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BDS3 Special Care Dentistry > rheumatology > Flashcards

rheumatology Flashcards

1
Q

what key features should be considered in the design of the practice and it’s facilities to enable those with limited mobility to access your GDP

A
  • Ramp access - temporary or permanent
  • Space for wheelchair turning circle/wheelchair in and out (less space)
  • Parking nearby - disabled priorty
    • Unlikely in high street
  • Lowered pavements at junctions - wheelchairs, mobility scooter
  • State pavement in - potholes, cracked, wobbly, moss covered (slippery when wet)
  • Grab rails - handles to help
  • Button to open door (door open in the way), handle at appropriate height if not
  • Reception desk at height that is good for wheelchair
  • Uncluttered corridors
  • Disabled toilet facilities
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2
Q

do you feel you have a responsibility to facilitate access to healthcare facilities for pts?

A

yes - moral

but sensible - may not be feasible

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3
Q

any legislative framework which exists to enable the access and provision of care for all individuals and groups of people

A
  • equality act 2010 (wider umbrella than previous Disability Discrimination Act (DDA))
    • protected characteristics
  • AWI act
  • Mental health act
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4
Q

9 protected characteristics of equality act 2010

A
  • age
  • disability
  • gender reassignment
  • marriage and civil partnership
  • pregnancy and maternity
  • race
  • religion or belief
  • sex
  • sexual orientation
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5
Q

reasonable adjustment

A

is a change to remove or reduce the effect of disability

positive action to help someone with protected characteristics

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6
Q

example reasonable adjustment for GDP

A
  • Ramp is steps into surgery entrance, installing handrails
  • Loop system for hard of hearing
  • Clearer signage
  • Layout of practice so suitable turning for wheelchair
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7
Q

example unreasonable adjustment GDP

A

If surgery is situated up the stairs in old building installing a lift as be too expensive to justify

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8
Q

what would you do if unable to make any reasonable adjustments to enable someone with disabilites to enter your practice

A

if not registered

  • Apologise
  • Refer/suggest other dentists in the area who will be able to facilitate her

if regestered already

  • your responsibility to transfer them to new suitable practice
  • not just signpost
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9
Q

possible options to aid transfer to chair

A
  • Hoist
  • Transfer boards
  • Pt turners / turn table
  • Wheelchair recliner
  • Reclining wheel chair - need temporary head rest
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10
Q

hoist

benefits and cons

A

Unlikely to get in GDP

  • Portable - big and bulky, space
  • when not in use - hoist needs to be in docking station for charging

need pt sitting in sling when they arrive in wheelchair

  • single use
  • different sizes
    • comes up to back of head - stiffened there
  • ensure right sling for hoist (attachments)

Pt may not feel comfortable/at ease using it

  • scary 1st time

need to 2 people to operate (maybe 3 depending on pt size)

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11
Q

transfer boards

A

Need a break leg facility or knee break

  • Not whole seat conventional dental chair

Wheelchair close to chair

  • Breaks on

Slide under pt and onto dental chair

  • Pt needs t be able to them self - upper body strength - risky
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12
Q

reclining wheelchair

A

cushions on chair to make pt more comfortable - ease pt pain and discomfort (can be more sensitive)

good as not compromising dentist’s posture

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13
Q

turn table

A

Need to be able to stand and support their weight

Usually 2 people to support

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14
Q

wheelchair recliner

A

best

but bulky, expensive

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15
Q

stand aid

A

like turntable but more supported

need 2 carers to support

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16
Q

considerations for someone with reduced mobility when planning appointment length

A

How long has it taken to get her into practice, out of wating room into chair

  • Probably need to give them longer appointment for mobility
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17
Q

social history importance for someone with restricted mobility/disability

A
  • travel
  • support at home
    • carers - when (time around) (first thing not ideal as often longer to get going)
  • diet
  • alcohol
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18
Q

medical history importance for pt with disability/restricted mobility

A
  • past and future hospital stays
  • medications,
  • is it stable
  • prognosis
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19
Q

methotrexate

A

immunosuppressant

  • inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines.
  • Reduces function of cells which are causing inflammation and should help relieve pain from joint damage (RA)
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20
Q

link between sjorgens and RA

A

RA - autoimmune disease, so is sjorgen

get one likely to get the other

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21
Q

predisnolone

A

corticosteroid

systemic

dampen down inflammation (RA)

22
Q

risk of corticosteroid and dental tx

A

need to know even if long time ago (months) - ask dose as can still be concern

  • dampen down inflammation

need body to be able to make cortisole - but will stop if on corticosteroid dose for long time (lose fight/flight response - may need to top up for tx)

