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special care dentistry need to know Flashcards

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1
Q

what is a multidisciplinary team?

A

group of healthcare professionals from different disciplines/specialities who share their expertise and work together in a team to provide the best and most holistic care possible for the patient

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2
Q

list possible members of a cancer MDT

A

surgeon
clinical oncologist
chemotherapy nurse
special care dentist
pathologist

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3
Q

what features of cerebral palsy would impair your access to the mouth?

A

muscle stiffness (hypotonia)
muscle weakness
random and uncontrolled body movements

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4
Q

give two ways you can aid a patient who struggles to open their mouth

A

mouth rests for opening
bedi shield

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5
Q

give methods of tilting a patient for access

A

wheelchair recliner
hoist
portable turntable
stand aid
banana board

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6
Q

what can you use for communicating if a patient cannot speal or write?

A

makaton
picture boards
talking mats
electrical tablet

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7
Q

what are the differences n medical models and social models related to disability?

A

social models- disability caused by how society is organised rather than a person’s impairment or difference
medical models - disability caused by a person’s impairment/differences and should be ‘fixed’ or ‘changed’ by other medical/other treatments

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8
Q

name 4 types of dementia

A

alzheimers
vascular
frontotemporal
dementia with lewy bodies

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9
Q

what is the most common form of dementia?

A

alzheimers

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10
Q

how does alzhemiers affect the brain?

A

reduction in size of cortex
severely affects hippocampus

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11
Q

what causes alzhemiers?

A

abnormal protein fragments (beta-amyloid) build up in spaces between nerve cells forming plaques and disrupting brain function

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12
Q

what are the features of alzheimers?

A

short term memory loss
aphasia
communication difficulties
muddled over everyday activities
mood swings
withdrawn
loss of confidence

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13
Q

what are the risk factors of alzheimers?

A

age
gender
head injury
genetic- abnormalities of chromosomes 1,14,21
lifestyle- smoking, hypertention, low folate, high cholesterol

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14
Q

what is the cause of vascular dementia?

A

reduced blood flow to the brain
damages and eventually kills the brain cells

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15
Q

what causes vascular dementia to develop?

A

narrowing/blockage of small blood vessels into the brain
single large stroke
lots of mini-strokes that cause small, but widespread damage
underlying health conditions

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16
Q

what are the features of vascular dementia?

A

memory problems of sudden onset
visuospatial difficulties
anxiety
delusions
seizures

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17
Q

what causes dementia with lewy bodies?

A

deposits of abnormal proteins called lewy bodies inside brain cells

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18
Q

what are the features of dementia with lewy bodies?

A

short term memory loss
cognitive ability fluctuates
visuospatial difficulties
attentional difficulties
overlapping motor disorders
speech and swallowing problems
sleep disorders and delusions

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19
Q

lewy bodies can be found in patients with what cerebellular disease?

A

Parkinson’s disease

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20
Q

what are the features of frontotemporal dementia?

A

uncontrollable repition of words
short term memory loss (sometimes)
personality changes
decline in personal and social conduct

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21
Q

what are the symptoms of late stage dementia?

A

inability to recognise familiar objects, surroundings or people
difficulty eating and swallowing
incontinence
gradual loss of speech

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22
Q

what is the most common way to test for dementia?

A

the mini mental state examination (MMSE)

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23
Q

name 3 cognitive testing methods for dementia

A

MMSE
blessed dementia scale
the montreal cognitive assessment (MoCA)

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24
Q

what are the advantages of the mini mental state examination?

