11 - Intellectual impairment 2 Flashcards
What are barriers to oral healthcare for those with learning disabilities?
- access
- individual characteristics
- pain recognition
- knowledge, skills and attitude of staff
- transition
How do individual characteristics make oral healthcare more challenging for those with learning disabilities?
- cognitive impairments (ie doesn’t understand importance of brushing)
- limited mobility
- sensory problems
- limited communication
- dependance upon others for support with oral care
- anxiety of dental services
How does access make oral healthcare more challenging for those with learning disabilities?
- may not have regular dentist, difficult to find dentist who is wiling to make reasonable adjustments
- cost
- transport
- reliance on others to support attendance
- access into surgery
How does pain recognition make oral healthcare more challenging for those with learning disabilities?
- may be unable to communicate pain or source of pain
- untreated pain can present as behavioural problem
How does the attitude, skills and knowledge of dental staff make oral healthcare more challenging for those with learning disabilities?
- can be difficult to manage patients who are uncooperative
- some dentists are not confident treating those with learning disabilities
- may lack knowledge about the condition
How does transition make oral healthcare more challenging for those with learning disabilities?
Child to adult health services transition is a difficult process for those with learning disabilities as may not have capacity
What are non-verbal signs of pain?
- aggression towards themselves or others
- changes in how a person holds their body
- altered facial expression
- changes to mobility and balance
- changes in behaviours
- changes to appetite
- confusion
- restlessness and changes to sleep
What are adjuncts that can be used to aid communication?
- makaton
- picture boards
- letter boards
- talking mats
- draw
- write
What can be used to aid examination of those with learning disabilities?
- bedi shield (plastic covering for finger)
- open wide mouth rests for patients who struggle to actively open mouth
When can clinical holding take place?
- if patient consents (should ask everyone in room)
- if no capacity, deemed of benefit and patient presents safety risk
- unplanned emergency
- should always be recorded in the notes with justification
What is important to ascertain during the social history of a person with a learning disability?
- living arrangements
- support, who and with what?
- transport
- likes/dislikes
Why is prevention key for those with a learning disability?
- there are higher levels of untreated caries
- do not cope well with restorative work which can lead to multiple extractions
- do not cope well with dentures
What oral risk factors are associated with people who have learning disabilities?
- frequent sugar intake and food pouching
- medication can cause xerostomia or gingival hyperplasia
- lower income/education levels
- difficult to access services
- non-oral feeders
- reduced dexterity and poor motor control
- sensory sensitivity can prevent cooperation with oral care
- difficulty understanding importance of oral care
- imbrication common
What conditions can be linked to self-injurious behaviour?
- cerebral palsy
- autism
- tourettes
- lesch-nyan syndrome
- profound neuro-disability
- exaggerated or abnormal oral reflex
What is lesch-nyan syndrome?
- when patient eat their own tissue
- can be managed with gloves, lip guards or even extraction of anterior teeth or creation of AOB
