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Test 1 Flashcards

1
Q

What condition is defined as a significantly sub average intellectual functioning accompanied by significant deficits or impairments in adaptive functioning that manifest during th developmental period before age 18?

A

Developmental disability

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2
Q

What is the etiology of developmental delays?

A

Unknown in 30-40% of cases
Chromosomal abnormalities
Prenatal conditions
Perinatal conditions
Postnatal conditions

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3
Q

What are the health manifestations of developmental delays?

A

Less physical stamina
Often underweight or overweight
Speech and physical defects
Poor oral health possible

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4
Q

What are the oral conditions seen with developmental delays?

A

Periodontal disease
Carious lesions
Poor OH
Malocclusion
Self biting
Thick, flaccid lips
Microdontia
Clenching and bruxism
Delayed tooth eruption
Dental attrition and sensitivity
TMJ disorder

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5
Q

What are the dental treatment considerations of developmental delays?

A

Behaviour management - use approached to accommodate their needs

Communication - tell, show, do. Explain how not why

Environment - create a comfortable environment, allow for breaks if needed

Sedation - if needed

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6
Q

What is the role of the dental hygienist for mild IDD?

A

Minimize distractions
Use short explanations
Simple language
More time to present information
Avoid explanation of causes
Focus on effects of lack of OH
Teach activities instead of concepts
Use tell-show-do
Positive reinforcement
Use verbal praise

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7
Q

What is the role of the dental hygienist for severe IDD?

A

TLC
Gentle firmness
Desensitization
Sedation
General anaesthesia
Combination of the above strategies

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8
Q

Significant sub average intellectual functioning refers to someone with an IQ below ____

A

75

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9
Q

What is a genius IQ?

A

144

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10
Q

What is a gifted IQ?

A

130-144

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11
Q

What is a mild developmental disability IQ?

A

50-70

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12
Q

What is a moderate developmental disability IQ?

A

35-55

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13
Q

What is a severe development disability IQ?

A

20-40

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14
Q

What is a profound developmental disability IQ?

A

Less than 20

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15
Q

What condition is genetic caused by the presence of an extra chromosome?

A

Down syndrome

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16
Q

What is the etiology of Down syndrome?

A

An extra chromosome

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17
Q

What health manifestations appear with Down syndrome?

A

IDD
Congenital cardiac anomalies
Seizure disorders
Immunological impairment
Upper respiratory disease
Leukaemia
Hepatitis

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18
Q

What are the oral conditions associated with Down syndrome?

A

Low caries rate
Risk of severe periodontal disease
Short conical roots
Tongue thrusting
Protruding tongue
Macroglossia
Fissured tongue
Malocclusion (class III)
Narrow palate
Delayed eruption
Bruxism
Drooling
Self injurious behaviour

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19
Q

What is the role of the dental hygienist for Down syndrome?

A

Antibiotic prophylaxis may be needed due to cardiac anomalies
Possible seizure management
Restricted nasal passaged may prevent use of N2O
Possible increased gag reflex
Sedation may help to control patient anxiety
Difficult cases may require GA

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20
Q

What are the OH considerations for Down syndrome?

A

Discuss risks associated with perio
Caregiver present if required
Step by step instructions
Large toothbrush handle
Optional interdental aids

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21
Q

What condition is defined as a disorder of movement and posture resulting from a permanent non progressive defect or lesion of the immature brain?

A

Cerebral palsy

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22
Q

What is the etiology of cerebral palsy?

A

Injury to the central nervous system at some time during development

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23
Q

What are some of the prenatal causes of cerebral palsy?

A

Anoxia
Uterine bleeding
Infections (rubella, chicken pox, etc)
Premature birth
Maternal diabetes
Exposure to radiation in first trimester
Mechanical trauma and hypoxia during labor/delivery

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24
Q

What are some postnatal causes of cerebral palsy?

A

Carbon monoxide poisoning
High-altitude anoxia
Cerebral vascular hemorrhage (car accident)
Cerebral infections (meningitis, brain abscess, etc)
Brain tumors

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25
Q

What is the most common of non progressive disabilities?

A

Cerebral palsy

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26
Q

Is cerebral palsy fatal?

A

No, but 1 in 7 die in the first year

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27
Q

What are the types of cerebral palsy?

A

Spastic
Athetoid
Ataxic
Rigidity
Tremor

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28
Q

What is spastic cerebral palsy?

