Week 10 PP Flashcards
What is a Category 1 Patient?
Healthy Patient
What is a Category 2 Patient?
Medical conditions requiring scheduling changes or shorter appointments
What is a Category 3 Patient?
Medical conditions requiring significant modifications in dental treatment planning
What is a Category 4 Patient?
Medical conditions requiring major modifications including dental treatment within the operating room
What is a Category 5 Patient?
Serious medical conditions and only limited care
What are Pulmonary Disorders?
Disorders that affect the lungs and are characterized by airway obstruction
-Allergies
-Bronchial Asthma
-Chronic Obstructive Pulmonar Disease
Allergies
-A condition in which the body reacts to an antigen
-Most reactions can be managed by having the patient take an OTC med or a prescribed medication that reduces the symptoms of the allergy
-if the reaction goes beyond this type of management, the allergy becomes a life-threatening emergency
Clinical Considerations for Patients with Allergies
-Complete a thorough medical history to determine specific allergens
-Attention given to latex products and ental material use
-Have an EpiPen available for potential allergic reaction
Bronchial Asthma
-chronic lung disease that inflames and narros the airways
-causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing
-coughing typically occurs at night or early in the morning
-often arises from allergies and is characterized by an increased hypersensitivity to various stimuli, resulting in bronchial edema and widespread narrowing of the bronchial airways
Clinical Considerations for Patients with Bronchial Asthma
-Minimize stress
-Short appointments
-Sedation techniques may be used to limit stress
-Use of epinephrine and aspirin should be minimized
-Epinephrine can enhance adverse effects of bronchodialators and aspirin may cause a laryngospasm or attack
Chronic Obstructive Pulmonary Disease (COPD)
-Pulmonary diseases characterized by blocked airflow during respiration
-Emphysema is the irreversible enlargement of the size of the air spaces that results in labored breathing and an increased susceptiblity to infection
Clinical Conditions for Patients with COPD
- Keep appointment short and schedule them in the morning
- In low to moderate risk patients consider the use od sedation
- Avoid use of nitrous oxide
- Don’t use the supine position to treat patient
- Avoid elective treatment during hot and humid weather
- May use humified oxygen given by nasal cannula
What do Blood Disorders involve?
Cellular elements of the body
What is Anemia?
condition when your blood lacks enough healthy blood cells or hemoglobin
What is Leukemia?
an excessive increase in white blood cells which may indicate an infection
What is Hemophilia?
Excessive bleeding caused by congenital lack of protein substance necessary for blood clotting
Clinical Considerations for Patients with Blood Disorders
- Factor in the patient’s susceptibility for infection
- Treatment modifications must be made for any surgical procedure
- Antibiotic prophylaxis maybe prescribed for highrisk procedures
Endocrine Disorders
- Glands located in many different regions of the body that release hormones into the bloodstream
- The thyroid gland regulates metabolism in body cells and stimulates passage of calcium into bones from the blood
Endocrine Disorders include:
◦ Hyperthyroidism
◦ Hypothyroidism
◦ Diabetes Mellitus
✓ hyperglycemia
✓ hypoglycemia
What is Hypothyroidism?
- Thyroid gland is Underactive and produces fewer hormones than usual
- Not in any danger associated with receiving dental care
- Can receive depressants, sedatives, or narcotic analgesics before dental treatment
- They could show exaggerated responses to barbiturates, tranquilizers and narcotic
tranquilizers - Due to the depressant effects on the central nervous system
What is Hyperthyroidism?
- Overactive thyroid gland
- Graves’ disease
- Affects women more than men
- Average age of onset is 40
- Infection, stress, trauma, pain or surgery may precipitate a hyperthyroid crisis.
