygoid?
Elevates and assists in protrusion of the mandible
What is the origin of the deep head of the medial pterygoid?
medial surface of the lateral pterygoid plate
What is the origin of the superficial head of the medial pterygoid muscle?
the maxillary tuberosity
How can a dentist cause facial palsy during an IDB?
if the needle is advanced to far distally bone will not be contacted and LA is deposited into the parotid gland
The facial nerve runs through the parotid gland
dense fascia around the gland will because the LA to remain oft a long time causing paralysis of the facial muscles innervated by the facial nerve
How do you determine the difference between a facial palsy and a stroke?
Stroke - patient can wrinkle forehead and blink
facial palsy - face is affected on the same side where LA was given, cannot move upper or lower face
Stroke affects the opposite side of the body from the location in the brain that is affected
Explain neurologically the difference between stoke and facial palsy
The upper half of the face is supplied by both contralateral and ipsilateral innervation
The lower half of the face is only supplied by contralateral innervation
Lesions affecting the motor cortex (STROKE) result in contralateral weakens of lower face muscles but the upper muscles of the face are spared due to innervation from the opposite side
Lesions affecting the facial nerve in the brainstem (FACIAL PALSY) affect ipsilateral innervation for both upper and lower muscles
How would you manage a patient that has a facial palsy due to LA?
- Reassure the patient
- explain the sensation and muscle control will return once the LA wears off
- Give the patient an eyepatch or tape the eye closed to protect the eye until blinking function returns
- give emergency contact number
What type of surgical flap should be used to remove retained roots of tooth 44 ?
2 sided flap
What are risk factors of stroke?
- hypertension
- smoking
- alcohol
- diabetes mellitus
- age
- DVT
What post op analgesic would you give to a patient on warfarin?
Paracetamol
What is the mechanism of apixaban ?
Apixiban is a factor 10a inhibitor
What are the protected characteristics from the Equality Act 2010?
- Age
- Disability
- Gender
- Marriage and Civil Partnership
- Pregnancy and Maternity
- Race
- Religion
- Sex
- Sexual orientation
What is the definition on impairment?
any loss or abnormality of psychological, physiological or anatomical structure or function
What is the definition of disability ?
a physical or mental impairment that has substantial long term negative effect on ability to do normal daily activities
What is aim of the Equality Act 2010 ?
provide a legal framework to protect the rights of individuals and advance equality of opportunity for all
places a legal duty on organisations to make reasonable adjustments to remove barriers that affect people accessing care
What is the inverse care law
the people who need health care the most are least likely to receive it
What are the 5 domains to overcoming barriers to healthcare
Accessibility
Accommodation
Affordability
Acceptability
Availability
What is the function of the Adults with Incapacity Act 2000 (Scotland)
to protect welfare and manage finances of individuals (16 and over) who lack capacity due to mental illness, learning disabilities
aim to support their involvement in making decisions as far as they are able to do so
what are difficulties associated with treating a bariatric patient?
- loss of anatomical landmarks
- ID blocks may be difficult
- may have to be treated semi-supine or sitting upright
- access may be more difficult due to excess soft tissue
- long procedures can cause acute leg oedema, cellulitis and pressure sores
How do you assess capacity ?
being incapable of:
- Acting
- Making a decision
- Communicating decision
- Understanding decision
- Retaining the memory of a decision
AMCUR
What are the principles of the AWI Act?
decisions made on behalf of another must be:
- benefit the patient
- minimum necessary intervention
- Take into account the wishes of the adult
- Consult with relevant others
- Encourage the adult to exercise residual capacity
What are the types of power of attorney
- Continuing power of attorney - makes financial and property decisions
- Welfare power of attorney - makes decisions on healthcare and dental treatment
Combined power of attorney - both financial and welfare decisions
What are the types of guardianship?
- Welfare guardian- can consent to dental treatment
- Financial guardian - cannot consent to dental treatment
Who can issue a AWI section 47 certificate ?
medical practitioner (GMP)
Consultant in charge of patients care
Dental practitioner *
Registered nurse *
Optometrist *
- must have done additional training course
What is sensory impairment ?
When one or more of a person’s senses are no longer normal
What is cataract ?
