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Special Care Dentistry Flashcards

(103 cards)

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1
Q

give four reasons why people with severe mental disorders are more susceptible to oral disease

A

poor oral hygiene
dental phobia
dental costs
xerostomia from anti-psychotic or anti-depressant drugs

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2
Q

name three impacts of good mental health

A

improved educational attainment
greater productivity
reduced mortality

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3
Q

name four examples of people who might be at risk of poor mental health

A

parental use of alcohol, drugs, tobacco during pregnancy
low birth weight
poor parental mental health
adverse childhood experiences

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4
Q

what are the three aspects of neurosis

A

anxiety
panic
phobia

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5
Q

what scale quantifies levels of anxiety

A

MDAS

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6
Q

what are the treatments available for anxiety disorders

A

CBT
medications

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7
Q

what could help overcome dental phobias

A

CBT
tell show do
acclimatisation
stop signals
needle desensitisation

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8
Q

name five dental implications of depression

A

chronic facial pain
burning mouth syndrome
TMD
dry mouth
halitosis

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9
Q

name two drugs anti-depressants interact with

A

benzodiazepines
codeine

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10
Q

what is tardive dyskinesia and what causes it

A

involuntary movement of tongue, lips, face, trunk and extremities
occurs in 15% patients who have been receiving antipsychotic therapy for years

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11
Q

what disorders is psychosis an umbrella term for

A

schizophrenia
bipolar disorder

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12
Q

what is hallucination

A

people see and hear things that don’t exist

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13
Q

what are delusions

A

where person has strong beliefs that are not shared by others

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14
Q

name four possible causes of psychosis

A

traumatic experience
stress
alcohol or drug misuse
side effects from prescribed medicines

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15
Q

name four dental effects of bipolar disorder

A

decline in oral hygiene
increased caries rate
increased periodontal disease
over use of oral hygiene aids during manic episodes = abrasion NCTSL

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16
Q

what is schizophrenia

A

disorder causing psychological symptoms like hallucinations and delusions

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17
Q

what effects may schizophrenic patients on haloperidol and phenothiazines experience

A

orthostatic hypotension - take care when raising patients from dental chair

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18
Q

what is schizoaffective disorder (SAD)

A

disorder that sits in the middle of the bipolar and schizophrenia spectrum
experiences symptoms from both

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19
Q

name four dental implications of eating disorders

A

dental erosion on lingual, palatal and occlusal surfaces
oral ulceration
xerostomia
sialosis

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20
Q

what is SCOFF

A

sick, control, one stone, fat, food questionnaire
if patient answers yes to 2 or more questions they are likely to have an eating disorder

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21
Q

what dental prevention aids should you take care with when providing prevention to people with mental health problems

A

mouthwash (alcohol)
floss (can be sinister)
wooden sticks for interdental cleaning (can be sharpened)

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22
Q

how does the pilocarpine HCl solution work for dry mouth

A

enhances salivary secretions in patients who have some salivary gland function

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23
Q

what is the prescription for pilocarpine HCl

A

5mg TID

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24
Q

why should you take caution when prescribing acidic pastilles for saliva stimulants (Salivix or Glandosane)