- Crisis could be fatal
Clinical Considerations for Patients with Hyperthyroidism
-Accurate and current medical history
-Medical consultatin may be necessary
-Patients who are not being treated for hyperthyroidism are highly sensitive to epinephrine and other amine anaesthetics
Diabetes Mellitus
- Disorder of the metabolism – way the body uses digested food for energy
- Hormone insulin helps cells in the body absorb glucose and use it for energy
- Diabetes develops when the body doesn’t make enough insulin or isn’t able to use insulin effectively
- Blood glucose levels become too high
- Classified into two categories
Type I Diabetes
- AKA juvenile diabetes
- Diagnosed in children and young adults
- Chronic condition
- Pancreas produces little to no insulin
- Patient becomes insulin dependent
Type II Diabetes
- AKA adult onset diabetes
- Commonly diagnosed in adults
- Chronic disease
- Affects the way the body processes sugar or glucose
- Patient is treated with lifestyle changes, oral medications and maybe insulin
Hyperglycemia & Hypoglycemia
- When the balance shifts from too little food being consumed or too much, insulin levels can change
- Too much blood sugar – hyperglycemia
- Too little blood sugar – hypoglycemia
- If untreated hyperglycemia may develop into diabetic ketoacidosis and a life-threatening diabetic coma
- Hypoglycemia (insulin shock) is an abnormal decrease in the blood sugar level.
- Can manifest quickly and most common cause is skipping a meal
Clinical Considerations for Diabetic Patients
- Minimize stress with short appointments
- Midmorning appointments
- Sedation techniques – Nitrous oxide or oral diazepam
- Instruct patient to maintain normal dietary intake prior to dental appointment
- Most common cause of hypoglycemia is failure to eat
- Minimize risk of infection
What is Schizophrenia?
Schizophrenia is a psychotic disorder characterized by varying degrees of personality disorganization. Thought processes are disrupted by bizarre delusions and perceptual disturbances (hallucinations). Routine daily functions are mpaired.
Clinical Considerations for Patients With Behavioural and Psychiatric Disorders
- Xerostomia may result from the psychoactive drugs
- Regular oral hygiene and use of fluoride supplements and saliva substitutes are important to preserve dental health
- Patient cooperation and consent may cause issues especially with a patient suffering from anxiety
Family Violence
-Behaviour by one individual toward another in an intimate or family relationship
-Most at risk - chilren, women, and elderly and persons with disabilities
Family Violence Categories
- Child abuse & neglet
- Intimate parter violence or domestic violence
- elder abuse and neglect
Child Abuse
nonaccidental physical, emotional or sexual acts against a child
Child Neglect
intentional or unintentional failure to provide for the child’s basic physical, emotional, educational and medical/dental needs
Child Dental Neglect
Failure of a caregiver to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedome from pain and infection
Physical Signs of Child Abuse/Neglect
- Clothing that may conceal bruises and lacerations, even in warm weather
- Uncleanliness, body odor, soiled clothes showing lack of care from caregiver
- Infestation of lice
- Failure to thrive – malnutrition
- Body fat ratio low for child’s age and height – not within the normal developmental range
Behavioural Signs of Child Abuse/Neglect
-Aggresive, destructive or antisocial behaviour
-Withdrawn behaviour
-Impulsivity, inattenton and hyperactivity
-Strong desire to please
-Lower self esteem
-Higher levels of depressive symptoms
-May exhibit lower IQ with less developed communication, reading and math skills
-May exhibit well developed problem-solving skills
Extraoral Signs of Trauma
-Abrasion and lacerations present in varying degrees of healing inconsistent without explanations
-Accidental injuries on both sides of the body or face
-Nose fractures or displacements
-Lip bruises or laceratoins. angular bruising
-Marks on skin that forma pattern of an object
-Human bite marks
-burns
Conditions that Mimic Abuse
-Skin lesions - bullous impetigo, birthmarks
-Burns/red lesions - port-wine stain, accidental burns
Bruising - hemophilia, accidental injuries
Intraoral Signs of Child Abuse
- Tongue, buccal mucosa, or palatal lacerations
- Lingual and labial frenum tears
- Discolored teeth (pulpal necrosis)
- Burns or lacerations of the gingiva, tongue, palate or
floor of the mouth - Fractured, displaced, avulsed or non-vital teeth
