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Module 7 > Special Care > Flashcards

Special Care Flashcards

1
Q

What is the definition of a learning disability?

A

a significantly reduced ability to understand new or complex information, to learn new skills & reduced ability to cope independently
IQ less than 70

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2
Q

How many people in the UK have a learning disability?

A

1.5 million, 350,000 severe

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3
Q

What are the clinical features of a learning disability?

A

epilepsy
visual defects
hearing and speech disorders
facial deformities
body-rocking and self-mutilation
feeding difficulties

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4
Q

What are the causes of learning disabilites?

A

genetic
problems during pregnancy
problems during birth
post-natal problems

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5
Q

What is the most common cause of Down’s Syndrom?

A

Trisomy 21 (extra chromosome)

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6
Q

What are the physical features of Down’s Syndrome?

A

atlanto-axial joint instability
short stature
brachycephaly
widely spaced upward slanting eyes
weight gain
brushfield spots

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7
Q

What health conditions are associated with Down’s Syndrome?

A

cardiac problems
spinal problems
malignant disease
dementia
immune disease
hearing loss
visual defects
seizures

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8
Q

What are the oral features of Down’s syndrome?

A

large tongue
thick, dry and fissured lips
poor anterior oral seal
tongue thrust
early onset perio disease
cleft lip and palate
malocclusion
delayed eruption
missing teeth
morphological abnormalities

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9
Q

What are dental aspects of fragile X syndrome?

A

short attention span
hyperactivity
behavioural disorders similar to autism
abnormally frequent open bite and crossbite

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10
Q

What is Cri du chat Syndrome?

A

deletion short arm of chromosome 5

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11
Q

What are the features of Cri du chat syndrome?

A

high pitched cry
microcephaly
micrognathia
wide set eyes
webbing or joining together of fingers and toes
slow development of motor skills, speech and language

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12
Q

How is autism spectrum disorder characterised?

A

poor social skills
lack of interpersonal relationships
delayed speech and language
ritualistic, compulsive behaviour

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13
Q

what is the clinical presentation of autism?

A

lives in ‘own’ world
avoid eye contact
echolalia
unaware of others
practice repetitive actions
obsessional desire to follow routine
self-mutilation
sensitivity to touch, smell and sound

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14
Q

what are the oral findings in autistic patients?

A

bruxism
traumatic lesions
poor OH
poor attendance
prefer sweet foods

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15
Q

how should you manage autistic patients?

A

patience
empathetic approach
OHI and support
pre-visit pack and questionnaire
short, quiet visits with same staff
avoid aspirator, high speed, etc
pain and anxiety control

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16
Q

what is a sensory impairment?

A

when one or more of a person’s senses are no longer normal

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17
Q

how many people are registered blind in the UK?

A

358,000

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18
Q

what are the symptoms of visual impairment?

A

reduction or loss of vision
eye pain
burning sensation
gritty feeling
blurring of vision

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19
Q

what are the causes of visual impairment?

A

glaucoma
cataract
macular degeneration
diabetic retinopathy
trachoma

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20
Q

what causes glaucoma?

A

a rise in intraocular pressure

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21
Q

what is a cataract?

A

clouding of the lens in the eye

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22
Q

describe the effects of wet macular degeneration

A

severe sight loss in a matter of months
rapid loss of central vision

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23
Q

describe the effects of dry macular degeneration

A

bilateral
gradual loss of central vision

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24
Q

what conditions cause retinopathies?

A

diabetes
hypertension

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25
Q

what are retinopathies

A

a combination of retinal degeneration and inflammation

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26
Q

what is hemianopia?

A

blindness in one half of the visual field

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27
Q

what is the most common cause of hemianopia?

A

stroke

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28
Q

how are visual impairments treated and prevented?

A

early diagnosis
protect eyes from sun
medical, surgical, non-invasive

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29
Q

how many people in the UK are affected by a hearing impairment?

A

11 million

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30
Q

what are the causes of hearing impairment?

A

inherited
congenital
infections
trauma
drugs
foreign bodies
excessive noise

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31
Q

what are symptoms of hearing impairment in children?

A

inactivity
reduced development of speech and language skills
deterioration of speech
reduced social and emotional development
irratibility
autistic like behaviour
confusion

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32
Q

what are the signs and symptoms of hearing loss?