Clouding of the lens of the eye which prevents clear vision
What are the two types of macular degeneration ?
wet - causes severe sight loss in a matter of months
dry - gradual loss of central vision
What causes wet macular degeneration ?
growth of new vessels under the retina which break and leak into the macula causing scarring
What causes dry macular degeneration?
Layers of the macula become progressively thinner causing it to function less effectively
What does macular degeneration look like visually?
loss of the central field of vision
patients may be sensitive to light
What causes glaucoma?
fluid build up in the front part of the eye which increases pressure inside the eye
what does glaucoma look like visually?
tunnel vision - dark black surrounding outside
What causes diabetic retinopathy
vascular changes in the retinal circulation due to diabetes
what does diabetic retinopathy look like visually ?
Black spots in the vision
what is the most common because of hemianopia ?
stroke
What does hemianopia look like visually?
vision from only half of the eye
What are the impacts of hearing impairment ?
functional impact - affects ability to communicate with others and can affect academic perdormance of children
Social and emotional impact - isolation and exclusion from communication with others
financial impact - higher unemployment rate
causes of hearing loss ?
congenital - low birth weight, infections during pregnancy, jaundice in neonatal period
acquired - infectious diseases (meningitis) , chronic ear infection, injury to head, recreational exposure to loud sounds
Explain the social and medical model in regards to disbability
social model - disability is cased by the way society is organised rather than the persons impairments or differences
medical model - people are disabled by their impairments or differences and these should be fixed or treated
What causes down’s syndrome?
extra copy of chromosome 21
co morbidities associated with Down’s syndrome
congenital heart defects
alzheimers dementia
epilepsy
leukaemia
diabetes mellitus
coeliac disease
intellectual impairment
what are dental implications of downs syndrome ?
reduced oral hygiene
increased risk of periodontal disease
immunocompromised
saliva quality is altered
what are physical features of cerebral palsy
- muscle stiffness
- muscle weakness
- random uncontrolled body movements
- balance and co-ordination problems
What are the different types of dementia
Alzheimers
Vascular dementia
Dementia with lewie bodies
what causes Alzheimers?
abnormal protein fragments that build up in the spaces between nerve cells forming plaques and disrupting brain function
What causes vascular dementia ?
reduced blood Flow to the brain which damages and kills brain cells
can be due to narrowing of vessels or stroke
What causes dementia with lewy bodies?
Lewy body proteins accumulate inside the brain cells
What is frontotemporal dementia?
a type of dementia that can affect younger peoplee and causes them to act out of character
it affects the frontal lobes of the brain which control emotion and personality
What are risk factors for dementia ?
Age
Gender
Medical history - high blood pressure, diabetes and high cholesterol increase risk
smoking
lack of exercise
What are early stage symptoms of dementia?
short term memory loss
confusion
anxiety and agitation
inability to manage everyday tasks
what are middle stage symptoms of dementia ?
require support and reminders to eat, wash and dress
distress, aggression and anger common
risk of wandering
may behave inappropriately - go outside in pyjamas
may experience hallucinations
What are late stage symptoms of dementia ?
inability to recognise familiar objects or people
Require assistance for all everyday tasks
Asphasia
Increased physical frailty
Difficulty eating and swallowing
What are tests used for dementia diagnosis ?
- Mini-Mental State Examination - Folstein!!
- blessed dementia scale
- Montreal cognitive assessment
- Single neuropsychiological tests
What drugs are used in dementia patients and why?
Anticholinesterases - may delay deterioration of cognition
how to make care homes dementia friendly?
- walls, flooring and skirting boards should be different colours to help way finding
- labels and images on drawers to help find things
Bedroom WC should be visible from bed to remind patients to go to the bathroom
How to make healthcare environments dementia friendly?
avoid non essential signs
walls and flooring used to help way finding
staff only areas should be the same colour as the walls to avoid attention
reception desk visible from the front door
Why can losing weight affect a patients denture ?
fat in the cheeks are used to hold in the denture and aid retention
what are questions to ask if you suspect a non verbal patient with dementia is in pain?
