Stroke and Seizure Management Quiz

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Questions and Answers

What is an ischemic stroke primarily caused by?

Congenital factors in arteries

A disruption in blood supply due to a clot (correct)

High blood pressure

A bleed in the brain

Which of the following is NOT a sign of an ischemic stroke?

Extreme headache (correct)

Weakness in one side

Facial drooping

Numbness and tingling

What symptom is uniquely associated with a hemorrhagic stroke?

Facial drooping

Numbness and tingling

Motor weakness

Violent explosive headache (correct)

Which tool is used for the pre-hospital stroke assessment?

FAST stroke assessment Signup and view all the answers

What is the 'last known well-state' in relation to stroke treatment?

The last time the patient was free of symptoms Signup and view all the answers

When is the optimal time frame for treating a stroke?

3 hours Signup and view all the answers

What is a common cause for a hemorrhagic stroke in individuals under 40?

Aneurysms Signup and view all the answers

What abnormal finding would you expect during the FAST assessment of speech?

Words slurred or inability to speak Signup and view all the answers

What symptom indicates expressive aphasia?

Inability to speak words Signup and view all the answers

Which of the following is a recommended dental management strategy for a stroke patient?

Minimize stress during treatment Signup and view all the answers

Which condition is NOT a common cause of seizure disorders?

Excessive hydration Signup and view all the answers

What is the proper action to take first when a patient has a seizure in the dental chair?

Clear all instruments away from the patient Signup and view all the answers

Which of the following is a characteristic sign of weakness in a stroke patient?

Sagging of one side of the face Signup and view all the answers

How should oxygen be administered during a seizure episode that lasts longer than 3 minutes?

At a rate of 6–8 L/minute Signup and view all the answers

What is the recommended method of applying fluoride for a stroke patient with limited self-care capabilities?

Daily fluoride gel application by the caregiver Signup and view all the answers

What is a critical consideration when performing dental treatment on an epileptic patient?

Ensure no bright lights or strobe effects are present Signup and view all the answers

What is another name for Down syndrome?

Trisomy 21 Signup and view all the answers

Which of the following statements about Down syndrome is true?

It can lead to low muscle strength. Signup and view all the answers

What is the initial action to take if a seizure lasts longer than 1 minute?

Administer a 10-mg dose of diazepam. Signup and view all the answers

What is a common characteristic of spastic palsy?

Rigid muscles on one side of the body Signup and view all the answers

What is the proposed modification for treating patients with cerebral palsy?

Minimizing distractions in the treatment setting Signup and view all the answers

What should be avoided following a seizure incident?

Further dental treatment that day. Signup and view all the answers

What describes sensory processing disorder (SPD)?

An inability to receive messages from the senses correctly. Signup and view all the answers

Which type of cerebral palsy is characterized by hypotonia and slow, uncontrolled movements?

Dyskenitic or athetoid palsy Signup and view all the answers

In managing a patient with Down syndrome, what is an important consideration during their dental treatment?

Use simple instructions and repeat them often. Signup and view all the answers

Which is NOT a recommended dental management practice for a patient with multiple sclerosis?

Perform all procedures without a saliva ejector. Signup and view all the answers

What is a significant issue that may occur in children with Down syndrome?

Heart conditions Signup and view all the answers

What can be a symptom of swallowing difficulty in patients with multiple sclerosis?

Fluid leaking from the nose after swallowing. Signup and view all the answers

How should dental care appointments be structured for patients with cerebral palsy?

Be supportive and calm with environments Signup and view all the answers

What is a common manifestation of trigeminal neuralgia in MS patients?

An 'electric shock' sensation when touching the cheek. Signup and view all the answers

Which dental management strategy is crucial for maintaining oral health in patients with multiple sclerosis?

Frequent reinforcement of hygiene instructions. Signup and view all the answers

In later stages of multiple sclerosis, which symptom may be observed?

Loss of muscle control of the cheeks and tongue. Signup and view all the answers

What occurs when the muscles responsible for moving food to the throat become weak?

Food can become trapped in the vestibule. Signup and view all the answers

What is the primary reason dentures need to be brushed daily?