A

well known
easy to administer

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25
what are the advantages of the mini mental state examination?
well known easy to administer
26
what are the cons of of the mini-mental state examination?
not sensitive to mild impairment not sensitive in testing frontal lobe non-standardised time between registration and recall
27
what is the treatment for dementia?
councelling can delay residential care up to 1 year aspirin/reducing cardiac risks can halt deterioration of vascular dementia NSAIDs may slow progression vitamin E can slow progression anticholinesterases for mild/moderate alzheimers cerebrolysin improves cognitive function for vascular dementia
28
when would treatment for a patient with dementia be stopped?
when it is deemed that treatment is no longer working the MMSE score falls below 10
29
what can care homes do to be more dementia friendly?
make walls, flooring, skirting different colours add labels/images to drawers etc. to help pts find things bedroom WC should be visible from bed position personal pics/items with personal relevance
30
how can healthcare environments be made more dementia friendly?
reception desk visible from front door no non-essential signs staff only doors same colour as walls colour of walls different from floor/celing signs should be simple, colourful;, eye level
31
What are risk factors of oral cancer ?
A smoking Alcohol intake HPV sunlight nutritional deficiencies candida infections
32
What are causes of liver cirrhosis
Alcohol Hepatitis virus fatty liver disease autoimmune causes:primary billary cirrhosis haemochromatosis hepatocellular carcinoma drug induced
33
why should a patient be dentally fit before a transplant
the patient will be immunosuppressed for the rest of their life so must reduce the risk of further dental intervention in the future
34
what teeth can be justified to extract when making a patient dentally fit
teeth with periapical periodontitis or other pathology teeth with poor prognosis - highly restored and secondary caries
35
what causes thrombocytopenia to occur
splenic sequestration impaired hepatic synthesis increased degredation of thrombopoeitin by platelets sequestered in the congested spleen drug related - alcohol, penecillin based drugs or heparin
36
what platelet level is considered safe to treat in general practise
> 100 x 10^9 / L
37
why might patients with advanced alcoholic liver disease have increased risk of bleeding
thrombocytopenia medication induced, patient may be taking heparin liver disease may have been caused by hepatitis or HIV which both affect bleeding clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
38
why might patients with advanced alcoholic liver disease have increased risk of bleeding
thrombocytopenia medication induced, patient may be taking heparin liver disease may have been caused by hepatitis or HIV which both affect bleeding clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
39
who can provide section 47 AWI certificate for dental treatment
dentist who has done additional training general medical practicioners consultants in-charge of patient care
40
What are risk factors of stroke?
hypertension smoking alcohol diabetes mellitus age DVT
41
What are the protected characteristics from the Equality Act 2010?
Age Disability Gender Marriage and Civil Partnership Pregnancy and Maternity Race Religion Sex Sexual orientation
42
What is the definition on impairment?
any loss or abnormality of psychological, physiological or anatomical structure or function
43
What is the definition of disability ?
a physical or mental impairment that has substantial long term negative effect on ability to do normal daily activities
44
What is aim of the Equality Act 2010 ?
provide a legal framework to protect the rights of individuals and advance equality of opportunity for all places a legal duty on organisations to make reasonable adjustments to remove barriers that affect people accessing care
45
What is the inverse care law
the people who need health care the most are least likely to receive it
46
What are the 5 domains to overcoming barriers to healthcare
Accessibility Accommodation Affordability Acceptability Availability
47
What is the function of the Adults with Incapacity Act 2000 (Scotland)
to protect welfare and manage finances of individuals (16 and over) who lack capacity due to mental illness, learning disabilities aim to support their involvement in making decisions as far as they are able to do so
48
what are difficulties associated with treating a bariatric patient?
loss of anatomical landmarks ID blocks may be difficult may have to be treated semi-supine or sitting upright access may be more difficult due to excess soft tissue long procedures can cause acute leg oedema, cellulitis and pressure sores
49
How do you assess capacity ?
being incapable of: - Acting - Making a decision - Communicating decision - Understanding decision - Retaining the memory of a decision AMCUR
50
Q What are the principles of the AWI Act?
decisions made on behalf of another must be: - benefit the patient - minimum necessary intervention - Take into account the wishes of the adult - Consult with relevant others - Encourage the adult to exercise residual capacity
51
What are the types of power of attorney
Continuing power of attorney - makes financial and property decisions Welfare power of attorney - makes decisions on healthcare and dental treatment Combined power of attorney - both financial and welfare decisions
52
What are the types of guardianship?
Welfare guardian- can consent to dental treatment Financial guardian - cannot consent to dental treatment
53
What is sensory impairment ?
When one or more of a person’s senses are no longer normal
54
What is cataract ?
Clouding of the lens of the eye which prevents clear vision
55
What are the two types of macular degeneration ?
wet - causes severe sight loss in a matter of months dry - gradual loss of central vision
56
What causes wet macular degeneration ?
growth of new vessels under the retina which break and leak into the macula causing scarring
57
What causes dry macular degeneration?