A

difficulty hearing clearly
misunderstanding
asking people to repeat themselves
listening to music or TV loudly
feeling tired or stressed

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33
Q

what are some ways to prevent hearing loss?

A

immunisation
avoidance of some drugs
reduction of occupational exposure
hearing aids

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34
Q

what are some ways to treat hearing loss?

A

early management - surgical or medical
rehabilitation

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35
Q

what is included in the equality act 2010?

A

age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation

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36
Q

what is the equality act 2010’s definition of disability?

A

physical or mental impairment
the impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities

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37
Q

what are the most common impairments and their %’s?

A

mobility 49%
stamina/breathing/fatigue 37%
dexterity 26%
mental health 25%

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38
Q

what is a physical disability?

A

any condition that permanently prevents normal body movement and/or control

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39
Q

what are causes of physical disabilities?

A

inherited or genetic disorders
conditions present at birth
serious illness affecting brain, nerves or muscles
spinal cord injury
brain injury
accidents

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40
Q

What should valid consent be?

A

Informed, freely given by a capable patient

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41
Q

What acronym is used to define incapable?

A

AMCUR

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42
Q

What does AMCUR stand for?

A

Acting
Making a decision
Communicating a decision
Understanding a decision
Retaining memory of the decision

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43
Q

How do you assess capacity?

A

Open questions
‘Chunk and check’
‘Teach back’

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44
Q

What is applied if a person lacks capacity to consent to dental treatment?

A

Adults with Incapacity Act

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45
Q

What does the Adults with Incapacity Act 2000 do?

A

Safeguards the welfare and manages the finances of people aged 16 years and over who lack capacity

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46
Q

What are the 5 key principles of a section 47 certificate?

A
  1. Benefit
  2. Least restrictive of freedom
  3. Wishes taken into account
  4. Consult relevant others
  5. Encourage residual capacity
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47
Q

What is a proxy?

A

Someone who has been authorised to act on behalf of an adult with incapacity

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48
Q

What is a power of attorney?

A

A person granted by the adult whilst they have capacity to choose who they wish to ack on their behalf, should the need arise

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49
Q

Who is a power or attorney registered with?

A

OPG

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50
Q

What types of power of attorneys is there?

A

Welfare
Continuing
Joint or combined

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51
Q

What documents should be checked for PoA’s?

A

All documents - need to read body of document as not all welfare PoA have the right to consent

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52
Q

What is the OPG?

A

Office of the public guardian

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53
Q

When would a guardian be granted?

A
  • no longer has capacity to choose who they wish to make decisions for them
  • the adult has never been able to make their own decisions
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54
Q

How does a person get a guardian?

A

Court process granted by a sheriff

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55
Q

What is required to get a guardian?

A

Medical reports
Social work report

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56
Q

Does a guardian have an expiry date?

A

Yes

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57
Q

Does a PoA have an expiry date?

A

No

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58
Q

What types of guardianship powers are there?

A

Financial/property
Welfare
Both

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59
Q

What statement would you look for in guardianship and PoA documents?

A

The power to consent or withhold consent to medical and dental treatment

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60
Q

What is an intervener?

A

Appointed for a one-off event

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61
Q

Who can legally consent for dental treatment?

A
  • patients with capacity
  • welfare PoA
  • welfare guardians
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62
Q

Can medical and dental professionals consent a patient for treatment?

A

No - they can only authorise to under section 47 of AWI act

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63
Q

What must be done when getting consent from a proxy?

A

Have an AWI (s47) certificate issued

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64
Q

What should be done to consent if there is no proxy?

A

Follow the 5 key principles of the AWI (AMCUR)
S47 certificate to authorise tax to go ahead

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65
Q

Who is able to complete an AWI certificate?

A

Doctors
Health professionals with relevant training

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66
Q

What are the risk factors for dementia?

A

Age
Gender
Ethnicity
Genetics
Down’s syndrome
Medical factors
Lifestyle factors
Head injuries

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67
Q

What are the medical risk factors for dementia?

A

Type 2 diabetes
Hypertension
High cholesterol
Obesity
Depression

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68
Q

What are the lifestyle risk factors for dementia?

A

Physical inactivity
Smoking
Unhealthy diet
Excessive alcohol

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69
Q

What kind dementia do head injuries cause?

A

Chronic traumatic encephalopathy

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70
Q

What is the link between football and dementia?

A

3.5x more likely to suffer dementia

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71
Q

How can you reduce risk factors for dementia?

