Special Care Overview

Question 1

What is the definition of an impairment?

Answer 1

Any loss or abnormality of psychological, physiological, or anatomical structure or function
(occurs at the level of organ/system function

Question 2

What is the definition of disability?

Answer 2

Any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human
(concerned with functional performance)

Question 3

What is the definition of a handicap?

Answer 3

A disadvantage for a given individual, resulting from impairment or disability, that limits or prevents the fulfilment of a role that is normal

Question 4

What are some barriers to care that special care patients may experience?

Answer 4

• physical
• attitudinal
• people centred
• professional centred

Question 5

What legislation discusses equality in dental care?

Answer 5

The Equality Act 2010
- protects people from discrimination in the workplace & in wider society

Question 6

Give examples of protected characteristics:

Answer 6

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

Question 7

What are the different types of discrimination?

Answer 7

• direct
• indirect
• harassment
• victimisation

Question 8

What is direct discrimination?

Answer 8

treating someone with a protected characteristic less favourably than others

Question 9

What is indirect discrimination?

Answer 9

putting rules or arrangements in place that apply to everyone, but that put someone with a protected characteristic at an unfair disadvantage

Question 10

What is harassment?

Answer 10

unwanted behaviour linked to a protected characteristic that violates someones dignity or creates an offensive environment for them

Question 11

what is victimisation?

Answer 11

treating someone unfairly because they’ve complained about discrimination or harassment

Question 12

What are the 5 domains of overcoming barriers to healthcare?

Answer 12

• accessibility
• accommodation
• affordability
• acceptability
• availability

Question 13

How can an upstream approach improve access to healthcare for those with special care needs?

Answer 13

• policies aimed at social inclusion & better access to education/employment
• better insurance policies for this group
• eligibility for free or subsidised dental care

Question 14

How can a downstream approach improve access to healthcare for those with special care needs?

Answer 14

design of a regional dental care infrastructure to increase access to dental care for disabled people

Question 15

What legislation is in place to protect individuals who lack capacity?

Answer 15

Adults with Incapacity (Scotland) Act 2000

Question 16

A person is unable to make a decision for themselves if they are incapable of …….

Answer 16

• acting
• making decisions
• communicating decisions
• understanding decisions
• retaining memory of the decision

Question 17

What is a bariatric patient defined as?

Answer 17

An individual of any age who has limitations in health and social care due to physical size, health, mobility and environmental access

Question 18

What does the World Health Organisation define an obese person as in relation to BMI?

Answer 18

> /= 30kg/m2

Question 19

What are some limitations of the BMI system?

Answer 19

• does not assess body fat distribution
• does not account for age, sex, ethnicity and muscle mass

Question 20

What is the role of the dental team in relation to bariatric care?

Answer 20

• identify and diagnose health issues associated with bariatric patient
• signpost patients to appropriate services
• be aware of comorbidities or predisposition to dental disease
• referral onto secondary/tertiary care
• may have to provide emergency care
• raise health concerns with patient, parents or carers of vulnerable adults/children

Question 21

How can obesity affect dental treatment?

Answer 21

• pt does not fit in regular dental chair
• pt may not be able to lie supine
• airway management compromised
• longer needles may be required
• reduced mobility may need longer appt times
• difficult access to oral cavity due to excess weight
• higher risk of MI occurring in practise
• loss of anatomical landmarks
• difficulty taking radiographs

Question 22

How might obesity affect a pts periodontal disease risk?

Answer 22

Pt at higher risk of diabetes, diabetes is a direct risk factor for periodontal disease development

Question 23

What are some dental implications of obesity?

Answer 23

• high caries risk
• poor wound healing (bariatric pts tend to have reduced immune function)
• tooth wear risk (GORD prevalence increased)

Question 24

Why might IV sedation undertaken in a primary care setting be contraindicated in bariatric patients?

Answer 24

• difficulty placing cannula
• compromised airway
• at risk of sleep apnoea

Question 25

When you are assessing for capacity, what key factors must you always consider?

Answer 25

- presume capacity - not an all or nothing event - capacity may fluctuate - consider residual capacity - always record your assessment

Question 26

In reference to consulting with relevant others when making decisions on behalf of adults with incapacity, who should you contact?

Answer 26

- nearest relative / primary carer - a welfare attorney

Question 26

What are the 5 principles of treatment decision making under the Adults With Incapacity Act?

Answer 26

1. benefit 2. minimum necessary intervention 3. take account of the wishes of the adult 4. consultation with relevant others 5. encourage the adult to exercise residual capacity

Question 27

Who can consent for dental treatment?

Answer 27

- patients with capacity - wellfare powers of attorney - welfare guardians - medical & dental practitioners under Section 47 of AWI Act

Question 28

Why can aging lead to poor dental health?

Answer 28

- polypharmacy - OH difficulties - lack of capacity - deteriorating immune system

Question 29

What does a good quality of life look like for the older generation?

Answer 29

- good social relationships - maintaining social activities - retaining a role in society - positive psychological outlook - good health and mobility - enjoy life - retain independence

Question 30

What are the characteristics of dementia?