A

they can cause tooth erosion and sensitivity in dentate patients

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25
what is the definition of a drug
a medicine or other substance that has a physiological effect when ingested or otherwise introduced to the body
26
what is the age group most likely to use drugs
young adults between 16-24
27
give five risk factors for drug misuse
genetic socioeconomic co-existing mental problems peer pressure trauma
28
what system has an important role in transition from occasional drug user to addiction
brain reward systems
29
what two effects can drugs have on neurotransmitters
increased levels of dopamine = euphoria decreased levels of serotonin = decreased levels of contentment
30
what is the traditional theory of addiction (opioids)
Intense initial intoxication development of profound tolerance escalation in intake profound dysphoria, physical discomfort with withdrawal
31
what is the alcohol pattern of addiction
initial intoxication less than opioids pattern characterised by binges severe emotional and somatic withdrawal syndrome intense craving for drug
32
what happens with the sensitivity of reward system through chronic exposure to drugs
reduces the sensitivity
33
give three classifications of drugs
behavioural classification pharmacodynamic classifications legal classification
34
what drugs are involved in the behavioural drug classification
stimulants opioids, antipsychotics, antidepressants
35
what drugs are involved in pharmacodynamic classification
psychedelics sedative hypnotics
36
name three infections you are at an increased risk of after using illicit drugs
TB STI BBV
37
name three complications related to injecting drugs
cellulitis abscess thrombophlebitis
38
what is the term used now to describe IV drug users
people who inject drugs PWID
39
name three social implications of drug use
suicides assaults death
40
name four effects of cannabis
euphoria slow thinking and reaction time confusion impaired balance and coordination
41
name three effects of alcohol
CNS depressant ataxia and motor coordination aggressiveness
42
name five signs of addiction
loss of reliability mood changes isolation impaired driving constricted or dilated pupils
43
name four barriers of drug addicts accessing dental care
they have chaotic lifestyles fear of dentists poor attendance and compliance cost
44
name four medical implications drug misuse may have
increased infection rate chronic liver disease infective endocarditis venous thromboses
45
In the dental setting, what do you have to be careful with when treating a person who abuses drugs
consent - if under the influence they cannot consent
46
what can occur when patients are taking cannabis and need LA
LA with adrenaline can prolong tachycardia
47
name a consideration for a patient with alcohol addiction that requires LA
LA is metabolised in the liver - keep dosage low as can trigger CNS toxicity
48
name three dental implications of substance misuse
rampant caries periodontal disease NCTSL
49
why is oral cancer more common in drug misusers
smoking alcohol direct application of drug to mucosa poor nutritional and immune status
50
name five effects of alcohol abuse on the dentition
advanced caries and periodontal disease glossitis NCTSL leukoplakia recurrent aphthous stomatitis
51
give three pieces of dental advice for methadone users
use a straw drink water after consumption dont brush teeth immediately after
52
what are the two main oral bacteria that can cause IE in susceptible patients
step viridans staph aureus
53
how long should patients refrain from cannabis before dental treatment
72 hours
54
why should you avoid adrenaline containing LA for patients on cocaine, ecstasy and methamphetamines
risk of systemic increase in blood pressure
55
name four factors that increase change of developing oral cancer
smoking alcohol HPV previous SCC
56
name three features of presenting oral cancer
ulcerated uneven surface rolled edges
57
how is performance status graded when evaluating cancer patients
ECOG performance status
58
what is CT scan used for when investigating cancer in head and neck
assess primary tumours assess for regional spread
59
what is the use of MRI scan when investigating head and neck cancer
extent of bone and nerve involvement surgical planning
60
name four people in the MDT for head and neck cancer
OMFS surgeons ENT surgeons speech and language therapist dietician
61
how is head and neck cancer graded
T - tumour size and depth of invasion N - nodal involvement M - metastases present
62
give three reasons why tumour staging is important
treatment planning prognostic research purposes
63
give three treatment options for primary site head and neck cancer
resection and packing resection and primary closure resection and reconstruction
64
how much tissue should be removed when removing a head and neck cancer
1cm margin of normal tissue around the margins of the cancer
65
how would oral cancer with bony involvement appear on an OPT
moth eaten bone pathological fractures generalised widening of PDL space unusual periodontal bone loss
66
name four warning signs seen on an ultrasound that would make you consider head and neck cancer
