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1 Hr Special Needs management of the poly-medicated patient, management…

- - - - classification
        
        GMFCS
- - - - psychotropic medication
        
        salivary gland hypofunction+ xerostomia
    - - Rampant caries- xerostomia + dietary habits
      - Denture stomatitis, glossitis, gingivitis, oral ulcers
  - - - xerostomia, stomatitis, glossitis
    - - diet counsel
      - perio
        
        increased smoking
        OH neglect
        altered immune response (type of bacteria)
  - - - Medications:
        
        SSRIs and SNRIs
        
        xerostomia
        increased risk of bleeding/ GI bleeding with aspirins and NSADIs
        Increased side effect with vasoconstrictors
        no analgesic effects with codeine, oxycodone and hydrocodone
        
        Tricyclic antidepressants (TCAs)
        
        increase risk of orthostatic hypertension : limit adrenaline containing LA
        
        MAO inhibitors
        
        increase risk of orthostatic hypertension : limit adrenaline containing LA
        
        Tramadol contraindicated - serotonin toxicity
        
        risk of serotonin syndrome (too much serotonin)
        
        Mood stabiliser
        
        Lithium - xerostomia, altered tastes due to taste of lithium tablets, lithium toxicitty with NSAID and Naproxen
        Carbamazepine - AC side effects, OH
        Gabapentin - OH, adrenaline in LA
        Valproate - bleeding risk
        
        remember thissss
        
        Antipsychotic drugs
        
        Anticholinergic side effects
        
        All cause orthostatic hypotension
        
        Increase side effects with adrenaline containing LA
        
        All can produce tardive dyskinesia
    - - timeout breaks - put hand up
        
        pt in control
        
        can't say the hallucination is not real - not helpful
  - - - manic and depressive phase
        
        manic phase
        
        abrasion of gingiva and teeth with bruhsing
        
        depressive phase
        
        disregard OH, caries (prefer carbs), perio (smoking, poor OH)
        
        medications
        
        xerostomia
        bruxism
        stomatitis/glossitis
        
        Goal of tx: stabilisation and maintenance
- - - - Sudden elevation in BP could lead to a stroke
        
        Dental Tx
        
        Defer elective dental treatment if BP is above 180/110mmHg- refer to GP
        
        Essential tx - manage in consultation with GP
        
        Stress management is important
  - - - prosthetic cardiac valve
        cardiac valve repair
        previous IE
        some congenital heart disease
        rheumatic heart disease
- - - - Periapical lesions, severe periodontitis and active abscess the already involve the medullary bone may exacerbate osteonecrosis
- - - - cold sore
        
        normally 2-6 times a year, HSV-1, rupture and crust, tend to resolve after 10 days.
        
        consult dentist for supportive management with topical analgesics or antivirals. Defer elective dental treatment for pt with active cold sores and practise standard precautions
      - VZV
        
        pt with primary varicella need to be seen in airborne contact isolation
  - - - no vaccine
      - risk of infection with a percutaneous injury is ~ 2 %
      - 15% of pt become spontaneously clear of the virus, 85% becomes chronic
      - Dental complications
        
        risk for lichen planus, salivary gland dysfunction, oral cancer
        
        xerostomia
        
        higher risk of caries/ perio
      - require a number of tests before dental tx e.g. INR and liver function test- consult dentist and GP, thorough Mhx e.g. cancenr, jaundice, meds, alcohol intakes, bleeding tendencies, recreational drug use
  - - - tx
        
        Antiretroviral therapy : might have complications e.g. xerostomia, angular cheilitis
- - - - mainly include:
        social communication impairment
        restricted interests/ repetitive behaviours
        
        onset age
        
        12-24 months
        
        Tx/ management
        
        Parent counselling, special education, speech therapy, social skills training
    - - might not work
        
        Traditional approach
        Tell-show-do
        distraction
        positive reinforcement
        non-verbal communication
      - Non-traditional approach
        
        Visual pedagogy with pictures, stories and video (ASD pt might response better with pictures than words)
        
        desensitization, just looking instruments
      - Advanced behaviour guidance
        
        Sedation
        
        General anaesthsia
        
        Nitrous still req good pt behaviour e.g. wear mask and understand to breath through the nose
        
        try to maintain OH before GA list
- - - - based on function, activity and participation
- - - - Dental problems
        
        Facial: Midfacial hypoplasia (the maxilla is deficit while the mandible can be normal or deficit)
        
        airway issues?
        
        Dental: hypodontia, peg laterals, over-retained primary teeth, delayed tooth eruption
        
        Implications
        
        lower caries
        
        High attrition and erosion
        
        poor OH - gingival inflammation
        
        more susceptible to infections
        
        Management
        
        Early intervention with parents and caregivers
        
        Early and regular visits, starting at 12-18 m
        
        Prevention is key : s/c, prophy, OH motivation, brushing
        
        TFA
        
        fissure sealant
        
        reduced recall interval
        
        diet counselling
        
        Structural: Fissured and protrusive tongue, macroglossia, malocclusion
        
        Implications
        
        Plaque trap
        
        gag reflex
        
        affected swallowing, speaking
        
        Management
        
        Use neck pillow
      - More prone to infections
      - Management
        
        pt with congenital HD should be assessed for the risk for IE prior to dental tx
        
        Good OH can prevent aspiration pneumonia
        
        check if ID affect the ability to OH independently