Law YR3 Flashcards
(179 cards)
1
Q
What is the aim of restraint? But, what must we consider?
A
- Removing the patients free will- Permitting the operator to impose their will upon the patient- Inhibit the patient from applying their own inhibitionsWe must consider the medico-legal implication
2
Q
What are the medico-legal issues concerning consent that we must consider?
A
- Duty of care- Standard of practice- Law- Risk avoidance- Management of critical incidents
3
Q
What are the 9 standards for a dentist?
A
- Patient’s interest first2. Communicate effectively3. Consent4. Protect and maintain patient info5. Clear and effective complaints procedure 6. Work the colleagues in a way in the patients best interests7. Maintain, develop and work within your professional knowledge and skills8. Raise concern if patients at risk9. Personal behaviour maintains patient’s confidence
4
Q
What is the definition of the dentist’s duty of care?
A
To provide safe, effective dental care of a standard a patient has a right to expect from a reasonable dental; practitioner; that is an individual holding themselves out to be someone professing to have the skills that a reasonably competent dental practitioner would have
5
Q
Procedures that are considered restraint? And, what is necessary before administration?
A
- GA and sedation| - Written consent is 100% needed
6
Q
Can restraint be used in the dental practice?
A
- Use of restraint may be lawful; provided that it was reasonable restraint - Reasonableness requires reference to accepted practice
7
Q
Forms of planned restraint?
A
- Physical (for LA)- Oral sedation- IV sedation- GA- Surreptitious use of sedation
8
Q
Process necessary to document, inform and perform restraint?
A
- How much and what restraint- Comprehensive records- Establish the need- Have and follow the protocol- Justify use- Act in the patient’s best interest
9
Q
Premises necessary to perform safe restraint?
A
- Access- Surgery accomodation- Recovery rooms- Admin facilities- Health and safety legislation
10
Q
Staff qualifications and training for the safety to perform restraint?
A
Staff: - qualified - registered - trained - in date - under indemnityTraining: - pre GA/sedation procedure- the procedure- recovery- emergency
11
Q
Equipment necessary to perform safe restraint?
A
- Appropriate- Availability- Maintenance- Documentation
12
Q
The needs of a suitable protocol for a treatment?
A
- Difference between guidelines, procedures and protocols- Available in surgery- Understood- Appropriate- Fully understood- Audited updated and developed
13
Q
What must a clinical practice demonstrate to be acceptable in the eyes of the GDC?
A
- Duty of care- Appropriate- Diagnosis- Treatment planning- Risks- Alternatives- Justifications- Consent- Review- CPD- Resus training- Staff training- Records
14
Q
What are the necessary assessment questions for use of all restraints?
A
- Separate appointment- Can be performed by different person- Assessor trained and competent- Discuss fully with patient- Discuss with colleague if in doubt- Document everything- Assess for treatment plan and treatment required- Discuss risks and alternatives- Write and duplicate referral letter
15
Q
Contents of a referral letter?
A
- Name, address and contact details of referrer and patient- Medical and dental history- Reasons for sedation- Risks and alternative described- Written pre and post OP instructions given
16
Q
What should records include and demonstrate?
A
- History- Clinical exam- Treatment plans- Treatment carried out- Problems- Future treatments
17
Q
What is included in the GDC’s definition of scope of practice for a dentist?
A
A set of skills and abilities each registrant should haveAdditional skills that may develop after registration to increase your scope of practiceUnderstand your limits and don’t exceed themTrained for medical emergencies
18
Q
What is expected legally from us as dentists?
A
EthicsProfessionalismProfessional governanceLawConfidentialityConsentNegligenceRecord KeepingRisk managementClinical governanceReferral of patientsDealing with complaintsWorking well as a teamProfessional developmentSelf appraisal
19
Q
What can dental nurses do?
A
Maintain equipmentCarry out infection preventionRecord dental chartingMix dental biomaterialsChairside supportKeep accurate patient recordsPrepare dental radiographyProcess radiographsPatient aid/adviceAid in medical emergencyMake appropriate referrals
20
Q
What can orthodontic therapists do?
