Community Dentistry final
Terms
undefined, object
copy deck
-
1. How is fluoride deposited in calcified tissues?
2. How is fluoride released from the body? -
1. -via plasma
2. -it is excreted in the urine - How long does it take for fluoride to clear the body?
- 8-9 hours
- Is fluoride stored or excreted in the child? The adult?
-
-child= stored
-adult= excreted - What is fluoride balance?
- fluoride storage efficiency
- Where is fluoride absorbed?
- In the upper GI tract
- What is the acute fatal poisoning level in an adult?
- 2.5-5 g of fluoride w/in 2-4 hours
- What is the acute fatal poisoning fluoride level in a child?
- 435 mg F in 3 hours
- What are adverse effects of fluoride toxicity?
- gastrointestinal effects = stomach pain, nausea, diarrhea
- Who recomended that fluoride concentration in dental health products be limited?
- ADA
- How much fluoride do home products contain?
- no more than 300mg F
- What type of first aid should be administered if too much Fluoride is injested?
- induce vomiting initially and then have the person ingest material that will bind fluoride such as milk.
- How is fluoride application the most effective in caries prevention?
- in constant low levels
- In what stage of tooth erruption is fluoride most effective? (the primary role of fluoride occurs in this stage)
- the post-erruptive stage
- How does the primary role of fluoride in carries prevention work?
-
-enhances the ability to remineralize a lesion
-it is incorporated into dental plaque and relaesed in response to lower pH
-inhibits bacterial glycolysis/ metabolism
-has a direct bactericidal action on S. mutans - What is the secondary role of fluoride and when does it take place?
-
-incorporation of fluoride into developing enamel hydroxyapatite crystals. This reduces enamel solubility in acid
-pre- erruptive stages - What are the benefits of fluoride in the saliva?
- constant bathing of teeth in fluoride allows for remineralization
- Where is caries reduction greatest as a result of fluoridation?
- on free smooth surfaces and proximal surfaces
- In the market, where is fluoride mostly found?
- In toothpaste
- How does fluoride help older adult's teeth?
- in the prevention of root caries
- When fluoride toothpaste is used, is caries reduction proportional to the fluoride concentration in the toothpaste?
- yes
- Is MFP fluoride or NaF (neutral sodium fluoride) more efficient in carries prevention?
- MFP
- What problem does acidulated phosphate fluoride in professional products cause and what type of fluoride would be safe to use?
-
-will etch resins and veneers
-neutral sodium fluoride - What propery of acidulated phosphate fluoride enhances fluoride uptake?
- -the acidic environment
- What is a benefit of high concentrations of fluoride?
- it will form a reservoir on the tooth surface that becomes available for remineralization
- Fluoride is the main type of modality used in community prevention programs. What type of programs are available?
-
-fluoride varnish programs
-school fluoride mouthrinse programs
-fluoride tablets
-salt/milk fluoridation
-community water fluoridation - What is a fluoride varnish and what are advantages of its use?
-
-professionaly applied NaF adhesive
-can remineralize an existing incipient lesion
- is not easily ingested- used on small children - What is the only toothpaste additive that has been shown to reduce cavities?
- Fluoride
- What is the "into the mouth of babes program?
-
Program that asked physcisians to look into babies mouths.
-do a risk assessment for oral disease
(what is put in bottle)
-oral screening for disease-DDS referal
-application of fluoride varnish
-health education for primary caregivers -
Where are NaF mouthrinse programs used?
Is this cost effective? -
-in areas without water fluoridation
-no, especially when compared with water fluoridtion but is reasonable for high risk groups - Is fluoride recommended for preschool children or children living in communities with water fluoridation? Why?
-
-No
-because fluoride is toxic and they might swallow the fluoride, may cause fluorosis - How do dietary fluoride supplements work?
-
-contain naF
-child should chew, swish, swallow naF tablet
-primary effect is post erruptive - Are prenatal supplements ever recommended?
- -no, they have not been shown to provide any effect
-
When would one use salt fluoridation?
Where is it used? -
-if there is no community water you must fluoridate something else
-places with water wells, or little political acceptance of fluoride in the water- Europe, Central and South America -
Who does milk fluoridation target?
Where is this favored? -
-children
-favored in eastern european countries - Where is school water fluoridation provided?
- drinking water of school in rural areas
- Is school water fluoridation advocated by the CDC anymore?