rounded shaped lymph nodes (instead of oval) enlarged lymph nodes (more than 10mm diameter) necrosis of nodes internal calcification
67
name two post treatment complications of radiotherapy for head and neck cancer
infection osteoradionecrosis
68
what does incidence of ORN in head and neck cancer patients depend on
dosage used (more than 50rN) field of view
69
what is impairment
loss or abnormality of psychological, physiological or anatomical structure or function
70
what is disability
any restriction or lack of ability to perform an activity in the manner or within the range to be considered normal
71
what is handicap
a disadvantage for a given individual resulting from an impairment or a disability
72
what is a legislation passed in 2010 that is relevant to dental care
equality act 2010
73
what are the 9 protected characteristics
age disability gender reassignment marriage or civil partnership pregnancy race religion or belief sex sexual orientation
74
what are the 5 domains to overcoming barriers (5As)
accessibility accommodation affordability acceptability availability
75
what was introduced to protect individuals 16 and over who lack capacity to make some or all decisions for themselves
adults with incapacity act 2000
76
how is a person decided they are unable to make decisions for themselves (AMCUR)
they are unable to: act make communicate understand retain memory
77
what is a cataract
clouding of the lens of the eye - prevents clear vision
78
what is age-related macular degeneration
loss of person's central field of vision
79
what is glaucoma
fluid building up in the front part of the eye increasing the pressure can lead to vision loss makes periphery of sight appear darker
80
what are the two types of glaucoma
primary open angle - slow onset and caused by drainage channels being gradually blocked angle closure - acute as the drainage system is blocked suddenly
81
what is diabetic retinopathy
occurs in diabetic patients and causes there to be dark spots in their vision
82
what is hemianopia
blindness in one half of the visual field
83
what are the two causes of hearing loss
congenital - maternal rubella, syphilis, low birth weight acquired - age, chronic ear infection, meningitis, mumps, measles
84
what are the 3Rs when reporting an incident to do with
recognise report record
85
what is four dental implications of obesity
periodontitis caries tooth wear impaired wound healing
86
what are examples of aids to get patients from wheelchairs to the dental chair
.hoist banana board reclining wheelchair turn table wheelchair recliner stand aid
87
what are ways in which you can prevent osteoporosis
stay physically active drink alcohol in moderation not smoking take prescribed medications eat nutritious diet in calcium and vitamin D
88
suggest modifications for oral hygiene for a patient who has disability in their hands
electric toothbrush foam handles ball handles suction brush to stick on the wall to clean dentures
89
what are local causes of pseudomembranous candidiasis
antibiotic use dentures local corticosteroid use xerostomia
90
what are systemic causes of pseudomembranous candidiasis
drugs extremes of age endocrine - cushing's iron deficiency smoking
91
how should pseudomembranous candidiasis be managed
use toothbrush to clean palate use of chlorhexidine 0.2% m/w remove denture at night appropriate cleaning of denture miconazole/ fluconazole/ nystatin
92
what is INR
ratio of prothrombin time to thrombin time
93
what value should the INR be before you would consider extraction of a tooth
below 4
94
how can you achieve local haemostasis
sockets packed with surgicel sutures pressure applied atraumatic technique tranexamic acid mouthwash
95
all of the DOACs are Factor Xa inhibitors except one - which one is it
dabigatran - direct thrombin inhibitor
96
how should a patient be treated if taking apixaban or dabigatran for procedures with higher risk of bleeding
miss their morning dose and take evening dose as usual
97
how should patients be treated if they are on rivaroxaban or edoxaban and require a dental procedure with a higher risk of bleeding
delay morning dose until 4 hours after haemostasis has been achieved
98
name the four dental procedures that are risk of causing bleeding but the risk is low
simple extractions incisions and drainage of swellings detailed 6PPC RSD direct or indirect restorations with subgingival margins
99
when should patients with haemophilia be seen at a special haemeophilia centre
dental extractions surgical procedures subgingival scaling anaesthesia requiring IDBs or lingual infiltrations
100
give some reasons why haemostasis may not be able to be achieved in some patients
inherited bleeding disorders (haemophilia) medication induced (warfarin/ antiplatelets) haematological disease (leukaemia) infections - HIV or HepC liver disease - alcoholic liver disease/ cirrhosis
101
what is the safe platelet level to achieve haemostasis in secondary care
50 x 10 to the 9 per litre
102
what is UKELD
UK score for Endstage Liver Disease predicts a patient's prognosis in chronic liver disease 49 is the minimum score for a patient to be assessed for liver transplant
103
what are the stages of liver disease
hepatitis liver cirrhosis liver failure

FINALS (25 decks)

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