- has their behaviour changes
- has sleep been disturbed
- has their eating behaviour changed
- have they been holding or touching their face
What are contraindications for fluconazole or metronidazole?
statins
patients taking warfarin
What is an alternative to giveng fluconozol if the patient is taking statins?
nystatin
Why can chemotherapy affect cells in the mouth?
chemotherapy affects cells with a high turnover.
Mucosa has a high turnover of cells and affects from chemo can lead to poor wound healing and oral mucositis
How can you treat a fluoride overdose ?
activated charcoal
what infections are more common during cancer treatment ?
candida - treat with fluconazole (systemic), miconazole (topical) or nystatin
herpes simplex virus - treat with acyclovir
What is schizophrenia ?
psychological condition affecting neurotransmitters in the brain which affects the way people interpret reality
What are the 2 types of symptoms in schizophrenia?
positive symptoms - things something is there that isn’t (e.g. hallucinations)
Negative symptoms - affects emotions and communication
what level of neutrophils would because concern?
<1 means have greater risk of infection
what LA is used in patients with advanced liver disease?
Articaine as it is not metabolism in the liver
what clotting factors does the liver produce?
1, 2, 7, 9 ,10 and 11
Apart from clotting factors what other product essential for achieving haemostasis is produced in the liver?
Thrombopoietin
What causes thrombocytopenia?
portal hypertension - leads t congestive splenomegaly and sequestration of platelets in the spleen
impaired hepatic synthesis
bone marrow suppression by hepatitis C
What anticoagulant is commonly used in patients requiring renal dialysis?
Heparin
What does low white blood cells indicate?
immunosuppression or autoimmune disease
what is the normal range for WBC?
4.5 - 10 x10^9/L
what does a high white blood cell count indicate?
current infection
what is a normal range for neutrophils in the blood?
> 1
if <1 give antibiotics before treatment
What can low haemoglobin indicate?
Thalassaemia
What is the range of platelets for a patient to be treated in general practice?
> 100
What does low red blood cell and low haemoglobin mean?
anaemia
what does low haemoglobin with reduced MCV indicate?
microcytic anaemia
caused by iron deficiency or Thalassemia
what does low haemoglobin with increased MCV indicate?
Macrocytic anaemia
caused by liver damage and b12 and folate deficiency
What does low haemoglobin with normal MCV indicate>
Normocytic anaemia
What questions would you ask a patient who smokes?
what do they smoke?
How often do they smoke?
How long have they smoked for?
Have they ever tried to quit before?
What advice would you give to patients about vaping?
Explain there is not enough research to determine long term effects of vaping however they are considered safer than normal cigarettes
recommend research backed methods to quitting smoking (e.g. nicotine patches)
don’t use as an alternative to smoking - use as a method of quoting
try not to use in public or infront of children
What are the 5 A’s in smoking sessation?
Ask - about smoking
Advise
Assess
Assist
arrange follow up for patients
What is the shortened approach to smoking cessation ?
Ask - establish smoking status and record
Advise
Act - offer referal to local stop smoking services
What are risk factors of oral cancer?
smoking
alcohol
sunlight
HPV
What are services to refer to for smoking cessation
local stop smoking services
Local pharmacy
What are services to refer to for smoking cessation
local stop smoking services
Local pharmacy
What periodontal issue might occur when patients stop smoking?
increased bleeding when brushing due to gingival blood flow increasing
Explain a randomised control trial
Gold Standard
used for determining effectivemness of treatment
uses blinding, randomisations and control groups
Explain a cohort study
a prospective study
establish risk factors, follows a group over time and identifies which individuals develop the disease
used for estimating incidence and causes of disease
Explain a case cohort study
retrospective study that looks back at exposure to particular risk factors and potential causes of disease
disadvantage: human error, and individuals cannot remember past events
What is the value that means data is not statistically valid?
if CI overlaps 0
What does SIMD mean?
Scottish index of multiple deprivation - ranks data zones from most to least deprived
What are roles of epidemiology?
To assess peoples risk of disease
To study the causes of disease
To develop preventative programmes
Define incidence
The amount of new cases in the population in a specific time period
Define prevalance
proportion of the population affected by the disease at a single point in time
What are factors of deprivation
housing
crowding
crime
education
health access
income
empoymeny