- No
- What are the advantages of school water fluoridation? Disadvantages?
-
Advantage= targets population at risk, reduced decay
Disadvantage=
-expensive
-began F treatment at age 5-6
-only receive F while in school
-higher than normal dose to aid in last comment. - What is community water fluoridation?
- Addition of fluoride to public water supply w/ intent to privent decay
- What is water fluoridation?
- adjustment of the natural fluoride content of water to optimal levels to reduce disease
- What is the optomal fluordation level w/ greatest caries reduction & least risk of fluorosis?
- 1.0 ppm
- What level of fluoridation is recomended by the World Health Organization?
- .5-1.0ppm
-
What country has mandatory fluoridation law?
What countries have banned adding anything to the water? -
-Ireland
-Denmark & Sweden - What type of grant has the CDC provided to fund expertice and water fluoridation?
- The prevention block grant
- What two large US cities are currently nonfluoridated?
-
-Portland, OR
-Honolulu, HI - Do most Texans drink fluoridated water?
- yes
- What two cities in Texas are not optimally fluoridated?
- Texarkana and San Angelo
- When did San Antonio get fluoride in their drinking water?
- August 1, 2002
- What is the definition of efficacy?
-
How well the procedure worked under ideal conditions.
-example a study such as a controlled clinical trial - What is the definition of effectiveness?
-
the degree of achievement of the intended result under real world conditions.
-example a field trial - What is the definition of efficiency?
-
A result expressed in terms of money, time spent or saved
-example: quality of life measures = days of work/school saved because of lack of dental pain - What is the justification for a prevention-based approach to oral health care?
- efficacy, effectiveness, efficiency
- What are some of the benefits of community water fluoridation?
-
-provides protection w/out regard to social status
-reduces need/cost for dental fillings
-modest cost
-decreased abscence from work or school
-increase in learning/productivity - What is the halo effect?
- exposure to fluoride from processed foods and other sources rather than water
-
Is caries preventive benefits additive?
Will decay increase if fluoride is taken away? -
-Yes, topical Fluoride application + water fluoridation shows a greater decrease in decay
-yes - What did the workshop on cost effectiveness of caries prevention in dental public health ,Ann Arbor MI 1989 establish?
- water fluoridation is the most effective preventive measure and the least costly
- What are some recommendations from the clinician's handbook of preventive services?
-
-asses fluoride exposure and supplement as needed
-counsel pt on dietary impacts
-instruct partents to wipe teeth after feeding an limit exposure to bottle in evenings after the first year - Is there a mortality difference between fluoridated cities and non-fluoridated cities?
- no
- Can fluoride cause cancer?
- only if way above optimal levels, affects all sizes and shapes of people equally
- Can fluoride cause osteoporosis?
-
-Not at optimal levels
-Some studies show high doses of Fluoride increase vertebral mass but appendicular skeleton fractures increase - What happened at Hooper Bay, Alaska?
-
-The community was poisoned by fluoride, thought they had the flu
-results= periodoic plant inspections
fail safe overfeed devices put into place - Do most brands of bottled water include fluoride?
- yes
-
Do commercial water filtration systems remove fluoride from the water?
Do reverse osnosis filtration systems eliminate fluoride from the water? -
-no
-yes - Has fluoride been shown to cause birth defects of differences in bone density?
- no
-
Politically, who approves of the fluoridation of the water?
Has a court ever ruled against water fluoridation? -
-state law or city/municipal mandate
-no - What are some reasons for opposition to water fluoridation?
-
-holistic health approach
-polution of "pure" water
-cost
-dental disease is no longer a problem
-freedom of choice - What was the purpose of the CDC's report on the recommendations for using fluoride to prevent and control dental caries in the US
- to evaluate professional and scientific eveidence by grading the quality of the evidence and assess the strength fo each recommendation
- What is fluorosis most likely caused by?
- multiple and poorly controlled fluoride exposures
-
What is diet?
What is nutrition? -
-food & drink that passses through the mouth
-absorption and metaboliam of nutrients - What is acidogenic food?
-
Any food that contains sugar or other readily available fermentable carbohydrate
-is a necessary cause for decay - What is cariogenic food?
- ability of food to foster caries in human conditions conducive to caries formation
- What is fermentable CHO?
- term used to define sugars and refined starches
- How do sugar subsitues reduce the prevalence of S. mutans?