Answer 30

- amnesia - inability to concentrate - disorientation in time, place or person - intellectual impairment

Question 31

What is Alzheimer's?

Answer 31

- most common type of dementia - reduction size of the cortex - plaques build up in the spaces between nerve cells

Question 32

What are some different types of dementia?

Answer 32

- Alzheimer's - Vascular - Dementia with Lewy Bodies

Question 33

What are some early stage symptoms of dementia?

Answer 33

- loss of short-term memory - confusion - poor judgement - anxiety, agitation or distress - communication problems

Question 34

What condition is pictured here?

Answer 34

Fibroepithelial polyp

Question 35

What condition is pictured here?

Answer 35

Geographical tongue

Question 36

What condition is pictured here?

Answer 36

Atrophic Glossitis

Question 37

How should xerostomia be managed?

Answer 37

- alter medication regime - salivary replacement - frequent sips of water - salivary stimulants (eg chewing gum/lemon)

Question 38

What can cause lichenoid tissue reactions?

Answer 38

- NSAIDs - beta blockers - amalgam - diuretics - statins - antimalarials

Question 39

What pathology is pictured here?

Answer 39

MRONJ

Question 40

Give some uses of bisphosphonates:

Answer 40

- osteoporosis - paget's disease - multiple myeloma - breast cancer - prostate cancer - fibrous dysplasia

Question 41

What are some risk factors of development of MRONJ while taking bisphosphonate medication?

Answer 41

- extremes of age - concurrent use of corticosteroids - systemic conditions affecting bone turnover - malignancy - long duration of therapy - previous MRONJ diagnosis - invasive dental procedures

Question 42

What patient advice can you give to reduce risk of MRONJ development after dental procedures?

Answer 42

- regular dental checks - maintain good OH - limit alcohol & stop smoking - report any problems [eg loose teeth, pain, swelling]

Question 43

What pathology is pictured here?

Answer 43

Herpes Zoster (shingles)

Question 44

What is post herpetic neuralgia?

Answer 44

* will have had a previous episode of shingles - constant burning sensation in dermatomal distribution - resolves within 2 months [50%] - high suicide risk

Question 45

How is post herpetic neuralgia treated?

Answer 45

- antidepressants - gabapentin - carbamazepine - topical capsaicin 0.035% - TENS machine

Question 46

How can trigeminal neuralgia be managed with medications?

Answer 46

- carbamazepine - gabapentin - pregabalin - lamotrigine - sodium valproate - phenytoin

Question 47

What surgical management is available for trigeminal neuralgia treatment?

Answer 47

- avulsion of nerve - microvascular decompression - cryotherapy - alcohol or glycerol injection

Question 48

Who is more likely to experience burning mouth syndrome?

Answer 48

Females (F:M = 3:1)

Question 49

What are some causes of burning mouth syndrome?

Answer 49

- idiopathic in 50% of cases - drugs - xerostomia - candidosis - haematinic deficiencies - parafunctional habits - hypothyroidism

Question 50

What is frailty?

Answer 50

A state of increased vulnerability to stressors due to age related declines in physiological reserve across neuromuscular, metabolic & immune systems

Question 51

What are aspects of the frailty phenotype?

Answer 51

- unintentional weight loss (4.5kg in last year) - self-reported exhaustion - weakness - slow walking speed - low physical activity

Question 52

What is an example of an oral health promotion programme for elderly?

Answer 52

Caring for Smiles

Question 53

How do you report concerns you may have for vulnerable adults?

Answer 53

Recognise Record Report - if immediate danger = call 999 - speak to line manager - refer to adult protection procedures - complete AP1 and send to social care directly

Question 54

What is intellectual impairment?

Answer 54

Affected functioning in: - intellectual functioning (learning, problem solving, judgement) - adaptive functioning (communication, independent living)

Question 55

How do the social and medical models of disability differ?

Answer 55

Social Model: - disability is caused by the way society is organised, rather than by a person's impairment or difference Medical Model: - people are disabled by their impairments or differences

Question 56

What are some syndromes that are associated with learning disability?

Answer 56

- downs - prader willi - autism

Question 57

What causes Down's Syndrome?

Answer 57

Genetic mutation of chromosome 21 - trisomy of chromosome (95%) - mosaicism (2-4%)

Question 58

Why are Down's Syndrome patients at a higher risk of periodontal disease?

Answer 58

- impaired neutrophil chemotaxis (migration of neutrophils to sites of inflammation) - upregulated production of inflammatory mediators

Question 59

In those that cannot communicate pain, what are some signs and symptoms that suggest a person may be in pain?

Answer 59

- unprovoked aggression - altered facial expressions - changes to mobility/balance - changes in behaviour (irritability, withdrawal, tearfulness) - changes to appetite or vocalisation - altered sleep pattern

Question 60

What are some adjuncts that can be used to aid communication?

Answer 60

- makaton - picture boards - letter boards - talking mats - drawing - writing

Question 61

What can be used to aid access to the mouth in special care patients?

Answer 61

- bedi shield - bite blocks