A
Prepare teeth for orthodontic treatmentMaintain equipmentInsert passive removable orthodonticsInsert removable appliancesRemove fixed appliancesPlace auxiliariesStudy modelsMake orthodontic applianceFit headgearFit facebowTake occlusal recordsClinical photographsPlace brackets and bandsPlace archwiresAdvice on appliance carFit tooth separatorsFit bonded retainersCarry out IOTNMake appropriate referralsKeep full recordsGive patient advice
21
Q
What can dental therapists do?
A
• obtain a detailed dental history frompatients and evaluate their medicalhistory• carry out a clinical examination withintheir competence• complete periodontal examination andcharting and use indices to screen andmonitor periodontal disease• diagnose and treatment plan within theircompetence• prescribe radiographs• take, process and interpret various filmviews used in general dental practice• plan the delivery of care for patients• give appropriate patient advice• provide preventive oral care to patientsand liaise with dentists over the treatmentof caries, periodontal disease and toothwear• undertake supragingival and subgingivalscaling and root surface debridementusing manual and powered instruments• use appropriate anti-microbial therapy tomanage plaque related diseases• adjust restored surfaces in relation toperiodontal treatment• apply topical treatments and fissuresealants• give patients advice on how to stopsmoking• take intra and extra-oral photographs• give infiltration and inferior dental blockanalgesia• place temporary dressings and re-cementcrowns with temporary cement• place rubber dam• take impressions• care of implants and treatment ofperi-implant tissues• carry out direct restorations on primaryand secondary teeth• carry out pulpotomies on primary teeth• extract primary teeth• place pre-formed crowns on primary teeth• identify anatomical features, recogniseabnormalities and interpret commonpathology• carry out oral cancer screening• if necessary, refer patients to otherhealthcare professionals• keep full, accurate and contemporaneouspatient records• if working on prescription, vary the detailbut not the direction of the prescriptionaccording to patient needs. For examplethe number of surfaces to be restored orthe material to be used.
22
Q
What can dental technicians do?
A
• review cases coming into the laboratory todecide how they should be progressed• work with the dentist or clinical dentaltechnician on treatment planning andoutline design• give appropriate patient advice• design, plan and make a range ofcustom-made dental devices accordingto a prescription• modify dental devices including dentures,orthodontic appliances, crowns andbridges according to a prescription• carry out shade taking• carry out infection prevention and controlprocedures to prevent physical, chemicaland microbiological contamination in thelaboratory• keep full and accurate laboratory records• verify and take responsibility for thequality and safety of devices leaving alaboratory• make appropriate referrals to otherhealthcare professionals
23
Q
What can dental hygienist do?
A
• provide dental hygiene care to a widerange of patients• obtain a detailed dental history frompatients and evaluate their medical history• carry out a clinical examination within theircompetence• complete periodontal examination andcharting and use indices to screen andmonitor periodontal disease• diagnose and treatment plan within theircompetence• prescribe radiographs• take, process and interpret various filmviews used in general dental practice• plan the delivery of care for patients• give appropriate patient advice• provide preventive oral care to patientsand liaise with dentists over the treatmentof caries, periodontal disease and toothwear• undertake supragingival and subgingivalscaling and root surface debridementusing manual and powered instruments• use appropriate anti-microbial therapy tomanage plaque related diseases• adjust restored surfaces in relation toperiodontal treatment• apply topical treatments and fissuresealantsgive patients advice on how to stopsmoking• take intra and extra-oral photographs• give infiltration and inferior dental blockanalgesia• place temporary dressings and re-cementcrowns with temporary cement• place rubber dam• take impressions• care of implants and treatment ofperi-implant tissues• identify anatomical features, recogniseabnormalities and interpret commonpathology• carry out oral cancer screening• if necessary, refer patients to otherhealthcare professionals• keep full, accurate and contemporaneouspatient records• if working on prescription, vary the detailbut not the direction of the prescriptionaccording to patient needs
24
Q
What can clinical dental technicians?
A
• prescribe and provide complete denturesdirect to patients• provide and fit other dental devices onprescription from a dentist• take detailed dental history and relevantmedical history• perform technical and clinical proceduresrelated to providing removable dentalappliances• carry out clinical examinations within theirscope of practice• take and process radiographs and otherimages related to providing removabledental appliances• distinguish between normal and abnormalconsequences of ageinggive appropriate patient advice• recognise abnormal oral mucosa andrelated underlying structures and referpatients to other healthcare professionalsif necessary• fit removable appliances• provide sports mouth guards• keep full, accurate and contemporaneouspatient records• vary the detail but not the direction of aprescription according to patient needs
25
What can a dentist do?
