Theory Quiz 2: Lectures 6 & 7 Highlights

Culture

set of guidlines that one can inherit as a member of a particular group or society.

Subbculture

is a group of people who have different goals and interests within a primary culture (Ex: Bikers)

Ethnocentrism

refers to the belief that one's culture is superior to that of others.

Stereotyping

is the often-erronous assumption that a person possesses certain haracteristics or traits simply because they are a member of a particular group.

Globalization

increasing interdependence of the worlds populations, due to increased trade and technology

(produced in more culturally diverse societies)

The clinician is required to ask clients about their _____ ______and their cultural backgrounds.

health beliefs

Diversity continuum In Communication Model:

emphasizes the presence of the clinicians self-awareness and self-exploration as being a necessary first step in the provsion of culturally competent care.

Cultural Sensitivity

an awareness of cultural differences and similarities exisit, which effect the values, learning and behaviors.

Cultural Competence

involves awareness of one's own biases or prejudices and is rooted in respect, validation and openness toward differences; involves recognizing patient's as unique individuals, all while understanding that experiences, beliefs, values and language affect perceptions of the healthare delivery and clinical outcomes.

How do you communicate for Cross-Cultural Competence?

- use facts; NOT judgement

* the use of gestures, eye contact, etiquette, physical contact, and listening will differ amongst cultures *

When in doubt, it is best to _________ _____ _________ to necessary touch ONLY.

restrict physical contact

Collectivist Culture

group is viewed as the findamental unit of society.

Individualistic Culture

Views the single person as central, with autonomy and self-determination being essential to medical and dental care.

Health Disparities/ Inequities

differences in health status or in the distribution of health determinants among different population groups

-Poverty

-Socioeconomic Status (SES)

Poverty

is a major contributor to health disparities and a barrier to individuals metting their basic human needs for systemic and oral health.

Socioeconomic Status (SES)

is correlated with race and ethnicity.

Inequality and Poverty

A major emphasis of culturally competent care is ensuring equitable, high-quality care among diverse and disadvantaged groups

_______ is a KEY predictor of poor oral and systemic health; it affects where one lives, how one spends money, where one recieves healthcare, and ultimately, one's general and oral health status.

Poverty

The oral health professional should take on the ___________ of reducing barriers to improve patients' access to and QUALITY of care.

responsibility

Sample Question #1:

Which of the following concepts and practicess will guide the clinican towards providing culturally competence care?

A. The clinician is encouraged to ask clients about the patients' health beliefs and their cultural backgrounds.

B. Having awareness that cultural differences exist.

C. Understanding that cultural differences affect values, learning and behaviors

D. Recongnizing patients' as unique individuals, while understanding that experiences, beliefs, values, and language affect perceptions of healthcare delivery and clinical outcomes.

E. All of the above.

E. All of the above

Sample Question #2

FILL IN THE BLANK: Research indicates that there are large health disparities in the United States that are pervasive and persistent. These health disparities reflect inequalities that exisit in our society and are correlated with: _____________

A. socioeconomic status

B. race

C. ethnicity

D. All of the above

D. All of the above.

Physiological dependence

is a behavioral pattern characterized by drug caving, out of control drug usage, overwhelming desire to obtain a drug supply often leading to crime. (personal and legal difficulties)

Physical dependence

is an adaptive state, occuring after prolonged use of a drug, in which discontinuation of the drug causes physical symptoms that are relieved by re-administering the same drug ot a pharmacologically related drug.

BOTH _________________ and ___________________ types of dependence can lead to compulsive patterns of drug use where the users lifestyle is focused on taking the drug.

Physiological and Physical

What is addicition?

a treatable, chronic medical disease involving complex interactions among brain circuits, genetics. the environment, and individuals life experiences.

* People w/ addiction use substacnes or engage in behaviors that become compulsive and often continue depite negative outomes*

Black Hairy Tongue

elongated; black, brown, yellow or white papillae that form in response to solif or gaseous wastes of tobacco being trapped on the tongue surface.

Slowed cell sloughing adds to this syndrome.

Food and bacteria can get trapped in the papillae and cause halitosis**

While saliva flow is generally reduced in chronic smokers, the act of smoking stimulates serous saliva flow. This can increase _______ production and _______ is generally present.

Calculus

Stain

Gingival and Periodontal Diseases:

Smokers have a higher risk of developing severe perio diseases such as.....

Necrotizing ulcerative gingivitis

Smoking:

List some possible oral changes.

Candidiasis

Nicotine Stomatitis

Smokers Keratosis

Pigmentation

Xerostomia

Nicotine is a ______________ and reduces the blood flow to the tissue.

vasoconstrictor

Leukoplakia

a precancerous lesion of the oral soft tissues that conists of a white patch or plaque that cannot be scraped off

-often associated w/tobacco use

-can persist w/o pain or irrtation

-can develop into more serious lesion

-some wil regress if tobacco use is discontinued

Chewing tobacco can lead to ____________ ________.

periodontal disease

When tobacco products are held in the mouth, it allows __________ to flourish

bacteria

What is a typical sign of perio disease caused by chewing tobacco.

bleeding, but bleeding may not occur is the nicotine use is high because nicotine is a vasoconstrictor and will stop the tissues from bleeding due to lack of blood flow.

What are some Nicotine Replacement Therapy options?

Patch

Gum (Pilocrilex)

Lozenge

Spray

Oral Inhaler

What is the Prescription Pharmacotherapies for Tobacco Cessation?

-Sustained- release buproprion (Zyban) (Wellbutrin)

blocks the dopamine from surging after nicotine is inhaled/absorbed.

is an antidepressant that helps balance dopamine levels when nicotine starts to leave the body, preventing nicotine withdrawl symtoms.