A

Physically active
Stop smoking
Healthy eating
Healthy weight
Reduce alcohol
Mentally active
Be social

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72
Q

What are the different types of dementia?

A

Alzheimer’s disease
Vascular
Mixed
Lewy-body
Frontal-temporal

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73
Q

How does Alzheimer’s present?

A

Short-term memory loss and word-finding difficulties
Mood swings and frustration as it progresses

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74
Q

What causes Alzheimer’s?

A

Amyloid plaques - tangles tau protiein - loss of connection between neurons - decrease in acetylcholine

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75
Q

What infections are associated with Alzheimer’s?

A

Oral herpes
Pneumonia
Spirochete bacteria

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76
Q

What is the associating between periodontal disease and Alzheimer’s?

A

Gingivitis more common in Alzheimer’s, higher numbers of P.gingival present in brain producing proteins

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77
Q

What causes vascular dementia?

A

Reduced blood flow to the brain

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78
Q

What is mixed dementia?

A

Combination of Alzheimer’s and vascular dementia

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79
Q

What is lewy-body dementia?

A

Small deposits of protein in nerve cells
Associated with Parkinson’s disease

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80
Q

How does fronto-temporal dementia present?

A

Short temperedness
Aggression
Mood swings
Sexually inappropriate behaviour

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81
Q

What questionnaire is used to assess mental abilities?

A

MMSE (mini mental state exam)

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82
Q

What drugs are licensed for Alzheimer’s?

A

Donepezil
Galantamine
Rivastigmine
Memantine

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83
Q

What happens in the early stages of dementia?

A

Loss of short-term memory
Confusion, poor judgement
Anxiety, agitation
Communication problems

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84
Q

What happens in middle stages of dementia?

A

Increasingly forgetful
Distress, aggression, anger, mood changes
Risk of wandering or getting lost
Inappropriate behaviour
Hallucinations

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85
Q

What happens in late stage dementia?

A

Inability to recognise familiar objects, surrounding or people
Increased physical frailty
Difficulty eating and swallowing, weight loss, incontinence

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86
Q

Why should you avoid GA in dementia pts?

A

Evidence suggests dementia can worsen following GA

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87
Q

How can you tell someone has dental problems who can’t communicate?

A

Refusal to eat
Pulling at face/mouth
Not wearing denture
Disturbed sleep
Swelling

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88
Q

How can you make your home dementia friendly?

A

Good lighting
Reduce excess noise
Safer flooring
Labels and signs on cupboard
Phones with big buttons

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89
Q

What are the different types of platelet disorders?

A

Failed platelet production
Excessive platelet destruction
Abnormal platelet function

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90
Q

What is thrombocytopenia?

A

Too little platelets

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91
Q

What are the causes of thrombocytopenia?

A

Autoimmune
Alcoholism
Bone marrow diseases
Cancer
Viruses (Hep C, HIV)
Chemotherapy

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92
Q

What is ITP?

A

Idiopathic thrombocytopenic purpura

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93
Q

What is Glanzmanns?

A

Autosomal recessive condition that affects platelet aggregation

94
Q

What does Glanzmanns cause?

A

Epistaxis
Menorrhagia
Gingival haemorrhage

95
Q

What should platelet levels be above before XLA?

A

50x10^9/L

96
Q

What should platelet levels be before major surgery?

A

Above 70x10^9/L

97
Q

What is tranexamic acid?

A

Used to treat or prevent excessive blood loss through antifibrinolytic action

98
Q

What clotting factor does haemophilia A affect?

A

Factor VIII

99
Q

What clotting factor does haemophilia B affect?

A

Factor IX

100
Q

What inheritance pattern is Von Willebrand disease?

A

Autosomal dominant

101
Q

What is Von willebrand factor?

A

An easement ion co-factor for normal platelet adhesion & carrier for factor VIII

102
Q

What is the treatments for VWB?

A

Tranexamic acid
Desmopressin
If severe, factor VIII

103
Q

What is desmopressin? (DDAVP)

A

Synthetic version of vasopressin
Stimulates the release of VWF and increase in factor VIII levels

104
Q

What inheritance pattern is haemophilia?

A

X linked recessive

105
Q

What are the severity %’s of haemophilia?

A

Mild 5-50%
Moderate 1-5%
Severe <1%

106
Q

What rate symptoms of haemophilia?