A

Tense, contracted muscles

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29
Q

What is athetoid cerebral palsy?

A

Constant, uncontrolled motion of limbs, head, and eyes

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30
Q

What is rigidity cerebral palsy?

A

Tight muscles that resist effort to make them move

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31
Q

What is tremor cerebral palsy?

A

Uncontrollable shaking, interfering with coordination

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32
Q

What is ataxic cerebral palsy?

A

Poor sense of balance, often causing falls and stumbles

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33
Q

What is hypotonia?

A

All muscles are flaccid with decreased function

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34
Q

Health manifestations associated with cerebral palsy?

A

Seizures
IDD
Sensory disorders
Learning and emotional disorders
Speech and communication defects
Decreased swelling and cough reflex

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35
Q

True or False: All people with cerebral palsy have below normal intelligence.

A

False. Many people with cerebral palsy possess normal intelligence

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36
Q

What oral conditions are associated with cerebral palsy?

A

Slightly higher rate of caries
Slightly higher rate of periodontal disease
Enamel hypoplasia in children
Abnormal function of the tongue, lips, and cheeks
Dilantin induced gingival hyperplasia
Tongue thrusting
Bruxism
Mouth breathing
Excessive drooling
Class II malocclusion
High narrow palate
Fractures of the max 2-2 due to seizures

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37
Q

What is the role of dental hygienists for cerebral palsy?

A

Thorough med history
Morning appointments
Short appointments, with breaks
Wheel chair transfer
Not in supine position, half way back
Padding
Move chair slowly to prevent spasms
Work with the uncontrolled body movements, can’t stop them
Muscle relaxants may be prescribed, watch for dizziness and hypotension
Possible sedation/GA

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38
Q

What are the OHI considerations for cerebral palsy?

A

Frequent plaque removal by brushing and flossing if possible
Oral physical therapy
Frequent debridement of food from the palate and vestibule
Daily fluoride gel applications
Dietary modifications
Toothbrush modifers for easy grasp

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39
Q

What are a group of developmental disabilities that affect how a person interacts, communicates, relates, plays, imagines and learns?

A

ASDs (autism spectrum)

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40
Q

What is the etiology of autism?

A

It is unknown

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41
Q

What other health issues can be related to autism?

A

Anxiety disorders
ADHD
IDD
Sensory processing issues
Gastrointestinal problems
Sleep disorders
Epilepsy

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42
Q

What are the possible oral manifestations of autism?

A

Neglect
Xerostomia
Hyperplasia (from epilepsy meds)
Nutrition deficits
Pouch their food
Desire sweet foods
Poor OH
Bruxism
Tongue thrusting
Self injurious behaviour (biting lips)
Increased risk for caries
Increased risk for perio

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43
Q

What is the role of the dental hygienist for autism?

A

Appointment structure
Calm dental environment
Visual pedagogy
Applied behaviour analysis
Communicative behaviour management techniques

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44
Q

What OHI considerations are there for autism?

A

Individualized approach
Visual aids
Routine establishment
Sensory sensitivities
Positive reinforcement
Caregiver involvement if needed
Regular monitoring

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45
Q

What is a condition defined as a chronic autoimmune degenerative disease of the white matter of myelin tissue of the CNS?

A

Multiple sclerosis

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46
Q

What is the etiology of MS?

A

Unknown

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47
Q

What other health manifestations may be present with MS?

A

Autoimmune
Tinnitus/hearing trouble
Blurred vision
Dysarthria
Dysphagia
Urinary retention
Spastic bladder
Constipation
Ataxia
Vertigo
Spasticity
Ridigity
Paralysis
Forgetful

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48
Q

What oral conditions are often seen with MS?

A

Poor OH
Increased risk for caries, gingivitis, and perio
Pain - facial, TMJ and muscle dysfunction
Trigeminal neuralgia

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49
Q

What is the role of the dental hygienist for MS?

A

Keep patient free of acute disease
Maintain oral function
Retain esthetics
Enable patient to care for their own health
Tx plans consider limited motor skills
Explain the infection exacerbates MS
Morning appointments are best
Adapt to visual changes, tremors, weakness
Short appointments for severe MS
Wheelchair transfer
Clients may have difficulty localizing intra oral pain
Not supine position, halfway
Sedation if needed
Severe respiratory problems - maybe use rubber dam

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50
Q

True or False: for clients with MS, any systemic inflammation could trigger an episode. It is important to reduce mouth’s inflammation.

