Rheumatology

Question 1

What must be considered for patients accessing a dental practice with limited mobility?

Answer 1

• access to building
  
  • availability of disabled parking
  • presence of kerbs and pavements
  • path into building and its state
  • ground level access to practice
  • ramp
  • railings
  • lifts
• access within practice
  
  • height of reception desk
  • space for wheelchair in waiting room
  • door width for wheelchairs
  • obstacles (corridors should be kept clear
  • level threshold
  • door opening (position and design of door handles)
  • accessible contact

Question 2

What aids can be used to aid someone into the dental chair?

Answer 2

• hoist
  + can be used for weight bearing individuals
  + allows safe transfer to dental chair
  
  • additional training required
  • additional equipment required
• banana board
  + self transfer
  
  • requires a leg break chair
• reclining wheelchair
  +no need to transfer
  
  • dental access challenging
  • management of medical emergencies challenging
  • expensive equipment
• turn table
  + promotes patient involvement
  
  • additional equipment required
• wheelchair recliner
  + no need to transfer
  + no cost to dentist
  + access in GDP
  
  • dentist access challenging
  • challenging management of dental emergencies
• stand aid
  + promotes patient involvement
  
  • must be able to bear weight
  • specialist equipment required

Question 3

What is a common oral manifestation of rheumatoid arthritis?

Answer 3

• xerostomia
  
  • mucosa sticks to dental mirror
  • food resides within oral cavity
  • frothiness of saliva (lower sulcular reflection)
  • lobulated, red appearance of tongue (potential depapillation)
  • salivary gland enlargement

Question 4

What are the common drugs a patient with rheumatoid arthritis may be taking?

Answer 4

• methotrexate
  
  • disease modifying drug
  • anti-inflammatory and immunosuppressive effects
  • not routinely stopped for treatment
  • antibiotic prophylaxis not routine
  • check blood work
• diclofenac
  
  • NSAID
• paracetamol
  
  • analgesic
  • anti-pyrexic
• prednisolone
  
  • short course on flare up of symptoms
  • steroid cover for individuals taking 5mg prednisolone >4 weeks

Question 5

What factors must be taken into account for the dental care of a patient with rheumatoid arthritis?

Answer 5

• access to the building, dental practice and dental chair
• access to the mouth
  
  • rheumatoid arthritis can effect the TMJ
  • muscular sedation
• appointment times
  
  • time of day
  • length of appointment
  • transport to appointment
• oral hygiene instruction
  
  • fluoride application
  • saliva replacement/stimulation
  • electric toothbrush
  • altered toothbrush
    - collis curve toothbrush
    - foam handles
    - putty handles
    - ball handles
  • denture brushes with suction to stick to wall