```diagnose disease• prepare comprehensive treatment plans• prescribe and provide endodontictreatment on adult teeth• prescribe and provide fixed orthodontictreatment• prescribe and provide fixed andremovable prostheses• carry out oral surgery• carry out periodontal surgery• extract permanent teeth• prescribe and provide crowns and bridges• provide conscious sedation• carry out treatment on patients who areunder general anaesthesia• prescribe medicines as part of dentaltreatment• prescribe and interpret radiographs```
26
What are the training pathway outcomes for dentists?
ClinicalCommunicationProfessionalismManagement and Leadership
27
What are the training pathway outcomes for dental therapists?
ClinicalCommunicationProfessionalismManagement and Leadership
28
What are the training pathway outcomes for dental hygienists?
ClinicalCommunicationProfessionalismManagement and Leadership
29
What are the training pathway outcomes for clinical dental technicians?
ClinicalCommunicationProfessionalismManagement and Leadership
30
What are the training pathway outcomes for dental technicians?
ClinicalCommunicationProfessionalismManagement and Leadership
31
What are the training pathway outcomes for orthodontic therapists?
ClinicalCommunicationProfessionalismManagement and Leadership
32
What are the training pathway outcomes for dental nurses?
ClinicalCommunicationProfessionalismManagement and Leadership
33
What are the CPD requirements for a dental therapist, hygienist, orthodontic therapist and clinical dental technician?
75 hours
34
What are the CPD requirements for a dentist?
100 hours over 5 year cycle and at least 10 hours for a 2 year period
35
What responsibilities does a dentist have when a complaint is made against his team?
Dentist's responsibility to talk to the patient and to the staff memberAt the end of the day, it all falls on the Dentist
36
What responsibilities does a dentist have when a complaint is made against his team?
Dentist's responsibility to talk to the patient and to the staff memberAt the end of the day, it all falls on the Dentist
37
What are the guidelines for tooth whitening?
Anything over 6% H202 is prohibited for tooth whitening or bleaching products, unless of treatment or prevention of disease
38
At what age does teeth whitening become legal?
Above 18 years old
39
What checks must be done before the treatment for teeth whitening?
Appropriate clinical exam to ensure no risk factor or oral pathology existsExposure to the h202 is limited and are only used for the intended use with frequency and duration consideredProducts should not be available to the consumer only via a dental care professional
40
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST| the following cycles can be administered by a dental care professional
41
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST| the following cycles can be administered by a dental care professional
42
What are the botox and fillers governed by?
Medical Acts
43
What is the definition of a legal restoration?
That it gives the tooth a therapeutic advantage at becoming healthier, than it was in its original state in the practice
44
What is a risk assessment?
Weighing up the risks vs the benefits for a specific procedure
45
What questions should we ask to the patient when gauging patient expectations?
What they want?What they care about?Intermediate restorations can appease the patient's expectationsOur own expectations need to be of sufficient standard
46
How to manage expectations?
Explain to the patient what modern medicine and your skills are capable ofDon't over sell yourselfBe realistic
47
When a new patient arrives for a check up, and you check their teeth, what questions should you ask them?
What are the patient's dental needs?What are the risks?What is the treatment?Ask patient what their thoughts are about their dentition?WIll the patient be happy with your treatment plan?
48
What problems can occur during treatment?
```Don't panicTake adviceLimit any damageDon't be afraid to say 'sorry' (if treatment failed/under expectations)Make the patient presentable (aesthetically)Deal with the pain firstDon't be afraid to referPrevent recurrence in the future```
49
What actions can you implement to reduce the likeliness of patient complaints?
Careful treatment planningRealistic expectations of treatment that patients understandProviding questionnaires to assess what that patient thinks about the practiceReacting promptly to patients comments giving reasons if you are not accepting themHaving a sound clinical governance programme in placeCarrying out critical incident analysisPeer reviewMaking patient feel that you have their best interests uppermost in your mndtreat patients with respectRespect equality and diversity (equality act)Advise patients if procedures do not go well and what you'll do to rectify and prevent recurrence (duty of candour)All practice staff maintain a professional demeanour
50
What is the definition of clinical governance?