To remove food deposits and plaque. Signup and view all the answers

Which method is recommended for cleaning the vestibule effectively?

Sweeping forward with a moist cloth or swab. Signup and view all the answers

Which should be avoided when caring for dentures to prevent damage?

Using a hard-bristled brush. Signup and view all the answers

What is described as a 'Special Patient' in the oral health field?

Individuals with physical, medical, or cognitive limitations. Signup and view all the answers

What is a potential consequence of allowing dentures to dry out?

Their shape may be lost. Signup and view all the answers

Which of the following is NOT part of oral hygiene management for individuals with special needs?

Ignoring salivary function. Signup and view all the answers

Which adaptive equipment is suggested for improving oral hygiene practices?

Electric toothbrush. Signup and view all the answers

What is one common barrier to dental treatment for patients with impairments?

Lack of funding for training Signup and view all the answers

Which condition is associated with excessive drooling and poor neuromuscular control?

Cerebral palsy Signup and view all the answers

What behavioral approach is recommended for managing challenging patients in dental care?

Using a 'tell-show-do' approach Signup and view all the answers

What is a common oral hygiene status issue among patients with impairments?

Higher prevalence of untreated decay Signup and view all the answers

Which of the following is NOT a key strategy for preventing hypersalivation?

Prescribing antibiotic therapy Signup and view all the answers

What might be a symptom of autism that complicates dental care?

Obsessive routines and repetitive behaviors Signup and view all the answers

Which form of sedation is often used to calm patients for dental treatment?

Nitrous oxide–oxygen Signup and view all the answers

What is a significant aspect of managing patients with challenging behavior in dental settings?

Practicing immobilization techniques only when necessary Signup and view all the answers

Study Notes

Neurological Disorders

Neurological disorders impact the nervous system, causing a range of impairments.

Cerebrovascular Accident (CVA)

CVA, commonly known as stroke, results from disrupted blood flow to a brain region.
Two main types of strokes exist: ischemic and hemorrhagic.
Ischemic stroke occurs when a blood vessel supplying the brain is blocked by a clot.
Hemorrhagic stroke happens when a cerebral artery ruptures.

Ischemic Stroke Signs and Symptoms

Ischemic strokes are often harder to detect.
This type of stroke can cause weakness in one side of the body.
Facial drooping can be a sign.
Numbness or tingling sensations may arise on one side of the body.
Problems with language.
Vision disturbances.

Hemorrhagic Stroke Signs and Symptoms

Hemorrhagic stroke symptoms often include a sudden, intense headache.
Visual problems.
Nausea and vomiting.
Neck and back pain.
Sensitivity to light.
Weakness on one side of the body.

FAST Stroke Assessment

A pre-hospital stroke screen.
Face: Facial drooping check.
Arm: Arm weakness.
Speech: Speech difficulties.
Time: Time of onset.

Face Assessment

Ask the patient to smile or show teeth.
Normal: Both sides of the face move equally.
Abnormal: One side of the face droops or doesn't move.

Arm Assessment

Have the patient close their eyes and lift both arms.
Normal: Both arms stay level.
Abnormal: One arm drifts downward compared to the other.

Speech Assessment

Ask the patient to say "You can't teach an old dog new tricks."
Normal: Clear and understandable speech.
Abnormal: Slurred speech or inability to speak.

Time of Onset

The critical window for effective stroke treatment is 3 hours (180 minutes).
This time window may, sometimes, be extended to 4.5 hours.
Knowing the patient’s "last known well state" is crucial.

Abnormal Speech

Slurred speech
Trouble forming words
Inapropriate words
Expressive aphasia (inability to speak words)
Receptive aphasia (inability to understand words)

Right-Brain Damage (Stroke on Right Side)

Paralyzed left side (hemiplegia)
Neglect of the left side
Spatial-perceptual difficulties
Minimization of problems
Quick performance, short attention span
Impulsivity, safety issues
Impaired judgment
Impaired time concepts

Left-Brain Damage (Stroke on Left Side)

Paralyzed right side (hemiplegia)
Impaired speech/language (aphasias)
Impaired right/left discrimination
Slow performance, cautiousness
Awareness of deficits: potential depression or anxiety
Impaired understanding related to language or math.