A

True

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51
Q

What condition is defined as a conglomeration of several chronic diseases involving atrophy of the skeletal muscles?

A

Muscular dystrophy

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52
Q

What is the etiology of muscular dystrophy?

A

Genetic mutations

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53
Q

What are the three most common types of muscular dystrophy?

A

Duchenne dystrophy
Limb-girdle dystrophy
Fasioscapulohmeral

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54
Q

What are the health manifestations associated with muscular dystrophy?

A

Cardiovascular problems
Respiratory complications
Skeletal deformities
Gastrointestinal issues
Endocrine disorders
Cognitive and behaviour concerns
Fatigue
Skin issues

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55
Q

What are the oral conditions associated with muscular dystrophy?

A

Loss of strength in muscles of mastication
Speech may be hard to understand
Open bite
Over expanded maxilla
Higher rate of caries
Higher rate of perio

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56
Q

What is the dental hygienist’s role with muscular dystrophy?

A

May need to secure head
Bite block
Seatbelts or pillows to stabilize client
Not supine position, halfway or sitting up
Protect airway, rubber dam
No foamy toothpastes of fluoride gels
Toothbrush handle adaptations
Short appointments
Wheelchair transfer

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57
Q

What should be considered with OHI for muscular dystrophy?

A

Nutrition due to impaired masticatory strength
Caregiver if needed
Limited motor skills

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58
Q

What disease is characterized by muscular rigidity, tremor, and bradykinesia (slowness of movement)?

A

Parkinson’s disease

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59
Q

What is the etiology of Parkinson’s disease?

A

Idiopathic
Cerebral vascular accident
Carbon monoxide poisoning
Cerebral trauma

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60
Q

What other health manifestations may be present with Parkinson’s?

A

Cognitive changes
Mood disorders
Sleep disturbances
Autonomic dysfunction
Speech and swallowing difficulties
Fatigue
Skin changes
Pain
Visual impairments

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61
Q

What are the oral conditions that may be present with Parkinson’s?

A

Drooling
Spasms
Difficulty swallowing
Tremors

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62
Q

What is the role of the dental hygienist for Parkinson’s?

A

Consider limited motor skills and tremor
Caregiver may be needed
Frequent recare
Topical fluoride
Antiplaque agents
Keep patient free of acute disease
Maintain oral function
Retain esthetics
Enable client to care for their own oral health
Short appointments
Morning appointments
Wheelchair transfer

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63
Q

What OHI considerations need to be taken into account for Parkinson’s?

A

Motor difficulties and tremor
Adaptive toothbrush handle
Caregiver if needed

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64
Q

What condition is defined as the loss of the ability to move one or more muscles in the body?

A

Paralysis

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65
Q

What type of paralysis results from the damage to the cervical portion of the vertebral column and affects the trunk of the body and all four extremities?

A

Quadriplegia

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66
Q

What type of paralysis is a partial paralysis/weakness?

A

Paresis

67
Q

What type of paralysis results from damage to the thoracic, lumbar, or sacral vertebrae and affects the lower trunk of the body and the lower extremities?

A

Paraplegia

68
Q

What type of paralysis affects one side of the body?

A

Hemipegia

69
Q

What is the etiology of paralysis?

A

Leading cause is car accidents
Occupational accidents are the second leading cause
Third is sports
Fourth is gunshot wounds and stabbing

70
Q

What other health manifestations are present with paralysis?

A

Gastrointestinal, bowel, and bladder complications may be present
Impaired ventilation

71
Q

What oral conditions may be present with paralysis?

A

Numbness of the face
Reduced gag and cough reflex
Difficulty controlling fluids

72
Q

What is the role of dental hygienists for paralysis?

A

Review MH, possible blood thinners
Adapt the unit to suit the client
Wheelchair transfer

73
Q

What to consider with OHI for paralysis?

A

Pooling
Unable to provide self-care
Mouth breathers
Difficulty breathing/swallowing

74
Q

What condition is defined a significant reduction in vision?

A

Visual impairment

75
Q

What are the leading etiologies of visual impairment?

A

Macular degeneration
Retinal hemorrhages secondary to diabetes
Glaucoma
Senile cataracts

76
Q

What other health manifestations may be present with visual impairment?