A mechanism for monitoring and reviewing the healthcare provided for patients to give assurance that all patient receive consistent health care of an appropriate quality irrespective of where it is provided or from whom it is provided by.To analyse the data to see if it can be used to improve the general health and healthcare of the population
51
How does clinical governance help the dentist?
Patient's need to know benefits outweigh risksBetter job satisfactionSave money from complaints or rectifying procedures
52
Why do we need clinical governance?
To ensure patient recieve safe treatment, effective treatment, consistent quality of treatment
53
What does clinical governance include?
```Clinical risk managementInformation governanceClinical effectivenessFitness to practiceOther risks in the practice```
54
What is included in information governance?
Data protection (GDPR 2018)Freedom of information actInformation securityRecords management
55
What is included in a clinical governance folder?
Contains all the protocols for each specific treatment and/or consent To protect yourselfConsider risks and advising patient about risks
56
What is included when considering clinical effectiveness?
```Dental materials usedEffectiveness of materialsSafety of dental materialsLongevity of treatmentsPerson centered careEfficiencySame treatment to each patientTiming```
57
What is included when considering Fitness to practice?
Registered with the GDCHave indemnityEnsure healthyContinue CPD
58
What is a proforma?
A list of steps that occur during a specific treatment
59
How to make a good and consistent referral letter?
```TypedCopyPatient details with contact infoMedical historiesDental historiesHistory of conditionRadiographsPhotographUrgency (routine, soon or urgent)Protocol if patient fails to turn up```
60
What to include to reduce risk when thinking about treatment planning and clinical notes?
Evidence of throught and appropriate examinationEvidence of perio conditionsRadiographs as requiredStudy models as requiredTests as requiredExplanation of risks and benefitsNecessity of the treatment for the patient
61
A key abbreviation to start every clinical note?
C.O.Complaining ofif none put noneif something put something
62
What are the guidelines to follow for radiographs?
IR(ME)R
63
Unless it is an emergency what is the dentist's ethical and legal requirement to undertake?
Must carry out a full examination and determine all the treatment necessary to secure and maintain oral health
64
How to increases the likeliness of a patient to attend follow up appointments?
Each appointment to be plannedWhat is proposed to be done at each appointmentLength of time for each appointmentExplain step-by-step to the patient what is going on
65
What are essential to write in the notes?
```Communication with the reception staff?Does patient understand the nature of contract which they are being treated?Why patient came to the surgery?Pain?Other problems?Use templates```
66
What other risks are there in the dental surgery?
```Health and safety risk assessmentSlips and tripsFire riskElectrical riskSecurity riskCritical incident analysisClinical risk assessment```
67
What to include for a critical incident analysis?
ComplaintsDisastersThings that go wellThings that do not go well
68
What is the definition of audit?
Identify a significant risk, do something to eliminate it, review to see if it worked
69
What is the definition of peer review?
Reviewing with peers processes and procedures that you follow to see what they do and see if what you are doing can be improved
70
What is the definition of duty of candour?
Must be open and honest with patients when something goes wrong with a patient's treatment or care which causes, or has the potential to cause, harm or distressSeek advice if unsure about the consequence and subsequently tell the patient something has gone wrongApologise to the patient and offer an appropriate remedy or support to put matter right and explain the short and long term effects of what has happened and document what has happenedRaise concerns where appropriate if you believe a patient's best interests have been compromised
71
Name the 5 substandards for child protection and vulnerable adults?
Always put the patient firstAct promptly if patients or colleagues are at risk and take measure to protect themMeasure sure if you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns and openly and without fear of reprisalMeasure sure if you employ, manage or lead a team that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that is is followed at all timesTake appropriate action if you have concerns about the possible abuse f children or vulnerable adults
72
What is included in the Wood report 2016?
4% of child deaths relate to safeguarding or require an SCR to be carried outShould be moved to the Department of HealthPromote innovation and deliver efficiency in the design of local arrangements to safeguard children and young peopleIf a tragic events happens learn from it and stop it from happening in the future
73
What is the definition of Child Abuse?
Physical and emotional abuse + neglect
74
Is early intervention good and why?
Have a greater chance they have to break the cycle and health
75
Is child abuse only violent?