Dental Management of Patient With Stroke

Avoid procedures increasing blood pressure.
Minimize stress.
Elective dental treatment is not advised until 6 months after stroke, but preventive measures should start sooner.
Treatment can be done in short, smaller increments due to possible weakness/impairments
Four-handed dental hygiene is required.

Dental Management of Patient With Stroke (continued)

The affected side of the face tends to sag, and the tongue may be less active.
Reduced sensation can elevate the risk of biofilm buildup and oral complications.
Rinsing may be challenging for stroke patients.
Daily fluoride treatments like gels or trays are beneficial for affected patients.

Seizure Disorders

Genetic factors
Missed medication
Stress (emotional/physical)
Sleep disturbances
Hypoglycemia
Alcohol withdrawal

Questions to Ask For Seizure Patient

Time since last seizure.
Type of seizure.
Frequency of seizures
Medication for seizure control.
How the seizure started.
Warning signs before each seizure.
How the patient can communicate during a seizure.
If the patient feels confused or tired after the seizure.
When was the last seizure.

Dental Treatment Considerations of Epileptic Patient

Complete medical history intake.
Medication verification
Scheduling proper oral hygiene routines.
Avoid any bright lights or strong light sources.
Periodontal and surgical treatment to manage hyperplasias and minimize damage to the teeth.

Management of Patient During Seizure

Clear instruments away from the patient.
Position the chair in a supine position.
Position the patient on their side.
Do not restrain the patient.
Call emergency if seizure lasts more than 3 minutes.
Call emergency if cyanosis occurs.
Administer oxygen at 6-8 L/min..
If a seizure lasts >1 min or repeated administer 10 mg diazepam (IM or IV).

Post-Seizure

No dental treatments that day.
Assess level of consciousness.
Don't let patient leave if awareness is not restored.
Contact family/caregivers if needed.
Do brief oral assessment.

Sensory Processing Disorders (SPD)

A neurological condition impacting the ability to interpret sensory information.
Affects how the body receives/interprets sensory messages into appropriate motor/behavioral responses.

Multiple Sclerosis (MS)

An inflammatory/demyelinating disease.
Causes inflammation in the nervous system, damaging the myelin sheath (protective covering for nerves).
This leads to the formation of scar tissue.

MS Main Symptoms

Central: Fatigue, cognitive impairment, depression, unstable mood.
Visual: Nystagmus, optic neuritis, diplopia. Speech: dysarthria.
Throat: Dysphagia.
Musculoskeletal: weakness, spasms, ataxia.
Sensation: pain, hypoaesthesia, paraethesia.
Bowel: incontinence, diarrhea, constipation.
Urinary: incontinence, frequency or retention.

Oral Manifestations of MS

Oral/facial pain
Swallowing difficulty
Medication side effects
Caries/periodontal disease (related to poor oral hygiene)

Dental Management of Patient With MS

Transfer assistance from a wheelchair to the dental chair.
Manage swallowing difficulties
Manage issues with spastic/involuntary movements.
Manage facial pain and other oral side effects of medication.
Dental management of dysphagia needs to be considered.

Dental Management of Patient With MS (continued)

Assess gag reflex.
Employ meticulous suctioning during procedures.
Ensure access to saliva ejectors.
Protect the patient's airway.
Position the patient in a way that reduces the flow of fluids into the throat.
Consider any compromised laryngeal reflex. Note any diminished cough strength.

Swallowing Problems in MS Patients

Extra effort chewing/swallowing
Slow eating
Food packing into cheeks
Drooling
Fluid leakage from nose after swallowing
Increased chest congestion after eating
Aspiration risk
Aspiration pneumonia (related risk)

Oral Health Strategies For Swallowing Problems (MS and other patients)

Daily oral hygiene care (with assistance if needed).
Assessment of dentures for proper fit and stability.
Routine professional dental checkups.
Address dental hygiene and periodontal issues.
Reducing loss of teeth.
Semi-supine to upright dental chair positioning.
Limit water use during appointments.
Use short-lasting anesthetic/local anesthetic.