A

Mental health issues
Cognitive decline
Mobility challenges
Sleep disorders
Increased sensitivity to light
Eye strain/fatigue
Social and communication difficulties
Poor nutrition

77
Q

What type of visual impairment is a diminished vision from mouse of eyes?

A

Amblyopia

78
Q

What type of visual impairment is a difference in the size and shape of an imagine perceived by each eye?

A

Anisekonia

79
Q

What type of visual impairment is a distortion resulting from imperfect curvature of the cornea?

A

Astigmatism

80
Q

What type of visual impairment is an opacity of the lens causing a blockage of light perception?

A

Cataract

81
Q

What type of visual impairment is the inability to distinguish one or more primary colours?

A

Colour blindness

82
Q

What type of visual impairment is double vision?

A

Diplopia

83
Q

What type of visual impairment is partial or total blindness resulting from intensive destructive pressure of fluids inside the eye?

A

Glaucoma

84
Q

What type of visual impairment is farsightedness?

A

Hyperopia

85
Q

What type of visual impairment is loss of central vision?

A

Macular degeneration

86
Q

What type of visual impairment is near sightedness?

A

Myopia

87
Q

What type of visual impairment is night blindness?

A

Nyctalopia

88
Q

What type of visual impairment is degeneration of the retina causing an inability of the eye to transmit images to the brain?

A

Retinitis pigmentosa

89
Q

What type of visual impairment is temporary blindness resulting from fluctuations in BP of the ophthalmic arteries?

A

Transient blindness

90
Q

What is important to know about blindness and learning?

A

A child born blind learns differently than an adult who acquired blindness.

91
Q

What oral manifestations are associated with visual impairment?

A

Higher perio rate
Higher caries rate

92
Q

What is the role of the dental hygienist for visual impairment?

A

Identify yourself and speak to client
Check with client with they want the printed material read aloud
Be precise and direct with instructions
Try appealing to the client’s tactile sense

93
Q

What should be considered for OHI for visual impairment?

A

Can be very difficult
Can not use conventional methods such as disclosing solution
Toothbrush and flossing are based on verbal cues

94
Q
A
95
Q
A
96
Q

What condition is defined as varying degrees of hearing loss to deafness?

A

Hearing impairments

97
Q

What condition describes an individual who has defective but functional hearing, with or without the assistance of a hearing aid?

A

Hard of hearing

98
Q

What condition refers to an inability to understand speech even with the use of a hearing aid?

A

Deafness

99
Q

How can hearing loss severity be defined?

A

By decibel loss

100
Q

What is slight hearing loss as decibel loss?

A

15-25 decibels

101
Q

What is partial hearing loss as decibel loss?

A

30-65 decibel loss

102
Q

What is serve hearing loss as a decibel loss?

A

65-95 decibel loss

103
Q

What is profound hearing loss as a decibel loss?

A

95+ decibel loss

104
Q

What is the etiology of hearing loss?

A

Many factors can damage the auditory mechanism. There are prenatal, perinatal, and post natal causes.

105
Q

What are the prenatal and perinatal causes of hearing loss?

A

Congenital anomalies
Herpes and other viruses
Trauma or anoxia during delivery
Prematurity
Blood incompatibility
Heredity
Unknown causes

106
Q

What are the postnatal causes of hearing loss?

A

Infections
High fevers
Trauma
Drugs
Cortical lesions
Environment
Aging

107
Q

What other health manifestations may be present with hearing loss?

A

Communication difficulties
Cognitive decline
Mental health issues
Balance problems
Fatigue
Increased sensitivity to noise
Tinnitus

108
Q

What oral conditions may be present with hearing impairment?

A

Cleft lip
Cleft palate

109
Q

What is the role of the dental hygienist for hearing impairment?

A

Determine how the individual communicates
Stand in front of client
Have paper and pen ready
Basic signing related to dental treatment

110
Q

What should be considered for OHI for hearing impairment?

A

Determine how the individual communicates
Stand in front of client
Have paper and pen ready
Basic signing related to dental treatment

111
Q

What condition is defined as a progressive disease characterized by the lungs episodic bronchospams, excessive mucus production, and reversible air obstruction?

A

Asthma

112
Q

What is the etiology for asthma?

A

Genetic factors
Environmental triggers
Immunological factors
Occupational exposures
Other health conditions

113
Q

What other health manifestations can be present with asthma?