-Varenicline (Chantix)- blocks nicotine receptors in the brain -smoking DOES NOT provoke same response.

Metabolism of Nicotine

1. Nicotine from smoking

A: Absorption: ____________

B: Distribution

Lungs

Metabolism of Nicotine

2. Smokless Tobacco

A. Absorption: _______

B. Distribution: ________

Oral Cavity

Intestinal

What are the oral manifestations of tobacco and nicotine use?

oxidative stress and cell death to epithelium tissue

List the Nicotine Free Therapies.

Bupropion SR

Varenicline Tartrate

Combination therapies systemic med PLUS NRT

Second line medications

For alcohol consumption, what are the clinical patterns of alcohol use?

Effecs of alcohol intoxication

Consequences of under aged drinking

Signs of AUD

For alcohol consumption, what are the etiology factors?

Genetics

Biophysical

Environmental

Alcohol

Drinking alcohol has been associated with _______ ______ and it breaks down ______________.

Can trigger infalmmatory response in the body*

oral cancer

acetaldehyde

Alcohol

Excessive use may damage the ____ and _____ ___ resulting in excessive bleeding during dental treatment.

liver and bone marrow

Alcohol

The drugs used in dentistry that are metabolized in the liver include ___________ ______ ____________ and ____________________. These drugs can have a reduced effect in patients who abuse alcohol.

amide local anesthetics and benzodiazopines

Alcohol

Studies have shown that _______ ________ is associated w/ periodontal disease.

Impairs neutrophil function, contributing to bacterial overgrowth which may lead to _______ ____________.

High intake increases ______ production of inflammatory cytokines (TNF-a), interleukins-1 and 6) in the gingival crevice which is association with ________.

neutrophilic phagocytosis

periodontal inflammation

monocyte

periodontitis

List the Metabolism of Alcohol in ORDER.

I. Ingestion and Absorption

II. Liver Metabolism*

III. Diffusion

IV. Blood Alcohol Concentration (BAC)

What is Naloxone (Narcan)?

nasal spray that black the effects of opioids in overdose situations.

What are some treatment methods?

Behavioral therapies

Drug Withdrawl Medications

A.Methadone (Dolphine, Methadose)

B. Buprenorphine (Subutex) Buprenorphine.Naloxine (Subuxone)

C. Naltrexone (Vivitrol/ Revia)

D. Other Meds

- Benzodiazipines- reduce anxiety/irritability

- Antidepressents- Prozac-Zoloft

- Clonidine- reduce sweating, cramps, muscle aches, anxiety

If a patient has CONSTRICTED PUPILS, what drugs could they be using?

Heroin

Morphine

Oxycodone

Fentanyl

Mathadone

Codeine

Hydrocodone

If a patient had DIALATED PUPILS, what drugs could they be using?

Amphetamines

Methamphetamines

Cocaine/Crack

Weed

Hallucinogens

Pharmacologic treatment includes....?

drugs that are usually prescribed to treat the symptoms of depressions and anxiety disorders are often given to treat patients with addictive behavior disorders.

List the types for Fluoride Absorption.

GI tract

Blood Stream

What does Fluoride do in the GI tract?

-it is rapidly absorbed as hydrogen fluoride through passive diffusion rate in the stomach.

-the rate and amount of absorption depends on the stability of the fluoride compound and stomach acidity.

-absorbed w/in 60 minutes

-less fluoride is absorbed if taken with milk and other food.

What does Fluoride do in the blood stream?

-plasma carries the fluoride to its distribution throughout the body and to the kidneys for excretion.**

-max. blood levels are reached within 30 mins of absorption.

What is the Distribution and Retention of Fluoride?

fluoride is distributed by the plasma to all tissues and organs; there is a strong affinity for mineralized tissues.

In 2015, the ___________________________________ updatd the recommendation for the optimal concentration of water fluoridation to ____ppm for ALL communities, regardless of climate.

U.S. Department of Health and Human Services

0.7ppm

No more than _____ mg NaF (120 mg fluoride ion) to be dispensed per household at one time.

254mg

List the Fluoride Compounds and their %.

2.0% NaF gel*

1.23% APF foam*

5% NaF varnish*

38% silver diamine fluoride (SDF)*

2.0% NaF foam

1.23% APF gel

Concentrations of _______ppm fluoride or less can be sold OTC. Some product containing less may be available as Rx.

1,500ppm

Fl2 is a contraindication for?

children under the age of 6 or any child that cannot properly rinse due to a disability.

Dentists prescribe no more that _______mg of fluoride at one time.

120mg

What does CDL stand for?

certainly lethal dose

~ 5-10g of NaF taken at one time

- 5mg/kg of body weight (varies by size and weight of child)

What does STD stand for?

safely treated dose (1/4 of CDL)

When do symptoms begin with Acute Toxic Dose?

w/in 30 mins of ingestion and may persist for as long as 24hrs.

How does fluoride affect the GI tract and what are the symptoms?

fluoride in the stomach is acted on the the hydrochloric acid to form hydofluoric acid, which is an irritant to the stomach lining.

Sypmtoms:

nausea, vomiting, diarrhea, abdominal pain, increased salivation and thirst.

What are the systemic involvments of fluroide?

Blood: Calcium may be bond by the circulating fluoride; causing sypmtoms of hypocalcemia.

CNS: Hyperreflexia, Convulsions, Paresthesis

Cardiovascular+ Respiratory Depression: if not treated, may lead to death in a few hrs from cardian failure or respiratory paralysis.