- they suppress the availability of nutrients (fermentable CHO)
- Name two noncariogenic sugar substitutes
- sorbitol and xylitol
- How does xylitol work?
-
-does not lower the pH of plaque to point where demineralization occurs
-xylitol gum can inhibit caries by a decrease in the quantity of supragingival plaque
-may promote remineralization and arrest established decay - How does sorbitol work?
-
-does not lower the pH of plaque to point where demineralization occurs
-does not promote caries & may help to reverse early demineralization - What type of protective foods can decrease the rishk of development of dental caries?
-
-Dairy- reduces the acidity of plaque and the cariogenicity of food
-Phosphates (in animals)
-reduction in sugar intake (drinks w/ sugar) - How should one counsel people on good food choices?
-
-choosing unrefined CHO
-moderate amounts of protein
-reduce consumption of foods high in fat - What type of systemic diseases has been causally implicated to perio disease?
-
-Type 2 diabetes
-cardiovascular disease - What are some eating disorders that affect oral health?
-
-binge eating
-pica
-anorexia
-bulemia - What are some oral manifestaion sof eating disorders?
-
-enamel erosion-(does not cause change in caries prevalence)
-salivary gland enlargement(parotid)
-tooth erosion (loss of vertical demension) - How should you handle someone with an eating disorder?
-
-Assesment( look for signs)
-intervention (increase dental visits)
-education
-referral - What is a fissure sealant?
- a plastic professionally applied material used to occlude the pits and fissures of teeth
- What are preventive sealants?
-
applied to at-risk, caries free pits and fissures to prevent caries in community dentistry we focus on these
-can be light cured or chemical cured - What are therapeutic sealants?
- applied to pits and fissures where caries is confined to enamel to arrest progression of incipient lesions
-
When is the loss of sealants most likely to occur?
Are sealants better retained in older children? -
-in the first six months after placement
-yes - Is retention of sealants better in bicuspids or molars,mandibular or maxillary teeth?
-
-bicuspids
-mandibular - Can sealants be placed over an incipient lesion?
- -yes, caries-active lesions become inactive under sealant
- What did the national preventive dentistry demonstration project do?
-
-combined fluoride mouthrinse program with community based sealant program
-showed that dental sealants work - Who is targeted by community sealant programs?
-
-Lower SES
-people with high # of unmet dental needs
-people around a shortage of dental professionals - Can trained auxiliaries apply sealants in public health programs in texas?
- yes- as of last year
- What is the definition of cost-effectiveness?
-
the least expensive way, among competing alternatives of meeting a defined objective, targets preventive procedures
- example: sealants to all teeth - What is cost-benefit?
-
the ratio of the cost of providing the service to the monetary benefit
-how much money will this save us if we do this procedure
-example: sealants only to those teeth with early lesions - Are sealants more cost effective in non-fluoridated areas?
- yes, in non-fluoridated areas there are more lesions to prevent
- What teeth are at highest risk for pit and fissure caries?
- first and second permanent molars
- What is the foundation for the Ecological Plaque Hypothesis?
- Perio prevention should be geared toward plaque control not plaque eradication because it is ubiquitous
- What happens to supragingival plaque if it is left undisturbed?
- becomes subgingival plaque that can be colonized by periodontopathogenic bacteria
- What is plaque?
- Natural biofilm that forms on the tooth surface, consisting of a diverse microbial ecology embedded in a matrix of bacterial/salivary origin
- How do you prevent periodontitis?
- prevent gingivitis
- What is the primary prevention of gingivitis?
- plaque removal,The cause of gingivitis is related to plaque mass
- How is subgingival plaque removed?
- Requires professional intervention to remove it
- What is the initial step in destructive periodontal disease?
- plaque
-
What starts plaque formation?
What causes the buildup of plaque? -
-microbial adhesion
-microbial multiplication - What does Plaque accumulation around the gingival margin leads to?
- an increase in crevicular fluid
- Subgingival plaque microflora shift from predominantly gram-positive aerobes to what?
- to more gram-negative anaerobes.
-
What is calculus?
What is subgingival calculus closely associated to? -
-a calcified matrix that can harbor periodontopathogenic bacteria
-both gingivitis and periodontitis. - What types of plaque must be removed by a professional?
-
-Subgingival Plaque
-Supragingival Calculus
-Subgingival Calculus - How often should plaque be removed by an individual?
- 24- 48-hours
- Is there a difference in effectiveness of power or manual toothbrushes if the person is normal?