A

Allergic rhinitis
Sinusitis
Eczema
Respiratory infections
Sleep disturbances
Anxiety
Depression

114
Q

What oral conditions may be present with asthma?

A

Xerostomia (from meds)
Oral thrush (from meds)
Taste changes
Increased caries risk

115
Q

What is the role of the dental hygienist for asthma?

A

Ask pertinent questions - (last attack, have they had an attack in a dental office, etc)
Provide stress free environment
Inhaler on counter
Avoid using cavitron and other aerosols

116
Q

What should be considered for OHI for asthma?

A

Xylitol aids
Rinse with water after inhaler
Antifungal agents

117
Q

What condition is a group of chronic respiratory diseases characterized by progressive tissue degeneration and reduction of airflow?

A

Chronic Obstructive Pulmonary Disease (COPD)

118
Q

What are the respiratory diseases in COPD?

A

Chronic bronchitis
Emphysema

119
Q

What condition is defined as a daily productive cough that persists for at least three months for two consecutive years?

A

Chronic Bronchitis

120
Q

What is the etiology of chronic bronchitis?

A

Inflammation of the bronchial tree due to prolonged infection or chronic exposure to irritants

121
Q

What condition is defined as an abnormal condition of the pulmonary system that features over inflation and destructive changes in the alveolar walls, resulting in air trapping?

A

Emphysema

122
Q

What is the etiology of emphysema?

A

Smoking

123
Q

What is the etiology of chronic bronchitis?

A

Smoking

124
Q

What oral conditions are seen with bronchitis and emphysema?

A

Xerostomia
Oral thrush
Higher rates of gingivitis and perio
Halitosis
Oral cancer risk is higher
Taste alterations

125
Q

What is the role of dental hygienists for chronic bronchitis/emphysema?

A

May need oxygen
Avoid N2O
Short appointments
Not supine position, halfway
May be a mouthbreather

126
Q

What should be considers for OHI for chronic bronchitis/emphysema?

A

Educate on links between plaque and lung infection
Tobacco cessation education

127
Q

What condition is a verbalized disorder that affects the exocrine glands of the body?

A

Cystic fibrosis

128
Q

What is the etiology of cystic fibrosis?

A

A mutation in the CFTR gene

129
Q

What other health manifestations may be present with cystic fibrosis?

A

Digestive problems
Liver disease
Diabetes
Reproductive issues
Osteoporosis
Sinusitis
Skin issues
Pulmonary hypertension

130
Q

What oral manifestations may be present with cystic fibrosis?

A

Enlargement of the salivary glands
Xerostomia
Less caries, plaque, and gingivitis but heavier calculus
Discoloured teeth

131
Q

What is the role of the dental hygienist for cystic fibrosis?

A

No scheduling during winter
Late afternoon appointments
Chair should be in upright position

132
Q

What OHI considerations are there for cystic fibrosis?

A

Reinforce OH and prophylaxis are necessary

133
Q

What condition is used to describe a group of disorders that are characterized by inflammation of the joint, with associated pain in the joints and connective tissue?

A

Arthritis

134
Q

What type of arthritis is the most common and classified as a non inflammatory type of joint destruction and can unilaterally affect one of more larger joints that have been damaged?

A

Osteoarthritis

135
Q

What is the etiology of osetoarthritis?

A

Congenital defect
Insufficient blood supply
Disease
Past injury

136
Q

What oral manifestations can be present with osetoarthritis?

A

Jaw pain/disfunction
Attrition
OH challenges
Malocclusion
Increase perio risk
Bruxism

137
Q

What is the role of the dental hygienist with osetoarthritis?

A

Complete MH
Later appointments
Assistance in positioning
May not be able to open wide
May not be able to remove their dentures easily

138
Q

What OHI considerations are there for osetoarthritis?

A

Alternative methods for brushing and flossing if the hands are affected

139
Q

What type of arthritis is a systemic inflammation of the joints due to a chronic autoimmune disorder?

A

Rheumatoid arthritis

140
Q

What is the etiology of rheumatoid arthritis?

A

Unknown

141
Q

What health manifestations may be present with rheumatoid arthritis?

A

Pain, discomfort
May be debilitating
Subcutaneous nodules at common pressure points like elbow
Sjögren’s syndrome

142
Q

What oral manifestations may be present with rheumatoid arthritis?

