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News Bulletin : ADA News Bulletin June 2011
44 JUNE 20 11 Dr O'Sullivan estimated there are over 500,000 elective general anaesthetics performed each year in a day surgery setting in NSW with few incidents. Statistically, a good percentage of these are provided for people with diagnosed and undiagnosed MCI. Attempting to scale patients with mini mental assessments before and after anaesthesia is very involved and has been inconclusive when performed in the USA. Intravenous sedation with local anaesthesia for the patient with a MCI could cause confusion and disorientation following dental procedures. Patient cooperation would be absolutely essential if sedation or regional anaesthesia were to be used. Sedation and dental care in an uncooperative patient may make matters worse. If cardio-respiratory health is satisfactory a general anaesthetic should still be considered. All current anaesthetic agents are suitable as they are rapidly metabolised and all have fairly short half-lives. However, pre-operative sedation as part of the GA should be avoided. Generally, first and second stage recovery following a GA will not be a problem although some patients may yell out or need to be restrained. The most common reason why a patient may become agitated after a hospital admission is because they have missed their regular medications. The unfamiliar changed surroundings alone can contribute to what is interpreted as a decline in cognition. Certainly, some patients with MCI may seem worse off after a GA. However, the underlying reason for needing a hospital admission or operation is the more probable cause of their MCI seeming to be worse rather than the GA itself. The anecdotal evidence that patients with dementia are 'never the same after a GA' has to be considered in context as family, carers and RACF staff are often Use the power of the internet to attract new patients and increase bookings www.dentalbookings.com.au WINA LUXURY ESCAPE FOR 2 TO HAMILTON ISLAND Register your business with Dental Bookings for your chance to win between 30/03/11 and 30/06/11. VALUED ATUPTO $4,500 2 a Open to Australian trade registrants only who sign up online or at the Dental Congress Dental Bookings stand for the Dental Bookings website. Promotion commences on 30/03/11. Entries close 11:59pm AEST on 30/06/11. The draw will take place at Level 15, Corporate Centre One, 2 Corporate Court, Bundall QLD 4217 on 06/07/11 at 10am AEST. Winner will be notified by mail and the winner's name will be published online on 11/07/11. The Promoter's decision is final and no correspondence will be entered into. Authorised under NSW Permit No: LTPS/11/01787, ACT Permit No: TP 11/00902.1. DB0001ADA Register now for free For more information please email firstname.lastname@example.org not good at identifying the incremental changes in MCI that take place over time. As most GAs for people with MCIs are as a result of fractures following falls with the most likely causes of the fall being a transient ischaemic attack, infection or hypoxia. CAN POOR ORAL HEALTH CAUSE BEHAVIOURAL CHANGES? From a dental perspective a high priority for our RACF patient and in particular those with Alzheimer's disease or other cognitive impairments must be our concern for them developing bacterial endocarditis or an invading neck space abscess such as Ludwig's angina if oral and dental health is ignored. As doctors and RACF staff have very little understanding of the implications of poor oral and dental health in the elderly, the mouth will often be overlooked as a possible cause of behavioural change. Doctors and nursing home staff may be faced with delirium or significant behavioural change in patients with a cognitive impairment which they will often attribute to urinary tract infection (UTI). UTIs are a common infection affecting women more often than men and can involve the kidneys, ureter, bladder and urethra. They are serious and even life threatening. Generally, a person who has an advanced cognitive impairment such as AD is not able to communicate how they feel or articulate what is wrong with them. VENTILATOR ASSOCIATED PNEUMONIA In the USA, a 337-bed regional medical centre in Washington DC has been providing oral care for patients to decrease risk factors for ventilator associated pneumonia (VAP), which is a common yet often fatal hospital acquired infection. The strategy aimed to save 100,000 patient lives by initiating several changes in hospital procedures. Each change focused on a specific problem, such as averting the incidence of VAP. The hospital aimed to decrease VAP and central-line infection rates as they had direct impact on mortality, morbidity and hospital costs. Their aim was to validate the introduction of oral care for the intubated patient in intensive care as a viable strategy for reducing VAP. They found that providing oral care is a means of improving nursing care, well-being, morbidity, mortality, and reducing health care costs. Although the highly respected and influential Centers for Disease Control (CDC) recommends the provision of oral care as a fundamental strategy in combating nosocomial infections such as VAP there is little evidence of it being universally implemented. A 9,080 US patient study found that the average VAP patient spends 9.6 additional days on mechanical ventilation, 6.1 extra days in ICU and 11.5 more days in hospital.4 VAP patients incurred an average of US$48,948 of additional hospital costs compared to uninfected patients.5 In 17 months, one US hospital reduced VAP by over 75% and saved US$1.6million.6 As VAP can commence within 24 hours of intubation and mechanical ventilation in an intensive care unit7 frequent oral care, including chlorhexidine application and twice daily brushing is essential. Improving cleanliness of the oral cavity by introducing comprehensive oral care in the intensive care unit reduces VAP and saves lives. There is a correlation between VAP and aspirational pneumonia. As pneumonia is one of the leading causes of death amongst the elderly and others who are chronically and terminally ill, aspiration of pathogenic oral microorganisms is a significant risk factor for the elderly. In the same way that comprehensive oral care in the intensive care unit reduces VAP, several studies support the provision of better oral health for the elderly as a strategy for reducing the incidence of aspirational pneumonia. Removal of opinion page
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