A

Nosebleeds
Prolonged bleeding from wounds
Bleeding gums
Easily bruised
Pain and stiff joints
Internal bleeding

107
Q

What bleeding disorders would require referral to hospital for routine dentistry?

A

Severe haemophilia
Those with inhibitors
Rare bleeding disorders

108
Q

What LA injections don’t enquire haemostatic cover therapy?

A

Buccal infiltration
Palatial infiltration
Intraligamentary injection
Intrapapillary injection

109
Q

What dental tx requires haemostatic cover therapy?

A

Extractions
Oral surgery
Periodontal surgery
Implant surgery
IDBs, lingual infiltrations

110
Q

Explain the XLA procedure for a pt with a bleeding disorder

A

Liaise with haemophilia centre to organise factor replacement therapy
Use buccal articaine
Tranexamic acid mouthwash (5%) or tablets (1g)
Topical haemostatic agents - pressure packs, sutures, Surgicel, Fibrin glue

111
Q

Name 2 anti-platelet drugs

A

Aspirin
Clopidogrel

112
Q

Name 2 anti-coagulants

A

Warfarin
Heparin

113
Q

What are the newer anticoagulants?

A

Dabigatran
Apixaban
Rivaroxaban
Edoxaban

114
Q

What types of blood cancers are there?

A

Myeloma
Leukaemia
Lymphoma
Myelodysplasia

115
Q

What does multiple myeloma cause?

A

Bone infiltration and destruction
Bone pain, pathological #
Hyperviscosity syndrome
Renal failure
Anaemia
Neurological lesions

116
Q

What are the dental aspects of myeloma?

A

Root resorption
Loose teeth
Mental anaesthesia
Pathological #
Rare cause of mandibular radiolucencies

117
Q

What are the medical implications of myeloma?

A

Anaemia
Infection
Haemorrhagic tendencies
Renal failure

118
Q

What therapies would be used in myeloma cases?

A

Steroids
Bisphosphonates
Biological therapies

119
Q

What forms of acute leukaemia are there?

A

acute lymphoblastic leukaemia
acute myeloid leukaemia

120
Q

What forms of chronic leukaemia are there?

A

chronic lymphocytic leukaemia
chronic myeloid leukaemia

121
Q

What is chronic leukaemia?

A

proliferation of more mature cells

122
Q

How might chronic leukaemia present?

A

Splenomegaly
Lymph node enlargement

123
Q

What are dental aspects of leukaemia?

A

Septicaemia from oral infections
Mucosal pallor
Ulceration
Gingival swelling
Spontaneous bleeding

124
Q

What is lymphoma?

A

Cancer of the lymph glands or other organs of the lymphatic organs

125
Q

What are the 2 types of lymphoma?

A

Hodgkin’s lymphoma
Non Hodgkin’s

126
Q

What are the symptoms of lymphoma?

A

Non-tender swollen lymph nodes
Fever
Night sweats
Unexplained weight loss `

127
Q

What is Hodgkin’s lymphoma?

A

Develops from B lymphocytes
Characterised by Reed-Sternberg cells
Aggressive but good prognosis if treated well

128
Q

What is non-hodgkin’s lymphoma?

A

affects either B lymphocytes or T lymphocytes

129
Q

What is the treatment for low grade lymphoma?

A

Watch and wait

130
Q

What is the treatment for high grade lymphoma?

A

Chemotherapy, radiotherapy, monoclonal antibody therapy (rituximab)

131
Q

What is myelodysplasia?

A

rare type of blood cancer
don’t have enough healthy blood cells
bone marrow makes abnormal cells instead of healthy cells

132
Q

What are the symptoms of myelodysplasia?

A

Weakness, tiredness and breathlessness
Frequent infections
Bruising and easy bleeding, such as nose bleeds

133
Q

What are the treatments for myelodysplasia?

A

Injections of growth factor medicines such as Erythropoeitin to increase numbers of blood cells
Blood transfusion
Antibiotics
Biological therapies - Lenalidomide
Chemotherapy
Immunosuppressants
Stem cell (bone marrow) transplant

134
Q

What should you do when treating patients with blood cancers?

A
  • Dental screening prior to treatment
  • Make patient dentally fit
  • Liaise with haematology consultant
135
Q

What should you be aware of when treating pts with blood cancers?

