Medical problems related to dentures Flashcards
Why might a patient have xerostomia?
- Tricyclic antidepressants
- Polypharmacy of medications
- Sjogrens
Why does xerostomia cause problems in denture wearers?
- Increased caries and periodontla disease risk
- Saliva helps with retention of the denture (reduced if pt has xerostomia)
- Pain and discomfort from not having saliva lubricating surfaces
- Associated oral mucosal problems such as oral candidiasis and angular chelitis
What is anaemia?
- Reduced healthy red blood cells (reduced haem )
- Insufficient to carry enough O2 around
What can aneamia and other deficiencies cause for denture wearers?
- B12, folate , iron
- Increased risk of associated oral mucosal problems (acute psuedomembranous candidiasis or angular chelitis
- Pain and discomfort from these
What conditions may cause a pt have a tremors?
- Parkinsons
- CVA (cerebrovascular accident - stroke)
- Huntington’s chorea
If a pt has a tremor what difficulties may this cause for denture design?
- Makes stages of denture construction more difficult
- Jaw reg stage difficult as not able to guide patient into RCP if actively tremors
- End up with inadequate occlusion (no posterior contacts)
- Have simple txt plans (no precision attachments and try not to combine bridge and crown work)
Give some examples of Anti-resopritve agents
Bisphosphonates - Alendronic acid
RANKL-inhibitors - Denusomab
Anti-angiogenic - Bevacizumab
What do you need to consider if pt is on anti-resoprtive agents?
- MRONJ risk (SDCEP guidelines) from ill fitting denture or from XLA of poor prognosis teeth
- Keep teeth / roots would normally XLA (compromises aesthetics)
What is NICE definition of frailty?
- State of increased vulnerability to poor resolution of homeostasis after a stress event
What is frailty associated with? How is performance status assessed?
- Low energy , slow walking speed, reduced strength
- Associated with multiple long term conditions e.g. RA or osteoporosis
- Fall, delirium
- Increased hospital admission
- Increased care home admission
Assessed using Karofsky or ECOG status
What is the definition of Dementia?
- Umbrella term for diseases/ conditions characterised by decline in memory, language, problem solving and other thinking skills that affect ability to perform everyday activites
What issues can arise from dementia pts for denture apppointments?
- Remembering appoint
- Remembering instructions
- Manual dexterity reduced
- Do they have the capacity to consent
What are the key features to assess a pts capacity to consent?
- acting; or
- making decision; or
- communicating decisions; or
- understanding decisions; or
- retaining the memory of decisions
What are the principles of Adults with Incapacity Scotland Act 2000?
- Benefit
- Least restrictive option
- Take into account pts past and present views and preferences
- Consultation with relevant others e.g guardian
- Encourage adult to develop and exercise as much skill as poss
Who can deem someone with incapacity?
- Drs
- Dentists that do appropriate training and sign a section 47 certificate