- -no
-
What type of brushing technique should children use?
Adults? -
-Scrub technique for patients with limited motor skills (ie. children)
-Modified Bass technique for adults - What is the most recognized method of interdental cleaning?
- -Flossing
- What are some examples of interdental floss aids?
-
-Threaders: Patients with FPD
-Floss Holders: Assistance with dexterity
-Interdental brushes or Stim-U-Dent are preferred to floss when papillae have diminished and interdental spaces are pronounced - What does Chlorhexidine gluconate do to prevent plaque?
- adheres to residual biofilm and is released over 8-12 hours
- What are some characteristics of Chlorhexidine gluconate?
-
-Reduces gingivitis, gingival bleeding, and plaque deposits
-Inhibits formation of supragingival plaque
-Does not inhibit formation of subgingival plaque
-Can be used in caries control
-Effective against S. mutans for patients with elevated levels in saliva - What are Adverse Side Effects of Chlorhexidine gluconate?
-
-Staining of teeth and tooth colored restorations
-Potential for colonization of resistant organisms - What are the uses of Chlorhexidine gluconate?
-
-Improve plaque control following surgery
-Used 3-4 weeks after surgery
-Oral hygiene aid for patients with immobilized jaws
-Institutionalized patients with limited ability to manage own oral care -
Is listereine accepted by ADA as effective antiplaque rinse?
Should you recomend this to alcoholics? -
-yes
-no - How does stannous fluoride's antiplaque properties work?
- Affects the growth and adherence of bacteria
-
What are some examples of anticalculus toothpastes?
What are their action? -
-Pyrophosphates
-Triclosan
Action: Adsorbing to the tooth surface
-May have anti-inflammatory effect
-Prevents plaque deposition
-Reduces gingival bleeding - What is the HP 2010 Goal?
- to Reduce Periodontal Disease
- What is the primary focus of community based efforts to reduce periodontal disease on community level?
- Oral hygiene education and tobacco education
- What art the principal oral cancer risk factors?
-
-Smokeless tobacco (because of the method of use) is key factor in young persons
-Chronic cigarette smoking is a key factor in mature persons
-Synergistic effect when used in combination
-sunlight exposure and previous cancer experience - What is another principal Risk Factors not listed on the other slide?
-
-Low SES- poor, homeless, unemployed
-Underutilization of dental services
-Reduced chance of having an early lesion detected and treated - What is the definition of Social responsibility?
- Broad term encompassing professionalism, personal and professional ethics, and the role of a profession in the context of the greater society.
- What do Physicians for social responsibility stand for?
- They are devoted to nuclear disarmament, violence prevention and environmental health
- What do Educators for social responsibility
- Are concerned about teaching young people develop the convictions and skills needed to shape a safe, sustainable and just world.
- What do Business for social responsibility organizations stand for?
- Strives to help member companies achieve success in ways that respect ethical values, people, communities and the environment.
- What do Computer Professionals for social responsibility organizations stand for?
- Provides the public and policymakers with realistic assessments of the power, promise, and problems of information technology.
- What is the Societal role of social responsibility include?
-
-The professionÂ’s obligation to raise the oral health IQ of the community
-Assuring the health and well being of the public
-A persons right to health care - What are the Special rights and responsibilities of the health care professional based on?
-
-must have Competency- pass clinical tests
-must have Virtues
-must have Professionalism - what does the Intensive training and acquired specific skills of the health care professional involve?
-
-Includes technical skills, via certifications, licensing, credentials
-Requires appropriate knowledge and critical judgment and applying knowledge
-Most important***- Caring, is the greatest opportunity for professional services and satisfaction - What is professional ethics?
-
-Standards of conduct that distinguish between right and wrong, good and bad, virtue and vice, justice and injustice.
- how we ought to behave
-the development of moral behavior - Is oral health care a right or a privilege?
-
-The US constitution does not specifically guarantee a “right to health”
-Health and access to health care are not so much a legal right but a “moral” right
-Society has not universally accepted this responsibility, this is where we can make a difference - What are Structural barriers?
- Lack of health care insurance, high out-of-pocket expenses, lack of transportation, language difficulties
- What are Cultural barriers?
- characteristics of minority groups, such as styles of interaction and expectations
- What is the Pluralistic health care system
- US system with numerous, distinct health care delivery systems coexisting simultaneously
- What is health care Need?