A

risk of bleeding
timing of extractions
platelet transfusion
sepsis
chemotherapy
MRONJ

136
Q

What is MRONJ?

A

exposed bone in the maxilla or mandible that has persisted for more than 8 weeks in pts taking anti-resorptive or anti-angiogenic drugs and where there is no history of radiation or no obvious metastatic disease to the jaws

137
Q

What are the symptoms of MRONJ?

A
  • delayed healing after extraction or other trauma
  • sometimes spontaneous without an obvious trauma
  • pain
  • soft tissue infection and swelling
  • numbness
  • exposed bone (sometimes absent)
138
Q

What is the incidence of MRONJ?

A

1% in cancer patients treated with anti-resorptive or anti-angiogenic drugs
0.01-0.1% in osteoporosis patients treated with anti-resorptive drugs

139
Q

What are the risk factors for MRONJ?

A

underlying medical condition
cumulative drug dose
concurrent treatment with steroids
surgery/trauma

140
Q

What drugs can cause MRONJ?

A

bisphosphates
RANKL inhibitors
anti-angiogenic drugs

141
Q

What are bisphosphonates?

A

Drugs that reduce bone resorption by hindering the formation, recruitment and function of osteaclasts

142
Q

What is the most common condition that bisphosphonates are used for?

A

osteoporosis

143
Q

What is the half life of alendronate?

A

10 years

144
Q

What are the oral bisphosphonates?

A

Alendronic acid
Risedronate sodium

145
Q

What are the IV bisphosphonates?

A

Pamidronate
Zolendronic acid

146
Q

What are RANKL inhibitors?

A

Anti-resorptive drugs

147
Q

How do RANKL inhibitors work?

A

Inhibit osteoclast function and bone resorption

148
Q

Name a RANKL inhibitor

A

Denosumab

149
Q

How frequently is denosumab given for osteoporosis?

A

Every 6 months

150
Q

How often is denosumab given for cancer?

A

Every month

151
Q

What do anti-angiogenic drugs do?

A

Restrict the grown of tumour blood vessels

152
Q

Name 3 anti-angiogenic drugs

A

Lenalidomide
Aflibercept
Sunitinib

153
Q

What is the guidance regarding denosumab and dental extractions?

A

9 month stop prior to XLA

154
Q

When would you use antibiotics to reduce the risk of MRONJ following XLA?

A

Only when clear evidence of infection and that patient will benefit from them

155
Q

What is the aim of the dental team in pre-treatment cancer patients?

A

Remove potential sources of infection so cancer treatment can proceed without delay

156
Q

How does radiotherapy work?

A

Uses ionising radiation
Radiation kills DNA of cancer cells
Also destroys healthy cells

157
Q

What are the general side effects of radiotherapy?

A

Fatigue
Nausea
Burns
Pain

158
Q

What are the dental side effects of radiotherapy?

A

Mucositis
Xerostomia
Radiation caries
Periodontal disease
Dysgeusia/ageusia
Trismus
Osteoradionecrosis

159
Q

What is dysgeusia/ageusia?

A

Loss of one or more taste sensations
May recover after 9-18 months

160
Q

What can we do pre-cancer treatment to prevent dental infection?

A

XLA hopeless teeth
Duraphat toothpaste/varnish
Fluoride trays
HPT
Therabite

161
Q

What would class as hopeless teeth?

A

Gross caries
Mobile teeth (grade 2 or >)
Pockets 5mm and greater
Periapical pathology
Furcation involvement

162
Q

How often would you tell a patient to wear fluoride trays?

A

Minimum 5 min per day

163
Q

How can hygiene phase therapy help pre-cancer tx?

A

May lessen severity of mucositis

164
Q

What is undergoing trials currently to help cancer patients?

A

LLLT low level laser therapy

165
Q

What is the preventative prophylaxis for ORN?

A

Pentoxyfylline
Vitamin E

166
Q

How does chemotherapy work?

A

Interferes with mitosis
Interferes with apoptosis
Interferes with tumour cell DNA

167
Q

Name 3 chemotherapy drugs

A

Cisplatin
Cetuximab
TPF

168
Q

What are the general side effects of chemotherapy?

A

Fatigue
Nausea
Vomiting & diarrhoea
Skin rash
Hair loss
Thrombocytopenia
Neutropenia

169
Q

What are the oral side effects of chemotherapy?