No, it can also be neglect and emotional abuse, they are more subtle and can have long-lasting effects
76
Is child abuse only carried out by 'bad people'?
No, not all abusers are intentionally harming their children, many have been victims of abuse themselves, and don't know how to parentOther struggle with mental health or a substance abuse problem
77
Where does Scotland lie in the substance abuse league table?
#1 in Europe
78
Does child abuse happen in 'good families'?
It can happen in all families| Behind closed doors it's a different story
79
Who are the people who child abuse?
Usually family members, but stranger abuse does happen
80
Do abused children grow up to be abusers?
Some will as they know no different, and so have a more likely chance, but if you can break the cycle as early as possible then the likeliness will become lowerSurvivors of child abuse have a strong motivation to become better parents
81
What are the effects of child abuse and neglect?
Leave lasting scarsCan be physical or emotionalDamaging child's sense of self, ability to make healthy relationshipsReduced ability to function at home, work or at school
82
What are the long lasting effects of child abuse and neglect?
Lack of trust and relationship difficultiesFeelings of being 'worthless' or 'damaged'Trouble regulating emotions
83
What are the long lasting effects of lack of trust and relationship difficulties?
Very difficult to learn to trust people or know who is trustworthyDifficulty in maintaining relationships due to fear of being controlled or abused, and can also lead to unhealthy relationships as they think it is normal
84
What are the long lasting effects of feeling of being 'worthless' or 'damaged'?
Adults may not strive for more education, or settle for a job that may not pay enough because they don't believe they can do it ro worth moreSexual abuse survivors, with the stigma and shame surrounding the abuse, often especially struggle with a feeling of being damaged
85
What are the long lasting effects of trouble regulating emotions?
Can't express emotions safelyEmotions are stuffed down and come out in unexpected waysStruggle with unexplained anxiety, depression or angerCan turn to alcohol or drugs to numb painful feelings
86
What do children need to have a good upbringing?
PredictabilityStructureClear boundariesKnowledge that their parents are looking out for their safety
87
Name the 3 types of child abuse?
EmotionalPhysicalNeglectSexual abuse
88
Give examples on how a child can be emotionally abused and its long term effects?
```Shaming and humiliating childCalling names and making negative comparisons to othersTelling child they're no goodFrequent yelling or threateningSilent treatmentLimited physical contactExposing the child to violenceDamage child's mental health or social development```
89
What is the definition of child neglect?
Pattern of failing to provide for a child's basic needs, whether it be adequate food, clothing hygiene or supervision
90
What is the definition of physical child abuse?
Involves physical harm or injury to the child
91
How do abusers explain their actions?
Insist that their actions are imply a form of discipline
92
What are the differences between physical abuse and discipline?
UnpredictabilityLashing out in angerUsing fear to control behaviour
93
What is the definition of child sexual abuse?
Layers of guilt and shame| Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved
94
What are the long lasting effects of shame and guilt in child sexual abuse?
Tormented by shame and guiltFeel some sort of responsibilitySelf loathing and sexual problems as they grow olderHard for them to come forwardIf they have the courage to tell you, take them seriously
95
What are the signs for physical child abuse?
Frequent injuries or unexplained bruises, welts or cutsChild very alertInjuries appear as patterns from hand or beltShies away from touchFlinches at sudden movementsAfraid to go homeWears inappropriate clothing to cover up injuries
96
What are the signs for emotional child abuse?
Excessively withdrawn, fearful or anxiousShow extreme behaviours (complaint, demanding or aggressive)Detached from parent or caregiverAct inappropriately adult-like or infantile (rocking, thumb-sucking)
97
What are the signs for child neglect?
Clothing are ill-fitting, filthy or inappropriate for weather clottingHygiene constantly badUntreated illnesses or physical injuryChild is frequently unsupervised or left alone in unsafe areasChild late or missing from school
98
What are the risk factors for child abuse and neglect?
```Domestic violenceAlcohol and drug abuseUntreated mental illnessLack of parenting skillsStress and lack of support```
99
How can domestic violence of a parent affect a child?
Witnessing violence| Situation extremely damaging
100
How can alcohol and drug abuse from the parents affect a child?
```Difficult to live withLead to abuse and/or neglectPoor parenting decisionsDangerous impulsesLeads to physical abuse```
101
How can untreated mental illnesses of a parent affect a child?