Control of Involuntary Movement

Extra/intra-oral mouth props
Rubber bite block; extended foam handle.
Gentle hand-holding.
Head stabilization

MS Oral/Facial Pain

Trigeminal neuralgia; facial palsy,
Possible early symptom of MS
Described as an electric shock-like pain in the face.
Can occur with tooth brushing or chewing.
Pain may occur several times per day.
Numbness in lower lip or chin.
Facial weakness or muscle paralysis may accompany the pain.

Dental Management for MS Oral/Facial Pain

Rule out dental etiology.
Occlusal orthotics management
Trigger point injections
Surgical management.
Peripheral nerve block/ablation.
Gasserian ganglion procedures.
MD consult: disease progression monitoring.

Xerostomia Management

Patient advice.
Water misting.
Let ice melt in the mouth.
Avoid mouth rinses with alcohol.
Humidify sleeping areas.
Limit caffeine intake.
Reduce tobacco use.
Use lip balm or sugar-free sweets/lozenges.

Meticulous Plaque Control

Mandatory for special needs patients
Caries prevention crucial
Plaque control instruction reinforcement (q3 mos).
Maximize fluoride rinse use.
Apply fluoride before bedtime
Professional fluoride varnish applications.

Tooth Brushing and Flossing Tips for Impaired Patients

Use toothbrushes with handles (for weak grip)
Consult a dentist for toothbrush modification.
Consider electric toothbrushes or other aids.
Assess the patient's need for adjusted flossing strategies..

Tooth Brushing and Flossing for Tired/Weak Patients

Sit while brushing and flossing
Start with water before introducing the toothpaste into the mouth).
Use weighted toothbrushes if trembling.
Consider weighted gloves to aid brushing.

Tooth Brushing Techniques.

Collis Curve
Twin Brush
Plaque Vac
Radius toothbrushes
Rotary toothbrushes
Ultrasonic toothbrushes (modified or adapted versions).

Flossing Techniques:

Waxed/Unwaxed floss.
Dental tape
Yarn/gauze strips.
Tufted/Superfloss.
Floss threaders.
Holders.
Rubber tips.
Interdental brushes.

Denture Care

Remove dentures daily.
Clean the oral vestibule.
Use a damp cloth, finger, cotton swab, or a large sponge to clean the vestibule.
Brush and clean dentures daily.
Remove from mouth before bed and place in suitable denture cleansing solution.

Tips for Caregivers of Patients with MS

Monitor for muscle decline in the cheeks and tongue.
Carefully assist with moving food to the back of the mouth to ensure swallowing
Removing dentures can ensure proper cleaning of the vestibule.
Denture brushing similar to natural teeth.
Do not force extremities into uncomfortable positions.
Use techniques to control movement and reduce any distractions during treatment.
Place patient in a slightly upright position.
Monitor for any signs of mouth/facial pain.

MS Oral Hygiene Strategies

Employ adaptive equipment for oral hygiene.
Electric toothbrushes, cords on toothbrushes.
Cuffs or utensil holders.
Suctioned denture brushes.
One-handed flossers.

MS Oral Hygiene Management

Early comprehensive oral rehabilitation.
Frequent professional visits.
Monitor caries/periodontal issues.
Monitor salivary function.
Educate caregivers on proper oral care routines.
Prevent infection and pain.

Special Needs Patient

Patients with physical, medical, developmental and/or cognitive conditions needing special considerations.
Daily oral care routines essential.
Prevent oral diseases.

Disabilities Overview

Physical disabilities
Intellectual disabilities
Learning disabilities
Syndromes (e.g., Down syndrome )
Cerebral palsy
Muscle atrophy
Autism

Congenital vs Acquired Disabilities

Congenital disabilities are present at birth.
Acquired disabilities develop during a person's lifespan due to illness, injury, or other events.

Barriers to Treating Special Needs Patients

Lack of funding for training and facilities.
Cost of specialist services and facilities.
Unwillingness of some general dental practitioners to treat special needs patients.

Physical Disability Considerations

Countries implementing special dental units or chairs for patients in wheelchairs.
Wheelchair platforms for better access and cheaper service options for special-needs patients.