A

Mucositis
Infection
Bleeding
Temporary xerostomia

170
Q

What can we do to help Mucositis post chemotherapy?

A

Soft splints
Caphosol
LLLT?
HPT before chemo starts

171
Q

What should you check if doing an extraction during/soon after chemotherapy?

A

Check bloods - FBC, coag screen

172
Q

What are the GDC standards for releasing confidential information?

A

In any circumstance where you decide to release confidential info, you must document your reasons and be prepared to explain and justify your decision and actions

173
Q

What age is an adult regarding the Adult Support and Protection act 2007?

A

16 years or older

174
Q

Who isn’t automatically protected by the Adult support and protection act?

A

Dementia
Learning disabled
Physical impairment

175
Q

What is financial harm?

A

Theft
Fraud
Misuse of money, property or resources without informed consent

176
Q

What is physical harm?

A

Physical assault
Bruising
Abrasions
Bites/burns/scalds
Scars
Fractures

177
Q

What counts as emotional/psychological harm?

A

Excessive shouting
Bullying
Humiliation
Rejection
Scapegoating
Denigration of culture/gender/religion/sexuality/disability
Denial of opportunities for appropriate socialisation

178
Q

What counts as sexual harm?

A

Incest/rape/acts of gross indecency
Exploitation through prostitution
FGM

179
Q

What counts as neglect?

A

Failure to provide access to appropriate healthcare
Withholding necessities such as nutrition, heating etc
Lack of appropriate food or clothing
Unhygienic home conditions
Isolation and withdrawal from social activities

180
Q

Who does the adult support and protection act 2007 support and protect?

A

Adults at risk of harm
Adults more at risk because they are affected by a disability, mental disorder, illness or physical or mental infirmity
Adults who are unable to safeguard their own wellbeing, property, rights or other interests

181
Q

When should intervention in an adults affairs occur?

A

When:
- it will provide benefit to the adult, which could not reasonably be provided without intervention
- the chosen intervention is likely to succeed and is the least restrictive of the adult’s freedom

182
Q

What should you record in your notes when you are concerned an adult is a risk?

A
  • was the adult with anyone? Who? Role/relationship?
  • Observe behaviour and physical signs
  • summary of discussions
  • record/draw/photograph injuries and reasons given for them
  • recognise historical patterns
  • distinguish between facts and opinion
183
Q

How do you report concerns?

A

Recognise - signs of harm
Record - believe. Listen. Take notes
Report - tell someone (preferable to get consent from patient for this)

184
Q

What should you never do when reporting concerns?

A
  • put yourself/team at risk of harm
  • attempt to confront an abuser
  • promise you will keep secrets for the victim
185
Q

What is it not your responsibility to do when reporting concerns?

A
  • assess legislative criteria
  • investigate harm
  • seek proof
186
Q

Who do you report concerns to if there is immediate danger?

A

999

187
Q

Who do you contact with concerns about proxy’s?

A

Welfare - social work
Financial - OPG
Advice - mental welfare commission

188
Q

What are the 6 principles of adult safeguarding?

A

Empowerment
Prevention
Proportionality
Protection
Partnership
Accountability

189
Q

What does the domestic abuse Scotland act 2018 cover?

A

Any form of:
- physical
- verbal
- sexual
- psychological
- financial
Abuse which might amount to criminal conduct anadromous which takes place within the context of a relationship (partners or ex-partners)

190
Q

What age range had the highest incident rate for domestic abuse?

A

26-30 years

191
Q

What behaviours are coercive control?

A

Isolation from support
Exploitation
Deprivation of independence
Regulating behaviour

192
Q

Name 5 types of exploitation

A

slavery
forced labour
prostitution
removal of organs
securing services and benefits

193
Q

What signs should you be aware of for exploitation?

A

physical abuse
isolation
poor living conditions
few or no personal effects
restricted movement
unusual travel times
reluctance to seek help

194
Q

What is fear?

A

the physiological reaction to actual threat/danger

195
Q

What is anxiety?

A

the physiological reaction to perceived threat/danger

196
Q

What is phobia?

A

a persistent and excessive fear of an object or situation that is not in fact dangerous

197
Q

What types of anxiety disorders are there?

A

phobic
panic disorder
generalised (GAD)
PTSD
adjustment disorders
hypochondrial disorders

198
Q

Explain the 2 groups of gagging

A

somatogenic - physical stimulation produces the reflex
psychogenic - stimulation appears to be psychological origin

199
Q

What are the types of triggers to gagging?