- Those services deemed by the health professional to be necessary after a variety of assessment and diagnostic tools and past experiences
- What is health care Demand?
- The health care services desired by societyÂ’s perception of what is acceptable and unacceptable in terms of health and aesthetics
- Do males or females get more oral cancer?
- males
- What are the primary risk factors for oral cancer?
-
-Tobacco Use: Smokeless/Smoking
-Alcohol Consumption
-Exposure to Sun (Lip Cancer) - The prevention for current T&A users is to increase cessation. How do you increase cessation?
-
-Increase the price (tax)
-Mass media campaigns
-Telephone quit lines- effective when coupled with other measures
-Smoking bans
-Reduction of cost of nicotine replacement theapies - How would one reduce initiation for future users of T&A?
-
-Increase the price (tax)
-Mass media campaigns- removal of the ash trays - For nonusers of T & A how would one reduce environmental tobacco exposure?
-
-reduce exposure in the home
-smoking bans in public - What do smoking bans lead to?
-
a. Reduced exposure to ETS
-A change in attitudes
-Reduced initiation
-Reduced consumption
-Increased quit attempts
-Increased cessation
-****Ultimately reduced morbidity and mortality - What are some recomended interventions to increase cessation of T & A
-
-Provider education programs (alone)
-Provider feedback systems - How do Provider Reminders form an Analytic Framework?
-
-Provider knowledge
-Patient smoking status
-Advice to quit
-Attempts to quit
-Quit = decreased morbidity/mortality - How do Prevention of Sales to Minors (T & A) Programs help?
-
-retailer knowledge----retailer perceptions-----retailer behaviors
-Community Norms---enforcement---is the main arm that makes a difference
-Youth knowledge---youth perceptions---youth tobacco purchases---other sources may obtain tobacco for youths, this can harm instead of help prevention - What are some guidelines for school health programs to prevent tobacco use and addiction?
-
-Develop and enforce a school policy
-Provide education about short- and long-term effects, both social and physiological
-Provide tobacco prevention education in K-12
-Provide program specific training for teachers
e. Involve parents/families in support of school based programs - What does the National Spit Tobacco Education Program target?
-
-prevention of starting smokeless tobacco
-targets at risk groups- baseball clubs, 4-H clubs, little league baseball - What is the COMMIT program?
- Community-based intervention program encourages modification of the social environment to discourage high risk behaviors and attitudes
- What is the major result of COMMIT?
- Community based interventions are effective for light and moderate smokers
-
What does the study ASSIST do?
What is the result of ASSIST? -
-Is a smoking intervention study at the state level
-ASSIST states had lower adult smoking prevalence than non-ASSIST states - What are the 5 A's regarding tobacco use history with all patients?
- Anticipate, Ask, Advise, Assist, Arrange
- What type of patients are at risk for oral cancer?
-
-the age of 50 years, With a history of tobacco and/or alcohol use
-Men under the age of 50 years, with a history of ST use
-Women with a history of tobacco and/or alcohol use - When should you begin to talk to children about smoking?
- Begin when children are early elementary school age
- What are some Clinical Events to look for at the patient exam?
-
ƒÞ Changes in Soft and Hard Tissue
ƒÞ Leukoplakia
ƒÞ Halitosis
ƒÞ Tooth Discoloration
ƒÞ Abrasion and Wear
ƒÞ Gingival Recession
ƒÞ Periodontal Involvement
ƒÞ Oral Cancer (primary sites - Does smokeless tobacco contribute to oral cancer?
- yes, Smokeless tobacco use contributes to leukoplakia (precancerous lesion) which becomes malignant in 3-5% of the cases
- What is the principal market for Smokeless tobacco?
- Adolescent and young adult white males
- What is indicated as the strongest influence in ST use?
- Peer pressure
-
In adults, do blacks or whites use more ST?
What occupation uses the most ST? -
-blacks
-baseball player - What did the Comprehensive Smokeless Tobacco Health Education Act enforce?
-
-Warning labels on smokeless tobacco products
-Prohibition of radio and television advertising
-Prevention of sales to minors
-Development of health education materials for the public - What is the prevention of smokeless tobacco use based on?
- Based on public and private prevention
- Who is the target for primary prevention of tobacco use?
-
-Target children to not begin using tobacco.
-Intervene early with those individuals who are at greatest risk for tobacco use= White males of MS or HS age - Who is the target for secondary prevention for tobacco use?