Trouble taking care of themselves and so much less of their childDistant or withdrawn from childQuick to anger
102
How can lack of parenting skills affect a child?
Unrealistic expectationsMay not know what to do in certain situationsAbuse survivors continue the cycle to their children
103
How can stress and lack of support of a parent affect a child?
No support from family + stress from job can lead to less caring for the childDisability needs extra care
104
What to do if you have suspicions of child abuse?
Write in patient's notesThink about the childChild isn't necessarily taken awayReporting is the first step to helping the childGarner information from their GP, and advice from other colleagues
105
When reporting child abuse what should you remember?
Be as specific as you can beIt is not our job to prove it, just report on the suspicionIf future incidents occur report them too
106
Name 2 legislations that protect children?
Children Act 1995 - section 19/20/21| Local Government in Scotland Act 2003 - Part 2/3
107
What does the Children Act 1995 - Section 19, 20 and 21 cover?
19@- local authority to prepare, publish and keep under review plans in relation to services for children and lists who should be consulted in prep of such plans20:- covers the publication of information about services for children21:- deals with coop between authorities
108
What does the Local Government in Scotland Act 2003 - part 2 and 3 cover?
2:- Community planning- places a duty of local authority to initiate and maintain a process of community planning and also a duty of agencies, to cooperate3:- deal with the power to advance well being- allows local authority to do anything to promote or improve well-being within an area
109
What are the typical oral signs for child abuse?
Bashed central incisorsDamage to the frenumFacial/head bruising (fatal)Cigarette burns
110
What is the % of children suffering serious abuse or neglect?
7% abuse| 6% neglect
111
What other problems can affect a child's oral wellbeing?
Eating disorders
112
What are the typical oral signs for eating disorders?
Eroded teeth due to acidCuts on knucklesTender palate
113
Explain the process for reporting child abuse?
Important to keep good and full recordsDiscuss concerns with colleaguesDiscuss concerns with their GPTake advice from defence organisationReport the case to social services if the doctor does notFollow up actions by colleagues, doctors and social services
114
Whom might be considered vulnerable?
```Domestic violence survivorsElderlyPoorDisabledChildrenMental illnessDepressed adultsSexual abuse survivors```
115
Whom is responsible for child protection?
EveryoneSharedEveryone in the dental teamNo such thing as justifiable chastisement
116
What is the legislation for female genital mutilation?
Call 101| Report ASAP, if sufficient evidence and/or suspicion
117
Who is best to discuss potential abuse claims with?
The families or person's GP
118
What is the most common form of abuse in England?
Neglect with 42%| Emotional with 19%
119
What is the definition of physical abuse?
Hitting, shaking, throwing, poisoning, burning, scalding, drowning, suffocating or otherwise causing physical harm to a childFabricated and induced illnesses
120
How to recognise physical abuse?
Bruising, abrasions, lacerations, burns, bites, eye injuries, bone fractures, intraoral injuriesSite, size and patternsDelay in presentationDoes not fit explanation
121
Name 8 types of Accidental injuries?
```Head - parietal occipital or foreheadNoseChinPalm of handElbowsKneeShins```Bony prominencesMatch historyKeeping with development of child
122
Name 12 types of abusive injuries?
```Black eyeSoft tissues of cheeksIntraoral injuriesForearms when raised to protect selfChest and abdomenAny groin or genital Inner aspect of thighSoles of feetBack and sidesInner aspect of armEarsTriangle of safety```
123
What is the triangle of safety?
Ears, side of face, neck and top of shoulders| All areas for accidental injury to be unusual
124
What is the definition of sexual abuse?
Forcing or enticing a child or young person to take part in sexual activity, including prostitution, whether or not the child is aware of what is happening
125
What trends can be seen with abusive injury?
```Injuries on both sides of the bodyInjuries to soft tissueWith particular patternsDoesn't fit explanationDelayed presentationuntreated injury```
126
How to recognise sexual abuse?
```Direct allegationsSTIsPregnancyTraumaEmotional and behavioural signs:- delayed development- anxiety- depression- self-harm- drug```
127
What is the definition of emotional abuse?
Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on a child's emotional development
128
How to recognise emotional abuse?
```Poor growthDevelopmental delayEducation failureSocial immaturityLack of social responsivenessAggressionChallenging behaviourAttention difficulties```
129
What is the definition of neglect?
The persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or developmentFailure to access appropriate medical care
130
How to recognise neglect?
```Failure to thriveShort statureInappropriate clothingFrequent injuryIngrained dirtDelayed developmentWithdrawn or attention seeking behaviour```
131
What is the role of the dental team when it comes to abuse or neglect?
We are not responsible for making the diagnosis of neglect or abuse, but sharing our concerns with someone whom can help the situationGPs are best to contact
132
Describe principle 8 of the GDC guidelines (Raise concerns if patients are a risk)
Always put patient's safety firstAct promptly if patients or colleague are at risk and take measures to protect themMaure sure you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns openly and without fear of reprisalMake sure if you employ, manage or lead a team that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that is is followed at all timesTake appropriate action if you have concerns about the possible abuse of children or vulnerable adult
133
What to do when you have NO concerns about the welfare of the child?
Provide necessary dental careFull clinical recordsProvide info about local supportArrange dental follow-ups
134
How to manage dental neglect of a child?
```Raise concernExplain what changes are requiredOffer supportKeep accurate recordsContinue to liaise with parentsMonitor the progressIf concerned involve other agencies```
135
How to manage dental neglect of a child?
```Raise concernExplain what changes are requiredOffer supportKeep accurate recordsContinue to liaise with parentsMonitor the progressIf concerned involve other agencies```
136
What is the gold standard for safeguarding children protocol?
Identify staff member to take the lead on child protectionAdopt a child protection policyCreate a step by step guide of what to do if we have concernsFollow best practice in record keepingUndertake regular team trainingPractice safe staff recruitment
137
Name the 7 steps for reporting child abuse?
Keep good and full recordsDiscuss concerns with colleaguesDiscuss with GPTake advice from defence organisationReport to social services if doctor does notFollow up with everyoneSafeguarded under the Public Information Disclosure Act if wrong
138
Name 2 publications about Child abuse in Scotland?
National action plan on Child sexual exploitation| Safeguarding Scotland's vulnerable children from child abuse
139
Name the 3 main groups that are considered vulneable?
Vulnerable adults especially elderlyMentally compromisedChildren
140
What is the definition of vulnerable?
Abuse occurs when a person is mistreated, neglected or harmed by another person who holds a position of trust
141
What is the definition of adult abuse?
A single or repeated act or lack of appropriate actions, occurring within any relationship where there is an expectation of trust, which causes harm or distress to a vulnerable person
142
What is the definition of a vulnerable adult?
Deparmtnet of health defines as a person aged 18 YO or older who is or may be in need of community care services by reason of mental or other disability, age or illness, and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation
143
What is the definition of safegaurding?
Protection of people
144
What are the risk factors for being the sufferer of abuse?
```Lack mental capacityIncreased ageBeing physically dependent on othersLow self-esteemPrevious abuse historyNegative experiences of disclosing abuseSocial isolationLack of access to health and social services or high quality information```
145
What are examples of financial or material abuse?
```TheftFraudWillPropertyInheritanceBenefits```
146
What is the definition of domestic abuse?
Psychological, physical, sexual, financial, emotional, so called honour based violence
147
What is the definition of organisational abuse?
Neglect and poor care practice within an institution
148
What is the definition of self-negelct?
Personal hygieneHealthHoarding
149
What is the primary aim of safeguarding?
Keep an individual safe and prevent further abuse from occurring
150
Name the 6 principles of good safeguarding practice?
```EmpowermentProtectionPreventionProportionalityPartnershipAccountability```
151
Name the 2 acts for safeguarding vulnervake adults?
Care Act 2014 (RoUK)| Adult Support and Protection Act 2007 (Scotland)
152
What are the limitations to safeguarding?
LimitlessAim to make life easierPossible mobility aid or something to maintain their independence
153
How does the Adult support and Protection Act (Scotland) 2007 defines 'adults at risk'?
Unable to safeguard their own wellbeing, property, right or other interestsAt risk of harm andBecause they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
154
How does the Adult support and Protection Act (Scotland) 2007 defines 'risk of harm?
Another person's conduct is causing or likely to cause the adult to be harmed orAdult is engaging or likely to engage in conduct which causes or is likely to cause self-harm
155
How does the Adult support and Protection Act (Scotland) 2007 defines 'Harm'?