A

tactile - exam, radiographs, imps
gustatory - taste
olfactory - smell
visual - room, white coat, dental chair
auditory - sound of handpiece
cognitions - memories

200
Q

What factors contribute to gagging?

A

anatomical - soft palate
medical - nasal obstruction, gastric, MND
psychological- fear, stress, phobia, alcoholism
dental/iatrogenic - overloaded imp tray, denture design faults

201
Q

What are the 5 intraoral trigger points for gagging?

A

palatoglossal and palatopharyngeal folds
base of tongue
palate
uvula
posterior pharyngeal wall

202
Q

what % of adults have moderate dental anxiety?

A

36%

203
Q

What percentage of the population are phobic of the dentist?

A

10%

204
Q

What does MDAS score 5-9 indicate?

A

no-low anxiety

205
Q

What does MDAS score 10-18 indicate?

A

moderate anxiety

206
Q

What does MDAS score 19 or above indicate?

A

significant dental anxiety/phobia

207
Q

name 3 coping strategies for anxiety?

A

deep breathing
progressive muscular relaxation (PMR)
grounding

208
Q

what techniques can help with gagging?

A

temporal tap
salt on anterior dorsum of tongue 5 secs prior to procedure
rinse with ice cold water prior to radiographs

209
Q

What are the 2 types of congenital cardiac conditions?

A

cyanotic
acyanotic

210
Q

what are the dental findings of congenital cardiac conditions?

A

delayed eruption of both dentitions
increased positional abnormalities
enamel hypoplasia
vasodilation of pulp
increased perio and caries

211
Q

what are the dental considerations of congenital heart conditions?

A

anticoagulation
risk of infective endocarditis

212
Q

what causes ischaemic heart disease?

A

atherosclerosis and hypertension

213
Q

what are the oral findings of IHD?

A

severe caries
severe perio
lichenoid reactions
gingival swelling
angiodema
ulcers

214
Q

how long should you defer tx post MI?

A

6 months

215
Q

what are the tx options for hypertension?

A

lifestyle changes
diuretic
b blocker
ca channel blockers
statins
aspirin/clopidogrel

216
Q

what are the dental considerations of hypertension?

A

xerostomia
salivary gland pain/swelling
lichenoid reactions
angio-oedema
gingival hyperplasia
sore mouth
paraesthesia

217
Q

what is the tx for cariomyopathy?

A

b blockers, anitcoagulants, diuretics
pacemakers or ICD’s
surgery
transplant

218
Q

what is the dental issues of B blockers?

A

interact with LA with adrenaline

219
Q

what teeth should you extract pre-cardiac surgery?

A

severe periodontal disease
gross caries
apical pathology

220
Q

what are the renal functions?

A

excretion of waste products
maintaining fluid and electrolyte balance
secretion of hormones
excretion of drugs

221
Q

what are the most common causes of chronic kidney disease?

A

diabetes
hypertension
glomerulonephritis

222
Q

what are the 5 stages chronic kidney disease?

A
  1. early CKD
  2. mild CKD
  3. moderately severe
  4. severe CKD
  5. end stage renal failure
223
Q

what is the clinical presentation of renal failure?

A

depression, lethargy
nausea, vomiting, anorexia
weakness, fatigue
peptic ulceration
bruising
diarrhoae
bone pain

224
Q

what are oral findings of CKD?

A

osseous lesions
dry mouth, metallic taste, halitosis
reduced salivary flow, protein and electrolyte changes
accelerated calculus production
pale oral mucosa
oedema, oral ulceration
paraesthesia

225
Q

what does haemodialysis do?

A

removes excess fluid and uraemic solutes

226
Q

when is the best time for treatment for renal dialysis patients?

A

the day after haemo-dialysis

227
Q

What are the implications of renal transplants?

A

lifelong immunosuppression
gingival hyperplasia
increased risk of oral tumours
candidiasis, herpes simplex

228
Q

how long do renal transplants last?

A

90% success at 1 year
70% survival at 5 years
less than 5% mortality

229
Q

what should be done dentally pre-renal transplant?

A

full dental assessment
extract teeth of poor prognosis
preventative regime

230
Q

what should be done dentally post renal transplant?

A

defer elective dental care for 6 months
consult with renal physician
delayed wound healing

Module 7 (8 decks)

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