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Module 8 > PAEDS medically compromised child > Flashcards

PAEDS medically compromised child Flashcards

1
Q

does pregnancy impact child oral health?

A

there is emerging evidence to suggest that it may impact
- tooth development
- caries risk

i.e., if there is maternal illness or complications with labour

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2
Q

what is the UK gov guidance on breastfeeding?

A

BF for at least 6 months and then alongside solid food for the 1st year of life

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3
Q

what is the benefit of breastfeeding?

A

it provides the best nutrition for babies and supports childrens health in the short and longer term

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4
Q

how much you approach a conversation about breastfeeding with a mother?

A

be mindful
in a non judgmental manner
this is an emotive topic for parents!

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5
Q

what is the link between breastfeeding and caries?

A

breastfeeding up to 12 months of age is associated with a lower risk of early childhood caries

however, after 12 months, breastfeeding along side drinks and foods containing free sugars may contribute to caries

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6
Q

what are the BSPD recommendations for breastfeeding?

A
  1. encourage and support mothers to BF
  2. when mothers cannot, they need support on introducing bottle feeding
  3. from 12 months old, if mothers want to continue BF they should work with health practitioners to reduce the risk of dental decay
  4. consideration given to reducing on demand and night time feeds
  5. from 12 months old, the last feed should take place before tooth brushing at bedtime
  6. respect choices of parents
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7
Q

what are the newborn health checks?

A

eyes, heart, hips, testicles
hearing
heel prick test

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8
Q

what does the new born heel prick test check for?

A

checks for sickle cell, cystic fibrosis, congenital hypothyroidism, and inherited metabolic disease

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9
Q

what are complications of measles?

A

pneumonia
meningitis
blindness
seizures

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10
Q

what are the risks of measles in pregnancy?

A

miscarriage/ stillbirth
premature birth
low birthrate

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11
Q

what is classed as a premature child?

A

born before 37 weeks

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12
Q

how are congenital cardiac defects classified?

A

cyanotic
acyanotic (no shunt)
acyanotic (L to R shunt)

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13
Q

aetiology of congenital cardiac defects?

A

genetic
maternal exposure to TORCH
maternal drug use
maternal systemic disease

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14
Q

what is TGA?

A

transposition of the great artery
- the aorta and pulmonary artery switch around

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15
Q

what is tetralogy of fallot?

A

a group of 4 defects:
1. ventricular septal defect
2. pulmonary stenosis
3. right ventricular hypertrophy
4. overriding aorta

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16
Q

what is the most common CHD?

A

mitral valve prolapse
(affects 5-10% of population)

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17
Q

what syndromes may you see mitral valve prolapse present in?

A

marfan
ehlers-danlos
downs

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18
Q

what are symptoms of mitral regurgitation?

A

pain
irregular/ racing pulse
fatigue
heart failure

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19
Q

what problems are associated with ventricular septal defect?

A

90% of children will have an additional cardiac defect
large defect = death in infancy
ventricular failure may develop
Dacron patch used to close = infective endocarditis risk

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20
Q

oral findings in cyanotic CHD?

A
  • delayed eruption of both dentitions
  • positional anomalies
  • enamel hypoplasia
  • gross vasodilation in the pulps
  • greater caries and perio disease activity
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21
Q

what is, in general terms, a cyanotic CHD?

A

any defect that causes the amount of oxygenated blood reaching the heart

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22
Q

what are the general significant points when you have a paediatric pt with a cardiac defect?

A

dental anomalies/ hypomineralisation?
enhanced caries prevention
infective endocarditis risk
how does this affect treatment planning?
cardiac medication

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23
Q

how may cardiac defect affect tx planning?

A

more aggressive treatment plan: free of caries before any cardiac surgery

remove all caries, xla

some pts may be on warfarin, check INR

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24
Q

what is infective endocarditis?

