PBL 2 - intellectual impairment Flashcards
(41 cards)
1
Q
what is Klinefelter’s syndrome
A
- male is born with an extra X chromosome so has XXY
2
Q
what can be the problems associate with klinefelter’s
A
- most individuals there are none
- in adulthood can have problems with infertility
- increased risk of type 2 diabetes, osteoporosis, blood clots, CVD, hypothyroidism and anxiety
- male breast cancer more likely
- low mood
- learning difficulties
3
Q
what do you need to be aware of when doing treatment on those with klinefelters
A
- if diabetic has poor wound healing
- plan appointment times in the morning
- could be anxious
4
Q
what do those with klinefelters often look like
A
- tall with narrow shoulders
5
Q
what is taurodontism
A
- enlargement of pulp chamber and tooth vertical and the expense of the root = occurs in molar teeth
6
Q
how can you make dental visits better for those with aSD
A
- could get health passport before hand
- give social stories
- ask how patient communicates = are any adjuncts needed
- desensitisation can be important
- distraction can be useful
- consider reducing light or noise in the surgery
- consider inhalation sedation = may or may not be effective as needs to be inhaled through nose so they must be cooperative enough
- GA may be needed
- for access to the mouth can use bedi shield or an open wide mouth rest
7
Q
what is a bedi shield
A
- place on finger and place in mouth to allow patient to bite onto it
- prone to fracturing
8
Q
what is an open wide mouth rest
A
- less likely to fracture
- can be placed in horizontal or vertical depending on access required
9
Q
wha treatment is given for klinefelters
A
- testosterone replacement therapy
10
Q
is testosterone stopped before dental procedures
A
- recommended to discontinue use 1-2 weeks before undergoing surgical/invasive procedures due to potential increased risk of blood clots and other complications
11
Q
what makes testosterone dangerous for GA
A
- it can worsen sleep apnoea which is dangerous for GA
12
Q
how does smoking cause chest infections
A
- causes paralysis of the cilia so they are unable to remove mucus, dust or impurities from the lungs
- makes smokers more likely to develop chest infections, particularly after a GA
13
Q
what does low levels of testosterone do
A
- shown to have a negative effect on bone metabolism
- related to an increased level of pro-inflammatory cytokines and enhanced osteoclastic activity
- studies show positive link between testosterone levels and periodontitis
14
Q
what can beta-2 agonists cause with prolonged use
A
- decrease salivary production which then increases the risk of dental caries
- also cause smooth muscles relaxation and this will effect lower oesophageal sphincter which leads to acid reflux and teeth erosion eventually
15
Q
what can repeated contact of corticosteroids with mucous membrane of the mouth cause
A
- depresses the immune system, leading to overgrowth of thrush-causing yeast
16
Q
what is important to tell patient when giving OHI to asthmatics
A
- rinse mouth with neutral or high pH mouth rinse immediately following inhalation of asthma medication
- wait 30mins before brushing teeth
17
Q
how does a spacer reduce risk of steroid-related oral candidiasis
A
- prevents the medication from scattering to the mouth, throat and stomach
18
Q
what 3 main areas do patients with ASD have difficulties in
A
- social interaciton
- communication
- repetitive behaviours or restricted interests
19
Q
what is oranurse
A
- toothpaste
- non-foaming, tasteless
- still has normal fluoride ppm
20
Q
why is oranurse god for ASD patients
A
- prevents sensory overload
- may be more accepting of it
21
Q
how long does guardianship take to get
A
- 6 months to a year through the council
- granted by the adult while they still have capacity
22
Q
who do guardians need to be registered with
A
- office of the public guardian
23
Q
how long are guardianship orders for
A
- court appointed
- requires 2 medical reports
- usually appointed for 3 years
24
Q
what are the 5 As for smoking cessation
A
- ask
- advise
- assess
- assist
- arrange
25
how does a patient demonstrate capacity
they understand:
- simple language about treatment
- risks and benefits
- consequences of not receiving treatment
- retain information to use and weigh it in the balance in order to arrive at a decision
26
who can consent for dental treatment
- patients with capacity
- welfare powers of attorney
- welfare guardians
- medical and dental practitioners under section 47 of AWI Act
27
how many ASA classifications are there
- 6
28
what is ASA I
- healthy patient no problems
29
what is ASA II
○ Patient with mild systemic disease
○ Current smoker, social alcohol drinker, pregnancy, obesity, well controlled diabetes mellitus,
○ Also patients who demonstrate more extreme anxiety and fear toward density
○ Can be higher risk of complication with sedation
Higher risk of complications with sedation, safe if correct precautions taken
30
what is ASA III
○ Patient with severe systemic disease
○ Substantive functional limitations because of the one or more moderate to severe diseases
○ Poorly controlled diabetes mellitus, COPD, morbid obesity, active hepatitis, alcohol dependence or abuse, implanted pacemaker
○ Needs to be in hospital for sedation
○ Chronic conditions
Hospital environment only
31
what is ASA IV
○ Severe systemic disease
| Hospital environment only
32
what is ASA V
○ Moribund Patient
| ○ Not appriate for dental sedation
33
what is ASA VI
○ Brain dead patient whose organs are being removed for donor purposes
Not appropriate for dental sedation
34
how many are affected with klinefelters
- 1 in 600
35
how can klinefelters affect dental development
- increased molar size = big pulp with little roots
| - prognathism = protruded mandible
36
what do you need to ask if patient is allergic to if asthmatic
- colophony
| - in duraphat varnish and toothpaste
37
what is a traumatic erosive ulcer
- adjacent to sharp tooth
- keratinisation suggests it has been chronic in that area
- erosion is common from trauma as the tooth wears away the top layers of mucosa
38
what are apthous ulcers
- commonly recurrent and multiple in mouth
| - often resolve themselves
39
what are the indications for conscious sedation
- dental phobia and anxiety
- traumatic and long dental procedures
- medical conditions aggravated by stress such as angina, asthma or epilepsy
- children over 1
- mentally challenged individuals
- ineffective LA due to any reason
40
what 3 main groups of patients get GA
- simple dental extractions in children aged 4-10 or in those with learning difficulties
- day care anaesthesia for extraction of permanent molars or minor oral surgery work
- in-patient anaesthesia for more complex or extensive dental work
41
how can give a AWI section 47 form
- GDP if they have training to do so
| - GP