- Radiographic evidence of fractures in different
degrees of healing
Signs of Sexual Abuse
- Bruising or petechiae (small red or purple spots) on palate
- Sexually transmitted genital lesions in mouth
- Exhibiting difficulty in walking or sitting
- Extreme fear of oral examination
- Pregnancy
- Especially in early adolescent
Intraoral Signs of Neglect
- Failure of caregiver to seek dental care (intentional or unintentional)
- Neglect becomes intentional when the caregiver fails to follow through with treatment deemed necessary
- Signs of oral neglect
- Lack of daily person care
- Appointments only made for emergencies
- Rampant decay
- Gingival inflammation and bleeding
Reasons for Dental Neglect
- Low priority
- Lack of education regarding the significance of oral
health related to overall health - Limited finances
- Family isolation – access to dental care
- Religious and/or cultural beliefs
Reasons for Abuse or Neglect
- Immature and unprepared for parenthood
- May have been maltreated themselves
- Witnessed violence as a child
- Unable to handle daily stresses –
unemployment/poverty - Drug use/alcoholism
- Lacking support network
- History of criminal activity
- Gender or social inequality
Elder Abuse & Neglect
- Immature and unprepared for parenthood
- May have been maltreated themselves
- Witnessed violence as a child
- Unable to handle daily stresses –
unemployment/poverty - Drug use/alcoholism
- Lacking support network
- History of criminal activity
- Gender or social inequality
General signs of Elder Abuse/Neglect
- May appear withdrawn, anxious, shy
- Provides illogical explanation of how injury occurred
- Depression or hostility
- May flinch at another person’s movement
- Defer responses to a caregiver or possible abuser
- May show signs of fear or apprehension if caregiver is present
Physical Signs of Elder Abuse/Neglect
- Bruises in various degrees of healing
- Human bite marks.
- Contusions or abrasions exhibiting handprints or
fingertip patterns - Inadequate clothing for the season
- Poor personal hygiene.
- Scratches or burns.
- Traumatic alopecia
- Wrapping bruises (restraints used on wrists and ankles)
- Patterned marks and bruising indicating object used to
inflict injury such as belt buckle, ropes, or a hand
Extraoral Signs of Elder Abuse/Neglect
- lip trauma
- Bruising of facial tissues
- Eye injuries
- Broken glasses or frames
- Fractured or bruised mandible
- Temporomandibular joint pain
Intraoral Signs of Elder Abuse/Neglect
- fractured, displaced, or avulsed teeth
- Sexually transmitted disease lesions
- Lesions or sore areas in the mouth from ill-fitting dentures
- Fractured denture
- Poor oral hygiene
- Rampant dental caries
- Untreated periodontal disease.
Discussion of Findings
-Decision by the dental team to discuss suspicion of abuse with caregiver
-No accusations or being judgmental
-Legal Obligation to report
Responsibilities of Dental Professionals
-Dental team is obligated to become familar with signs of abuse and to report occurences to proper authorities in compliance with AB law
- Each office should have written protocol for documentation of abuse/neglect
-Training in recognition and reporting of abuse/neglect
-Dental teams are protected from liability as long as reports are made with reasonable grounds and without malice
Dental Team’s Approach when dealing with abuse/neglect
- Document detailed extraoral/intraoral findings including photographs of injuries
- Practice routine inquiry – “Do you feel safe at home?”
- Respect and maintain confidentiality; talk in a private setting (door closed to treatment room)
- Provide references for counseling, telephone numbers for community services.
- Prepare to share your findings with authorities when called to provide evidence. When it is known that the interview will be used in a legal setting, a witness needs to be present.
- When reporting suspected child maltreatment, it is
necessary to have the following information available:
- Name and address of the child and parents or other persons having custody of the child.
- Child’ s age.
- Names of siblings if there are any.
- Nature of the child’s condition, including evidence of previous injuries.
- Any information that might be helpful in establishing the cause of abuse or neglect and the identity of the person believed to have caused such abuse or neglect.
- Information required for reporting suspected abuse/neglect of the elderly or a disabled individual is the same to what is needed for a child