23
Q

primary sjorgen

A

dry eyes and mouth

24
Q

secondary sjorgens

A

dry eyes and mouth with assoicated disease

25
Q

if pt says they have dry mouth

want info do we want

A
  • Wan to know how long experience symptoms
  • Has she got eye symptoms
    • referral –> risk loss sight
    • Does she have sensation of sand/gravel in eyes
  • How severe oral symptoms
    • impacts everday life
    • swollen glands - recurrent or persistantly
    • Drink liquid to aid swallowing
    • Salivary flow rate - normal, stim and unstim
  • Blood test
26
Q

blood test

for sjorgens and RA

A

autoantibodies SS-A/Ro and SS-B/La and rheumatoid factors (if RA)

indicates CT disease (RA, SLE, sjorgen)

27
Q

hands of RA pt

A

twisted

claw like

grip issue - toothbrush

28
Q

impact of dry mouth on tooth hard tissue

A

demineralise

acidic environment

29
Q

differential dx for dry mouth (10)

A
  • Medication
  • Polypharmacy
  • Endocrine disease - diabetes
  • Anxiety stress
  • Dehydration - starvation
  • Cancer therapy
    • transient dry mouth in chemo,
    • radiotherapy - glands irritated - profound chronic and progressive dry mouth (fibrosis of tissues)
  • Heridiatry causes
  • Cystic fibrosis
  • Inflammatory - lupus, sarcoid, sjorgen
  • Infections - HIV, hep C, epstein barr
30
Q

ramfjords teeth

A

16, 21, 24, 36, 41, 44

31
Q

BPE2

A

supra or sub gingival plaque/calculus

no probing depths >3.5mm

32
Q

BPE3

A

supra or sub gingival plaque/calculus

probing depths between 3.5-5.5mm

33
Q

BPE4

A

supra or sub gingival plaque/calculus

probing depth 6mm or more (black band entirely in pocket)

34
Q

BPE *

A

furcation involvement

35
Q

tx BPE2

A

plaque and gingivitis chart

OHI

remove supra- gingival calculus and plaque and sub gingival if present

36
Q

tx BPE3

A

6PPC if more than one sextant

plaque and gingivitis chart

OHI

remove supra- gingival calculus and plaque and sub gingival if present

RSD

37
Q

tx BPE4

A

6PPC

plaque and gingivitis chart

OHI

remove supra- gingival calculus and plaque and sub gingival if present

RSD

assess need for complex tx referral

38
Q

tx BPE *

A

assess need for complex tx referral

39
Q

which radiograph to take for RA pt

A

OPT maybe more comfortable if reduced opening

not ideal when pt in wheelchair (better if standing and supported)

maybe size1 PA of anterior teeth id OPT not adequate

40
Q

consideration for tx planning for someone with restricted access

A

how can we minimise appointments

  • quadrant or arch approach possible ?
41
Q

endo for restricted access pts

A

demanding, several tx so not ideal options for access

42
Q

why may a pt have a particular area of worse perio health if have RA

A

may find that area particularly hard to clean e.g. right handed lower if right handed

43
Q

questions to ask about access

A

How easy to get

How regularly will she be able to come

Would she need accompanied

Best time for her for appt

44
Q

autoimmune disorders and maligancy

A

possibility of malignant change in autoimmune disorders

b cell lymphoma and sjorgens

45
Q

xerostoma and infections

A

more likely with sore mouth

  • Fungal - acidic dry mouth
  • Staph aureus - sialitis - red swollen shiny hot cheek if parotid (antibiotics) less common in submandibular
46
Q

when tx planning for restricted access pt consider

A

how to carry out tx

  • pt level fatigue
  • prop needed
  • sedation - muscles relax better - possible better access?
47
Q

long term tx planning for pt with RA

A
  • Stability of disease
    • Rate of dental disease - are we getting control of her dental disease
  • Frequency of check ups post tx plan
    • 3 months (idea getting on top of disaese - managing prevention)
  • Complications of sjorgens
    • chronic progession condision
      • Caries - demin teeth
      • Gingiva sore inflammed
      • Denure - can she use - saliva, putting it in and out
48
Q

aids for toothbrush dexterity

A
  • electric?
  • adapt handle
    • foam
    • putty handle
    • acrylic lab made handle
  • curve toothbrush
  • multiple sided
49
Q

denture cleaning aid for reduced dexterity

A

denture hold to aid cleaning

made so denture face sits

one for fitting surface, other for outer surface

50
Q

immunosuppressant risk

A

infection

depend on dosage

likely drug interactions

BDS3 Special Care Dentistry (21 decks)

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