Causes:- physical harm- psychological harm- unlawful conducts which affects property rights or interests- self harm
156
How can the Mental Capacity Act (2005) make things difficult?
No legal authority to make best interest decisions on their behalf, however, balancing a respect for the choices of adults who retain capacity, against the desire to promote welfare can present genuine dilemmas
157
Name 5 factors to consider when inquiring about abuse?
```Vulnerability of individualNature and extent of abuseLength of time occurred forImpact on individualRisk of repeated or increasingly serious acts```
158
How to manage the conversation with an individual when abuse is suspected?
Abuser not presentBe accompanied by a more trusted personAppropriate support to express themselvesBe clear with what will happen to the informationEstablish facts of the allegation and acknowledge the impactMake them feel safe
159
What to consider when thinking about reporting abuse?
Where to report and how
160
What relevance does legislation have to working with the elderly as a dentist?
```Working lawfully and legallyDuty of care to patientWorking with proper skill and attentionRIsk versus benefit analysisworking in a patient's best interestsWorking within one's own capabilitiesAchieving expected outcomes```
161
What are the factors leading to ageing?
Decreasing ability to survive physiological stressRate of organ function decline caries with the wear and tear of the cellsCytokines
162
What is the definition of a cytokine?
Interact with cells of the immune system in order to regulate the body's response to disease and infectionAlso mediate normal cellular processes
163
How is the skin affected in an old patient?
Pale and thin| Altered wound healing
164
How is the skeletal muscle affected in an old patient?
30-40% reduction in muscle mass, strength, functionaluty and endurance
165
How are the eyes affected in an old patient?
PresbyopiaImpaired adaptation to the darkDecreased lacrimation
166
How is the CVS affected in an old patient?
HR decreases| BVs stiffer
167
How is the immune system affected in an old patient?
Decreases with ageIncreases infectionsAutoimmune disordersNeoplasms
168
How is the NS affected in an old patient?
SMall decreases in brain mass, synaptic and NuT changes| Decreased sensitivity in feet and to hot and cold
169
How is the skeleton affected in an old patient?
Loss of bone possibly resulting in osteoporosisRisk of fractureWorse in women
170
How is the GI affected in an old patient?
```Reduced body fatLiver massMetabolic rateIncreased gastric acid leading to peptic ulcersIncreased Vit DCholesterol increases```
171
How are the kidneys affect in an old patient?
Low renal mass and reduced ability to respond to stress| Reduced renal BF and hormones decreases
172
How is the endocrine system affected in an old patient?
Increases| Increased adenomas in pituitary and adrenal glands + thyroid
173
What are the findings of the Meeting the challenges in Oral Health a strategic Review 2005?
2025 1 in 5 people aged 65+ will be edentulous2025 40-45% of older people will have 21 or more teethIncreased maintenance
174
What will change if the elderly have more teeth at older ages?
Shift in resto treatment from middle age to olderIncreases exposed rootsIncreased risk factors for decay (dry mouth and medications)Pain via denture wearingPoor oral hygiene from frailtyReliance of carers for oral hygienePoor diet (high sugar)
175
How may treatment change for the elderly in the future?
```Specialist careFree/closer parkingInfection fear for COVID-19Home visits?Online visits?aerosol producing procedures more risky for elderlyAccess to surgery and dental chairsSuctionPaymentDomiciliary care```
176
What is domiciliary care?
Home visits
177
Name the 8 ethical obligation of a dentist?
```Good not harmRelieve painAct in patient's best interestFulfill your duty of careGather information from many sources to fulfil obligationsUse information to fulfil ethical obligationsHonestySafety against the virus```
178
What are the oral side effects for:- aspirin, methotrexate, NSAIDs, antibacs, antivirals and anticonvulsants (sulfonamides)?- ACE inhibitors, antidiabetics and diuretics?- antibac?
BurnsCytotoxicityOral ulcerationErythema multiform or Stevens-Johnson syndromeLichenoid eruptionsCandida
179
What are the oral side effects of:- chlorhexidine- tetracycline- Fl- bisphosphonates
```Cl:- brown stainingTetra:- intrinsic stainingFl:- Fluorosis and mottlingBisphosphonates:- MRONJ- Osteoporosis- Paget's disease```