- -Encourage those who are currently using to stop
- What is the five A list and who is it for?
-
-Ask, Advise, Assess, Assist, Arrange
-Cessation Protocol for Tobacco Users who are Ready to Quit - What is the five R list and who is it for?
-
-Relevance, Risks, Rewards, Roadblocks, Repetition
-Cessation Protocol for Tobacco Users who are NOT Ready to Quit - What are healthy people 2010 goals for reduction in oral cancer?
-
-50% of oral cancers detected in Stage I
- 20% of individuals report having had an oral cancer screening in past 12
-Reduce tobacco use in adults
-Reduce tobacco use in adolescents - What are some strategies to prevent oral injury?
-
-Seatbelt use/legislation
-Child safety seats
-Helmet use/legislation
-Mouthguard programs - How many states have seatbelt laws?
- 49
- What are primary laws concerning safetybelts?
- Allows police officer to stop a vehicle solely for not wearing a safety belt (without having other reasons for stopping the vehicle)
- What are secondary laws concerning safetybelts?
- Police officer may issue a safety belt law citation only if vehicle has been stopped for another violation.
-
Do all 50 states have child safety seat regulations?
Is primary or secondary enforcement used? -
-yes
-primary - What are some Child Safety Seat Programs?
-
1.Enhanced Enforcement Campaigns- Combinations of mass media and enforcement with penalties
2.Distribution and Education Programs-
Provide free/reduced cost seats with educational program
3.Incentive and Education Program-
Provide incentives for use of seats - Do dentists have a legal requirement to report suspected cases of child abuse?
- yes
- What are different Types of abuse and neglect?
-
-Child abuse (must be reported)
-Spousal/partner abuse
-Elder abuse
-Dental neglect - What are Potential signs of abuse?
-
-Bruises around the head and neck
-Bruises of multiple colors (indicate multiple stages of healing)
-Injuries that are inconsistent with events relayed to provider
-Inappropriate clothing for temperature
-Unusual shyness, withdrawal, or reaction to an oral procedure - Where do most child abuse injuries occur?
- in the head and neck region.
- Are abusers most likely to take child to dentist or doctor?
-
-Abusers are more likely to take the child to the DDS than the MD and are more likely to return to the same DDS.
-More often, abusers will NOT return to the same physician or ER. - MISC summary points
-
-dentists need to recognize their roll in overall health care
-dentists need to inform pts of risks of oral injury
-only 10% of dentists counsel on smokeless tobacco use behaviors - What is the definition of an underserved popultation
-
Any group of people without access to resources, either human or material, to enhance their quality of life.
-Because demographically diverse, lack of geographic and/or financial access to oral health care, inadequate attention to prevention - What is the definiton of a special needs population?
- Persons who have difficulty accessing dental services because of complicated medical, physical, social or psychological situations.
- What is the definition of a caregiver?
-
Individual who provides care for the patient on a routine basis
-Could be a parent or family member, direct staff member in a residential care facility, licensed vocational nurse in a nursing home - Why are Dental services available in the institutional setting not always available for special needs patients in the community?
-
-Dental providers are not trained to serve special needs patients
–Limited third party payment for delivery of complex services
–Treatment usually focused on ‘crisis care’ - Americans for Disabilities Act (1990) requires what?
- modification of physical space for access and provision of dental services
-
What is the leading cause of disability over age 75?
Do 50% of seniors report some level of diability? -
-dementia-AlzheimerÂ’s Disease, ParkinsonÂ’s Disease
-yes - Can Dental hygienists practice under general supervision in the nursing home?
- -yes
- What problems do nursing home residents face?
-
-Have limited access to dental care
-Lack of awareness among caregivers about the importance of oral health
-Under nutrition is a critical problem that effects oral health - What type of barriers to care do mentally and emotionally challenged people have?
-
-informational
-physical
-behavioral - What are some issues special populations face?
-
-Determination of Legal Guardianship
-Difficulties in Transfer of Patient from Wheelchair.
-Turnover of Caregivers
-increased Risk for Certain Diseases
-Reimbursement - What are some prevention considerations for the special needs patient?
-
•Use of fluoridated toothpaste on a mechanical toothbrush.
•Promotion of a healthy diet
•Consider xylitol gum for patient’s who can tolerate chewing gum
•Increase fluoride exposure (varnish applications)
•Regular dental visits for plaque removal and fluoride application
•Consider chlorhexidine gluconate rinse