Layers of the macula become progressively thinner causing it to function less effectively
58
What does macular degeneration look like visually?
loss of the central field of vision patients may be sensitive to light
59
What causes glaucoma?
fluid build up in the front part of the eye which increases pressure inside the eye
60
what does glaucoma look like visually?
tunnel vision - dark black surrounding outside
61
What causes diabetic retinopathy
vascular changes in the retinal circulation due to diabetes
62
what does diabetic retinopathy look like visually ?
Black spots in the vision
63
what is the most common because of hemianopia ?
stroke
64
What does hemianopia look like visually?
vision from only half of the eye
65
What are the impacts of hearing impairment ?
functional impact - affects ability to communicate with others and can affect academic perdormance of children Social and emotional impact - isolation and exclusion from communication with others financial impact - higher unemployment rate
66
causes of hearing loss ?
congenital - low birth weight, infections during pregnancy, jaundice in neonatal period acquired - infectious diseases (meningitis) , chronic ear infection, injury to head, recreational exposure to loud sounds
67
What causes down’s syndrome?
trisomy of chromosome 21
68
co morbidities associated with Down’s syndrome
congenital heart defects alzheimers dementia epilepsy leukaemia diabetes mellitus coeliac disease intellectual impairment
69
what are dental implications of downs syndrome ?
reduced oral hygiene increased risk of periodontal disease immunocompromised saliva quality is altered
70
what are physical features of cerebral palsy
muscle stiffness muscle weakness random uncontrolled body movements balance and co-ordination problems
71
What are the different types of dementia
Alzheimers Vascular dementia Dementia with lewie bodies
72
what are questions to ask if you suspect a non verbal patient with dementia is in pain?
has their behaviour changes has sleep been disturbed has their eating behaviour changed have they been holding or touching their face
73
what infections are more common during cancer treatment ?
candida - treat with fluconazole (systemic), miconazole (topical) or nystatin herpes simplex virus - treat with acyclovir
74
What is schizophrenia ?
psychological condition affecting neurotransmitters in the brain which affects the way people interpret reality
75
What are the 2 types of symptoms in schizophrenia?
positive symptoms - things something is there that isn’t (e.g. hallucinations) Negative symptoms - affects emotions and communication
76
what level of neutrophils would because concern?
<1 means have greater risk of infection
77
what LA is used in patients with advanced liver disease?
Articaine as it is not metabolism in the liver
78
what clotting factors does the liver produce?
1, 2, 7, 9 ,10 and 11
79
Apart from clotting factors what other product essential for achieving haemostasis is produced in the liver?
Thrombopoietin
80
What does low white blood cells indicate?
immunosuppression or autoimmune disease
81
what is the normal range for WBC?
4.5 - 10 x10^9/L
82
what does a high white blood cell count indicate?
current infection
83
What can low haemoglobin indicate?
Thalassaemia
84
What is the range of platelets for a patient to be treated in general practice?
> 100
85
What does low red blood cell and low haemoglobin mean?
anaemia
86
what does low haemoglobin with reduced MCV indicate?
microcytic anaemia caused by iron deficiency or Thalassemia
87
what does low haemoglobin with increased MCV indicate?
Macrocytic anaemia caused by liver damage and b12 and folate deficiency
88
What does low haemoglobin with normal MCV indicate>
Normocytic anaemia
89
What are oral complications of radiotherapy?
osteoradionecrosis radiation caries hypogeusia - loss of taste due to radiation affecting taste buds xerostomia - may be due to damage of salivary glands difficulty wearing dentures more prone to fungal infections trismus may occur due to replacement fibrosis of muscles of mastication
90
what sites of the teeth are affected by radiation caries?
gingival margins and incisor edges
91
what are causes of radiation caries?
dry mouth loss of taste change in diet hypersensitivity of teeth makes OH difficult
92
What do you need to know about patients who have had radiotherapy?
what dose of radiation was given what area of the body was exposed to the radiation duration of treatment
93
hat are preventative measures used for patients who have had radiotherapy?
OHI higher concentration of fluoride toothpaste fluoride varnish
94
how do you treat osteoradionecrosis?
irrigation of necrotic debris remove loose sequestra
95
What methods help prevent risk of osteoradionecrosis?
scale teeth near extraction site and use chlorohexidine mouthwash careful extraction technique antibiotics, chlorhexidine mouthwash and review hyperbaric oxygen before and after extraction to increase local tissue oxygenation close soft tissues
96
what are the causes of congestive heart disease?
Coronary artery disease - Cardiomyopathy - Heart attack - alcohol abuse - hypertension - valve disease - diabetes - MI idiopathiccauses
97
what are the symptoms of congestive heart disease?
* rapid irregular heart beat * fatique and weakness * swelling of abdomen * oedema in leg/ankle/feet * nausea * shortness of breath * cough, wheezing * chest pain when breathing
98
what is the treatment of congestive heart failure?
lifestyle changes ACE inhibitor beta blockers diuretics digoxin pace maker
99
what microbe is the ain cause of infective endocarditis?
streptococcus viridians
100
give features of parkinsons disease
bradykinesia- slow movement rigidity- increase motor tone mask like face resting tremors posture instability, impaired use of upper limbs
101
how does parkinsons differ from other cerebellular diseases?
resting tremors as apposed to intentional active tremors
102
how does parkinsons cause dry mouth?
anticolinergic effects of drugs e.g. benztropine
103
how can you prevent dentures being lost in a care home?
initials during process store in a labelled container

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