Other Flashcards
(27 cards)
What is RSVP
E- recency- recent events, changes, hospitalisation, A&E
S- systemic symptoms- breathing problems, pain
V- Vital signs- body temperature, pulse rate, respiration rate, BP
P- prescription drugs
Side effects of steroids (Prednisone, Dexamethasone)
Osteoporosis, diabetes, hypertension
Mood changes, weight gain, gastric ulceration, adrenal suppression
Examples of neurological disorders
Headaches
Stroke
Transient attack epilepsy
Seizures
Parkinson’s disease
Dementia
Multiple sclerosis
Cerebral palsy
Umbrella term of non progressive neurological and physical disabilities
Can be developmental or as a result of peri natal insults like infection (rubella, syphillis…), Hypoxia, pre eclampsia (high BP), trauma; post natal infections (meningitis…)
Most common congenital cause of physical impairment
Affects 2-2.5 per 1000 live births
Types of cerebral palsy
Spastic- most common, muscles are stiff and tight, arises from motor cortex damage
Dyskinetic- involuntarily movements and spasms, arises from basal ganglia damage
Ataxic- least common, shaky movements, affects balance and sense of positioning in space, arises from cerebellum damage
Mixed type- combination damage
Types of cerebral palsy of the body parts
Monoplegia- only one limb affected
Hemiplegia- one side of the body
Paraplegia-lower limbs affected
Quadraplegia - whole body except head/face muscles
Oral and dental features of cerebral palsy
Higher level of untreated disease
Developmental abnormalities
Malocclusion
Uncontrolled movement
Bruxism
Drooling
Periodontal disease and caries
Multiple sclerosis
Complex autoimmune neurological disorder occurring due to damage to myelin sheath of nervous system
Affects both motor and sensory nerve transmission
Inflammatory disease of brain and spinal cord (immune system attack myelin sheath and destroys it- unable to send signals to rest of the brains nd body)
Can be relapsing or progressive, ;
chronic disease
Unclear cause (could be genes, lack of vitamin D, smoking, infections (ebstein barr))
Onset usually between 20 and 40 years
More common in females ( unclear why)
Symptoms:
Vision problems, numbness or weakness, facial pain or trigeminal neuralgia, spasms, tremor, fatigue, depression,
MS and dental management
Shorter appointments needed
Rigorous prevention
Wheelchair acces
Good communication
Dysphagia
Dizziness and vertigo
Cannabis use (contraindications if conscious sedation)
Huntington disease
Inherited, progressive, degenerative neurological disorder
Autosomal dominant
Both males and females equally
Progresses until death (pneumonia is a common cause of death)
Symptoms: uncontrollable muscular movements, lack of body coordination, lack of concentration, memory loss but in later stages
Depression, mood swings, frustration etc
Huntington and dentistry
Prevention is essential
Some have swallowing difficult so high fluoride toothpaste used with caution
Diet advice as part of prevention
Intravenous sedation can be useful
Care with trauma to lips, tongue due to involuntary movements and spasms
Consent should be obtained as they can understand unless proven otherwise
Most common inherited coagulation disorders
Haemophilia A- deficiency of factor 8, x linked recessive trait, 1:10 000 males affected
haemophilia B- deficiency of factor 9, x-linked recessive trait, 1:25-30 000 males
Von Willebrand disease-von Willebrand factor deficiency leading to low factor 8 activity/reduced platelet adhesion, dominant inheritance pattern, 1 in 100 males and females, more common to have gingival bleeding than in haemophilia
All common to have bleeding into joints, muscles….- in severe cases
Moderate cases will have spontaneous bleeding while mild cases bleeding following the trauma, surgery or XLA
Management strategy
Most dental procedures do no require augmentation of coagulation factor levels
Pt can be on: coagulation factor replacement therapy, desmopressin, tranexamic acid (anti fibrinolytic-prevents lysis of the clot) local haemostatic measures for improvement of clot stability or disease management
Factor 8- and dental treatment
Factor 8 has 10-12 h half life so dental treatment needs to be taken on the same day of the cover
Factor 9 has longer half life so allows better arrangements of treatments
Von Willebrand disease-
Extended bleeding time due to poor platelet function and low levels of VWF
Usually treated with synthetic antidiuretic hormone desmopressin ( stimulates release of endogenous stores of clotting factors- factor 8 and vWF)
Can be self administrated via nasal spray or infusion IV at haemophilia centre
Post op in congenital bleeding diseases
If severe, treated in hospital
Pt need to return for a review post XLA
Tranexamic acid (used to help stabilize the clot) usually given in tablet of 1 g /3xday up to 10 days ( can be a syrup or mouthwash)
Causes of learning disability
Pre natal- drug/alcohol use, infection
Natal- difficult birth
Post natal- infection, trauma
Genetic- Downs
Idiopathic
Impairments associated with learning difficulty
Impaired understanding, problem solving, motor skills, communication, self direction self care, delayed development, coping strategies, self awareness…
Continence, speech difficulties, vision, hearing, eating difficulties, sleep problems, behavioral problems, aggressive or self-injurious behaviour
Learning disabilities
20 in every 1000 will have mild or moderate learning disability
3-4 in every 1000 will have a profound or multiple disabilities
Mild learning disability
Lack comprehension
Independent or self care
Difficulties with formal learning like reading, writing
Undeveloped coping strategies
IQ: 55-69
Moderate learning disability
Slow in developing comprehension
Self care limited
Can do simple practical work
Generally fully mobile
IQ: 45-54
Severe learning disability
Very limited communication
Lack self help skills
May have additional physical disabilities
Require full time support
IQ 25-44
Profound learning disability
Severely limited inability to understand requests
Usually severely restricted in mobility and continence
Little or no ability to self care
IQ bellow 25
Why are lingual infiltration and ID high risk or need cover?
As there is a risk of muscle haematoma
Risk of airway obstruction as there can be haematoma formation in retromolar pad or pterygoid space