A

TMD
Xerostomia
Ulcers
Bleeding gums

143
Q

What is the role of the dental hygienist with rheumatoid arthritis?

A

If on immunosuppressants send medical consult
Short appointments
Use heat/cold therapy after tx if needed
Appliance for TMD if needed
Bite block
Perio considerations
Extra pillows/support

144
Q

What OHI considerations are there for rheumatoid arthritis?

A

Adapt handles on toothbrush
Awareness of perio considerations

145
Q

What condition is an autoimmune disorder characterized by the body’s immune system attacking its own moisture-producing glands?

A

Sjogren’s syndrome

146
Q

What is the etiology of Sjögren’s syndrome?

A

Unknown

147
Q

What health manifestations are present with Sjögren’s syndrome?

A

Visual impairments
Ocular problems
Dry tissues/skin

148
Q

What are the oral manifestations of Sjögren’s syndrome?

A

Difficulty swallowing
Altered taste
Difficulty wearing denture
Fissured tongue
Atrophy of papillae
Infections - thrush, angular cheilitis
Enlarged salivary glands
Burning mouth syndrome
Xerostomia
High caries risk

149
Q

What is the role of the dental hygienist for Sjögren’s?

A

Alter OHI to consider saliva substitutes
Consider fluoridated tx
Increased risk for lymphomas (screen for symptoms)

150
Q

What considerations are there for OHI for Sjögren’s?

A

Saliva substitutes (Xylitol)
Fl tx
Water intake

151
Q

What condition is characterized by out of control growth of abnormal cells that outlive normal cells?

A

Cancer

152
Q

What is the etiology of oral cancer?

A

Tobacco use
Alcohol consumption
HPV
Sun exposure
Chronic irritation
Nutrition
Genetics

153
Q

What are the oral manifestations of cancer and/or cancer treatment?

A

Mucositis
Xerostomia
Ulcers
Hypogeusia
Increased susceptibility to infections
Poor healing
Radiation caries
Trismus

154
Q

What is the role of the dental hygienist for cancer?

A

Instructions for importance of OH
Control perio
Eliminate/manage other infections
Nutrition counselling
Fl trays
Check with oncologist to get medical clearance
Recommend antimicrobial mouth rinse
Rinse with diphenhydramine for ulcers
Sodium bicarbonate rinse for burning mouth
Antifungal agents
Educate

155
Q

What should be considered for OH for cancer?

A

Changing dental aids if painful
Nutrition counselling
Fl trays
Recommend antimicrobial mouth rinse
Rinse with diphenhydramine for ulcers
Sodium bicarbonate rinse for burning mouth

156
Q

What condition is characterized by an over production of abnormal leukocytes?

A

Leukemia

157
Q

How many die from leukemia?

A

About 2/3

158
Q

What is the etiology of leukemia?

A

Genetic
Environmental
Age
Immune system disorders
Previous blood disorders
Viral infections

159
Q

What oral manifestations are seen with leukemia?

A

Gingival hyperplasia
Lesions
Xerostomia
Bleeding
Perio
Taste alterations
Oral infections

160
Q

What is the dental hygienist’s role for leukemia?

A

Instructions for importance of OH
Control perio
Eliminate/manage other infections
Nutrition counselling
Fl trays
Check with oncologist to get medical clearance
Recommend antimicrobial mouth rinse
Rinse with diphenhydramine for ulcers
Sodium bicarbonate rinse for burning mouth
Antifungal agents
Educate

160
Q

What to consider for OHI for leukemia?

A

Flossing not recommended
Brush with a soft nylon brush
Rinse with sodium bicarbonate

161
Q

What condition is a genetic disorder that affects the blood’s ability to clot properly?

A

Hemophilia

162
Q

What is the role of the dental hygienist for hemophilia?

A

Medical clearance is needed
Single appointments
Ultrasonic used with caution
Rubber cup polishing required careful adaptation
More excessive bleeding procedures require heavy replacement therapy
Film packet corners should be rounded
Avoid laceration
Line impression tray with wax
Careful with HVE
Ortho bands must be placed to avoid trauma to the tissues

163
Q

What are the OHI considerations for hemophilia?

A

Stress importance of good OH to minimize gingival bleeding
Toothbrush modifications may be needed for patients with joint deformities
Dental tape is often less traumatic to the tissue
Infections should be cared for first

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