Definujte zápatí – název prezentace nebo pracoviště1 Patient with sensory handicap Restorative dentistry – differential diagnosis Seminar 1 Deaf patient ̶ Clear pronounce – lip reading ̶ Our face should be illumunated ̶ Speak slowly ̶ Simple sentences ̶ Check if the patient understood – question ̶ Verbal communication combine with non verbal communication – facial expression, gesture ̶ Patience, toleranceDefinujte zápatí – název prezentace nebo pracoviště2 Unseeing (blind) patient ̶ These patients are normal people, do not commiserate with them ̶ Speak to the patient not to the escort ̶ Introduce osf and inform about the position ̶ Missing visual perception compensate with verbal description of our work ̶ Inform about pain or discomfort in advance and give reasons for it ̶ Minimize disturbing noise Definujte zápatí – název prezentace nebo pracoviště3 Unseeing (blind) patient ̶ Remove obstacles and barriers ̶ Do not move quietly Definujte zápatí – název prezentace nebo pracoviště4 Pationet with physical ̶ Perceive the patient with attention ̶ Suppose always normal intelligence ̶ Give the patient enough time ̶ For communication withthe lying patient or the wheelchair user always sit down ̶ Keep all common convention ̶ Remove barriers Definujte zápatí – název prezentace nebo pracoviště5 Inflammation in oral cavity ̶ Infectious origin or secondary contamination (e.g. traumatic aethiology) ̶ The most common diseases: ̶ dental caries ̶ periodontitis Mentally handiccaped person ̶ Usually no typical diseas in the orofacial region, but some genetic symptoms can be related to some craniofacial anomalies ̶ Level of oral hygiene is usually worse – higher plaque accumulation, gingivitis, periodontitis, dental caries and its complications ̶ Approach to this patient with higher tact and empathy Definujte zápatí – název prezentace nebo pracoviště7 Mentally handiccaped person ̶ Communicate mainly with the patient despite the escort is participating ̶ Adapt the level of information to the ability of the patient, repeat question and instruction how many is necessary ̶ The mentally handiccaped person deserve the same respect as normal person Definujte zápatí – název prezentace nebo pracoviště8 Mentally handiccaped person Patients with uncontrolled muscular aktivity (muscular twitch,clench teeth) must be referred to the special department – the treatment in general anaesthesia is necessary Definujte zápatí – název prezentace nebo pracoviště9 Definujte zápatí – název prezentace nebo pracoviště10 Gerontological patient Restorative dentistry – differential diagnosis Seminar 1 Gerontological patient ̶ Biological age do not always correspond to the physical and psychical condition – individual approach Definujte zápatí – název prezentace nebo pracoviště11 Thre categories of gerontological patients ̶ Self – sufficient patients ̶ Patients with poor health ̶ Physically dependent on the help Definujte zápatí – název prezentace nebo pracoviště12 Gerontological patient - polymorbidity ̶ Arthritis ̶ Hypertension ̶ Cardiovascular diseases ̶ Diabetes mellitus ̶ Respiratiory diseases ̶ Stp.ictum ̶ Oncologic diseases Definujte zápatí – název prezentace nebo pracoviště13 Gerontological patient - polymorbidity ̶ Therapy acc to the diseases ̶ Various and multiple farmacotherapy Definujte zápatí – název prezentace nebo pracoviště14 Gerontological patient- polymorbidity ̶ History (be patient) ̶ Motivation, confidence in the dentist ̶ Elderly patients often want to speak about their healthy troubles Definujte zápatí – název prezentace nebo pracoviště15 Gerontological patient - approach ̶ Welcome ̶ Seating into the chair ̶ The dentist sit also (the same level of eyes) ̶ Encourage the patient ̶ Basic questions of the history – listening and observing ̶ Complementary questions Definujte zápatí – název prezentace nebo pracoviště16 Gerontological patient - history ̶ Farmacological medication – written ̶ Contacts of all doctors ̶ Assure that the patient took the medication before the treatment Definujte zápatí – název prezentace nebo pracoviště17 Gerontological patient ̶ Wide variety of physical and psychical status – individual approach ̶ Higher accumulation of fat and water ̶ Worse metabolism of glucose ̶ Weaker function of endocrinal glands and immune system ̶ Lungs are loosening their elasticity and ventilation ability Definujte zápatí – název prezentace nebo pracoviště18 Gerodontologic patient - polymorbidity ̶ Arterial elasticity is decreasing ̶ Cardiovascular diseases are mor often (heart insuficiency, disorders of cardiac rhythm, atherosclerosis) ̶ The function of the liver is decreasing (decreased blood circulation) ̶ The gastric acidity, intestinal motility and anorectal function is decreasing, Definujte zápatí – název prezentace nebo pracoviště19 ̶ Renal function is decreasing (the number of glomeruls is lower): the conequency can be lower elimination of some medicaments ̶ The muscular and osteous mass is decreased, risk of osteoporosis ̶ The function of brain athrofy Definujte zápatí – název prezentace nebo pracoviště20 Gerodontologic patient - polymorbidity Gerodontologic patient – clinical symptoms in orofacial region ̶ Hydratation of enamel is lower – uptake of fluorides is possible ̶ The enamel is thinner due to the abrasion and attrition ̶ Dentin tubules are getting more narrow, can be closed ̶ The pulp chamber is being reduced and dystrophy occurs Definujte zápatí – název prezentace nebo pracoviště21 Gerodontologic patient – clinical symptoms in orofacial region ̶ Sign of attrition or abrasion – abrasive facetts ̶ Loss or the periodontal elasticity, resorption of alveolar bone ̶ Production of saliva is lower (hyposialia - medicaments) ̶ Occlusal disorders – non stabile occlusion, postural muscular tonus – disorders of TMJ ̶ Skin: pigmentation, hyperkeratosis, basalioma ̶ - Cancer primary or secondary lesions Definujte zápatí – název prezentace nebo pracoviště22 Osteoporosis ̶ Bisphosphonate and similar medicaments ̶ Always check the effect of the medicament ̶ Extraction is indicated with atb – before and after the treatment (2-3 weeks!) ̶ It is better to refer the patient to the special department o or consult with specialist ̶ High risk of osteonecrosis - osteomyelitis!!! Definujte zápatí – název prezentace nebo pracoviště23 Arteficial joint ̶ Very often ̶ Eliminate the risk of focal infection before the treatment ̶ Patients have anticoagulation therapy – time limited ̶ Invasive treatment atb prophylaxis – chceck the farmacological interactions! Definujte zápatí – název prezentace nebo pracoviště24 Definujte zápatí – název prezentace nebo pracoviště25 Thank you for your attention ! lroubal@med.muni.cz 00420 607 122 064