13- mental disorders

What is Alzheimer’s, 4 general presentations?

Acquired chronic organic brain disease

Amnesia, intellectual impairment, disorientated, can’t concentrate

Autopsy only definitive diagnosis

8 dental considerations of Alzeheimer patients

Appointments in morning

In familiar environment

Explain and avoid discomfort

Complex procedures asap

Poor oral hygiene

Dry mouth

Preop sedation with short actongBDZ

Caution- using VC in patients taking tricyclic antidepressants and SNRIs

What is ADHD?

Excessive long term impulsivity, inattention, hyperactivity

Diagnose before age 7- persist at least for 6 months

5 dental considerations of ADHD?

Short morning app 30-60 mins after medication

Avoid anxiolytics (BDZ)- may aggravate hyperactivity not depress it

Safest- sedation with Nitrous oxide- conscious sedation or GA essential

LA with adrenaline may increase BP

5 characteristics of ASD

Seem unable to form emotional bond/indifferent

May physically attack others- no reason

May seem deaf/incapable of understanding feelings and thoughts

Fixated on single item/activity

Disturbed by noise

4 Dental considerations for ASD

Don’t keep them waiting

Develop routine- same staff

Short, quiet visit

Antidepressants and b blockers may help

5 dental considerations for body dysmorphic disorder

Longer apps at end of day

NSAIDs may diminish SSRI effect- SRI may increase NSAIDS antiplatelet effect

SSRIs decrease BDZ metabolism

Don’t use Carbamazepine and tramadol with SSRIs

6 dental considerations of depression

Dry mouth due to medication

Painful disorders in orofacial region- BMS, TMJ

Delusional complaints- xerostomia despite normal salivary flow, lumps, imagined halitosis

Paracetamol can inhibit tricyclic antidepressants

MOI with GA- prolonged respiratory depression

Postural hypotension

8 dental considerations of eating disorders

Tooth erosion (vomit)

Parotid enlargement

Angular stomatitis

Ulcers on soft palate (fingers in throat)

Risk of cardiac arrhythmias due to electrolyte disturbances

Paracetamol may be hepatotoxic

VC with caution

Sedatives may interact with and increase sedation

What is mania and 2 types?

Elation, butterfly ‘flighty’ thinking, poor judgment, extrovert

Bipolar 1- classic mania with recurrent depressive episodes

2- lower mania level with major depression- high functioning

Increase NE, decreased serotonin + dopamine

6 dental considerations of mania- avoid, safe drugs?

Xerostomia - due to lithium and antidepressants

Difficult to manage

Avoid- NSAIDS and metronidazole- toxicity

Safe- aspirin, paracetamol, codeine

Arrhythmias triggered during GA

Interaction with lithium- stop 2-3 days before

4 dental considerations of OCD

Compulsive tooth brushing

Imagined possibility of

• halitosis

• infections

• cancer

4 dental considerations of Panic disorder, how to manage a panic attack

Bruxism

Lip chewing

Dry mouth

Facial arthromyalgia

Peaks in 10 mins, last 20-30 mins- discharge after recovery and reschedule

6 dental considerations of schizophrenia

No specific oral features- delusions, but long term neuroleptics cause-

Hyposalivation

Xerostomia- candidiasis, caries

Oral pigmentation

• muscular rigidity or tonic spasms

• Communication difficult

• Early morning apps

4 dental considerations of self harm

Short, stress free apps

Avoid anxiety, stress and pain

Oral lesions

If not emotionally stable, don’t treat