General Oral Status

Patients may exhibit poor cooperation in oral hygiene.
Resistance or challenging behaviors common.
Limited access to dental services possible.
Oral hygiene prevalence higher in patients with impairments.
More untreated decay and missing teeth common.

Preventing Dental Caries in Special Needs Patients

Employ topical fluorides (high doses).
Use high fluoride toothpastes.
Utilize fluoride mouthwashes/alternatives
Employ dietary oral medications and constituents.
Utilize chlorhexidine gel or varnish treatments.

Tooth Wear in Special Needs Patients

Neurological impairments can cause clenching or grinding.
Cerebral palsy can lead to gastroesophageal issues causing tooth wear from vomiting.
Other factors might cause abrasion (bizarre oral habits).

Preventing Tooth Wear in Special Needs Patients

If patients cannot tolerate extensive dental treatments, remove badly worn teeth.
Use sedation if needed
Provide full coverage on affected teeth and molars.
Use non-erosive cleaning aids/techniques.

Gingivitis in Special Needs Patients

Poor oral hygiene leads to plaque buildup and gingivitis common
Down syndrome prevalence of periodontal disease and early tooth loss.
Epilepsy medications commonly associate with gingival hypertrophy.
Oral care support systems crucial.

Preventing Gingivitis in Special Needs Patients

Difficult/ill patients might employ care routines in bed or with a caregiver.
Use mouthwash/chlorhexidine dipped toothpaste.
Sustained chlorhexidine varnish may be used (up to 6 months) for affected patients.
Handle behavioral challenges with modification and desensitization.

Self-Inflicted Trauma

Self mutilation involving oral tissues in syndromes is common.
Teething sometimes triggers such behaviors.
Lip/tongue biting can cause pain, swelling, mouth soreness, dehydration, and hospitalizations.

Preventing Hyper-salivation

Excessive drooling prevalent in patients with poor neuromuscular control (from cerebral palsy, stroke).
Prevention & management includes surgical, pharmacological (e.g., hyoscine patch), and behavioral modification strategies.

Managing Challenging Patients in Dentistry

Employ premedication to calm patients.
Nitrous oxide-oxygen for mild sedation.
Physical restraints for safety considerations.

Autism

A complex developmental disability impacting communication, social, behavioral, and intellectual functioning.
Characterized by unpredictable body movements/repetitive behaviors/self-injurious behaviors.
Consultations with physicians, families and caregivers mandatory.
Gaining valid legal consent essential.
Patients may exhibit challenging behaviors, causing difficulty in daily communication/relation.

Autism Treatment modifications

Communicate/use a "tell-show-do approach" in simple terms.
Use/keep instruments and bright/stark lighting out of patient's visual field.
Keep appointments short and positive.
Praise/reinforce good behavior and ignore inappropriate behaviors.
Use immobilization techniques only when necessary.

Down Syndrome

Also known as trisomy 21.
Chromosomal disorder affecting physical characteristics and intelligence.
Low muscle tone and strength.
Heart conditions possible.
Dental development anomalies possible.
Periodontal problems can occur as well.

Cerebral Palsy

Non-progressive neural disorder often caused by prenatal, birth, or postnatal central nervous system damage.
Characterized by motor function impairments (paralysis, muscle weakness, lack of coordination).
Poor oral hygiene commonly affects patients with Cerebral palsy.
Various types exists (e.g., spastic, ataxic, dyskinetic .

Types of Cerebral Palsy

Spastic palsy: muscle stiffness/rigidity affecting limbs.
Dyskinetic palsy: uncontrolled/writhing movements.
Ataxia palsy: balance/depth perception problems.
Combined palsy: a combination of these types.

Cerebral Palsy Treatment Modifications

Focus on creating a stable/calm environment.
Avoid forcing unnatural extremity positions.
Make appointments and treatment short.
Minimize distractions.
Informing the patients prior to treatment about any planned movements.
Place in a slightly upright position.

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Description

Test your knowledge on the causes, symptoms, and management of ischemic and hemorrhagic strokes, as well as seizure disorders. This quiz covers important concepts such as the FAST assessment, treatment timelines, and dental management for stroke patients.