A

infection of endocardium due to bacteria in the blood

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25
who are patients at risk of infective endocarditis?
1. pts with prosthetic valves 2. pts with previous episodes of infective carditis 3. pts with congenital heart disease: - cyanotic CHD - CHD repaired with prosthetic material
26
what are symptoms of infective endocarditis?
flu like symptoms with a high temperature that lasts for longer than a week
27
what are the most common childrens cancers in the UK?
leukaemias brain and spinal tumours lymphomas
28
what are the types of leukaemia?
acute lymphoblastic leukaemia (ALL) chronic lymphoblastic leukaemia (CLL) acute myeloid leukaemia (AML) chronic myeloid leukaemia (CML)
29
what are the stages of ALL treatment?
induction - chemo, targeted cancer drug (imatinib) consolidation - may be on methotrexate maintenance - lasts 2 years stem cell transplant
30
if you have to do dental tx on a pt with ALL, when is best in their tx plan to do so?
during maintenance phase, if not consolidation
31
side effects of leukaemia tx?
low resistance to infection anaemia bleeding + bruising bleeding fatigue sore mouth + tummy taste changes poor mobility hair loss nausea constipation
32
what treatment can be done to relieve pain from ulcers and mucositis in cancer pts?
low level laser therary
33
dental effects of cancer and cancer tx?
high caries risk mucositis and ulceration immunocompromised bleeding risk painful mouth hypomineralisation delayed tooth dev hypodontia microdontia
34
what are the 3 types of bleeding disorders?
haemophilia A and B Von Williebrand's Disease Thrombocytopenia
35
what factor deficiencies are present in the haemophillias?
haemophilia A - factor 8 haemophilia B - factor 9
36
dental considerations of pts with bleeding disorders?
enhanced prevention avoid regional blocks for LA alteration to tx planning avoid NSAIDs factor replacement + inhibitors desmopresssin tranexamic acid
37
why do you avoid blocks in pts with bleeding disorders?
there is a risk of bruising and hitting a blood vessel
38
why do we need factors in the blood?
to clot
39
what is a factor replacement?
infusion to increase factor levels in blood some pts may be on regular factor replacement
40
why are inhibitors given to patients receiving factor replacement?
after a period of time, the body can react to factors provided inhibitors will stop factor 8 from working
41
what is desmopressin?
it replaces factor 9, in von williebrands disease it increases the level of hormone (desmopressin) your body produces you must already have a reserve of desmopressin for this to work
42
sickle cell disease incidence?
African/ Caribbean background - 10-25% 1in79 babies in UK born with it
43
what are problems of sickle cell disease?
failure to thrive renal impairment retinal issues sickle cell crises splenectomy risk of childhood stroke GA risk
44
what causes a sickle cell crisis?
stress
45
what type of sedation can pts with sickle cell disease not have?
inhalation
46
what is asthma?
diffuse obstructive lung disease hyper-activity of airways to a variety of stimuli
47
what are dental considerations of child pts with asthma?
dental anxiety - may induce acute exacerbation colophony - fluoride varnish avoid medical emergency management steroid inhaler = dry mouth caries risk
48
what is cystic fibrosis?
multisystem disorder of exocrine glands mucus production respiratory systems are susceptible to infection
49
symptoms of cystic fibrosis?
failure to thrive/ gain weight delayed puberty/ decreased female fertility CF related diabetes
50
dental implications of cystic fibrosis?
delayed dental development enamel opacities calculus accumulation highly calorific diet GA risk liver cirrhosis = clotting issues
51
what is epilepsy?
a neurological condition where there is a tendency to have seizures that start in the brain
52
what are epilepsy considerations?
dental trauma risk medications - gingival overgrowth, sugar containing medical emergency management
53
what is cerebral palsy?
damage to the brain or the brain has developed atypically affects the ability to control movement, posture and balance
54
what are symptoms of cerebral palsy?
challenge with communication - can understand but may struggle to talk back dexterity challenging salivation tooth grinding dental trauma risk
55
associated medical issues with down syndrome?
congenital cardiac defects susceptibility to leukaemia hypothyroidism GORD early onset dementia sleep apnoea diabetes hypotonia cervical spine atlantoaxial instability obesity
56
extra oral features of pt with down syndrome?
maxillary hypoplasia = class III malocclusion, small sinuses, mouth breathing flat nasal bridge widely spaced eyes, down slant medially
57
what are intra oral features of pt with down syndrome?
high arched palate = food trapping enlarged tonsils = heightened gag reflex, sleep apnoea fissured tongue = candida relative macroglossia
58
dental features of down syndrome?
hypodontia and microdontia small conical roots defects of enamel delayed eruption anterior open bite increased risk of perio disease
59
what is feotal alcohol syndrome?
prenatal alcohol exposure - it affects the developing brain and body
60
what are the side effects of foetal alcohol syndrome?
lifelong neurodevelopmental condition cognitive, emotional and behavioural challenges intellectual disability ADHD
61
what are the symptoms of feotal alcohol syndrome?
attention, concentration and hyperactivity difficulties speech and language deficits working memory and processing speed challenges emotional regulation difficulties sensory impairments defensiveness
62
incidence of cleft lip and/or palate?
1.35 in every 1000 live births a baby born with it every 3.6 minutes
63
cleft lip and palate aetiology?
genetic environmental - phenytoin, alcohol, smoking, radiation
64
what genes have been shown responsible for cleft lip and palate?
MSX1 TGFA
65
when are clefts referred to as syndromic?
when one or more additional features are involved
66
what other syndromes are associated with CLP?
pierre robin syndrome treacher collins syndrome
67
associated dental anomalies with CLP?
class III hypodontia (on the cleft side) supernumeraries delayed eruption hypomineralisation retrognathic maxilla and mandible
68
what are muscular dystrophies?
a group of inherited genetic conditions that gradually cause the muscles to weaken it is a progressive condition which is life limiting
69
what does ectodermal dysplasia affect?
skin nails hair teeth sweat glands
70
dental features of ectodermal dysplasia?
hypodontia conical teeth
71
symptoms of osteogenesis imperfecta?
DI type I growth problems manual dexterity issues
72
what medications are people with OI generally on?
bisphosphonates

Module 8 (28 decks)

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