8 - Dentistry for children with disabilities Flashcards
What are the different classifications of disability?
- intellectual
- physical
- sensory
- medically compromised
What are the clinical implications of social communication with a child with ASD?
- may have limited language so use preferred mode of communication ie makaton
- think literally so use concrete language and avoid jokes
- body language is not always understood
- may not understand unwritten social rules
- find people unpredictable so ensure everything is explained clearly
- can appear uninterested so check understanding
What are the clinical implications of routine with a child with ASD?
- may become upset if routine is interrupted so ensure same features of each appointment
- may need acclimatised
- if possible, follow the same routine at each appointment (and same staff)
What are the clinical implications of special interests with a child with ASD?
Make the effort to learn about their own interests and note of of these in notes to put patient at ease
What are the clinical implications of sensory difficulties with a child with ASD?
- avoid stimuli that can trigger child if possible
- use ear defenders or other aids
- can find waiting rooms difficult so have first appointment of day or wait in side room
- withdrawal or meltdown can be in response to overstimulation - don’t disturb unless essential
- may have strong dislikes of flavours so mild toothpaste is ideal
How do you manage a child with ASD in the dental surgery?
- prepare yourself and the patient
- questionnaire to parent can be useful for first appointment
- use any sensory aids the child needs
- keep environment quiet
What are the dental features associated with downs syndrome?
- maxillary hypoplasia
- class III occlusion
- macroglossia
- AOB
- hypdontia
- microdontia
- predisposed to periodontal disease (inhibited macrophages and neutrophils)
What are the different types of cerebral palsy?
- spastic
- ataxic
- dyskinetic
- can be mixed
Describe spastic cerebral palsy.
- most common type
- affects cortex in brain
- causes increased muscle tone
- can be described as diplegic, hemiplegic or quadriplegic
Describe ataxic cerebral palsy.
- affects cerebellum
- coordination and balance are affected
- difficulty with movements that require lots on control ie writing
Describe dyskinetic cerebral palsy.
- basal ganglia affected
- cause uncontrollable movements
- face be affected and person can struggle with swallowing and talking
Define diplegia.
Legs are affected, arms are less affected or not at all
Define hemiplegia.
One side of the body affected and arm is usually more affected than leg
Define quadriplegia.
All four limbs, trunk and face affected
What are the dental implications for people with cerebral palsy?
- find it hard to remain still and accept dental treatment
- malocclusion more common
- increased risk of dental trauma
- high prevalence of bruxism
- drooling
- poor OH
- unsafe swallowing (calculus if PEG fed)
- hyperplastic gingivitis
What communication aid is available for those with a visual impairment?
Braille
What communication aid is available for those with a hearing impairment?
- BSL interpreter
- hearing loops
What is the most common childhood cancer?
Acute lymphoblastic leukaemia
What are the oral manifestations of ALL?
- gingival swelling
- ulceration
- spontaneous gingival bleeding
- unusual mobility of teeth
- mucosal pallor
- herpetic infections
- candidiasis
What are the dental effects of chemotherapy?
- mucositis
- decreased neutrophils cause an increase in infection risk
- decreased platelets cause an increase in bleeding risk
- long term, enamel hypoplasia, microdontia or thin roots as developing dentition is affected
What are the dental effects of radiotherapy?
Short term
- mucositis
- xerostomia (caries, IO infection and taste disturbance)
Long term
- malocclusion
- ORN risk
- increased of soft tissue neoplasm
- affects to developing dentition
How are children with cancer looked after in the dental surgery?
- all possible sources of infection should be removed before treatment begins
- optimal OH important
- management of mucositis
Define a cyanotic CCD.
Deoxygenated blood is able to enter the bloodstream
Describe an acyanotic CCD.
Normal levels of oxygen remain in the blood
What is the most common cyanotic CCD?
Ventricular septal defect
What is the most common acyanotic CCD?
Tetralogy of Fallot
What CCD is commonly associated with downs syndrome?
Atrial septal defect
What are the dental implications of CCD?
- medication can increase bleeding tendency
- higher risk if requiring GA
- adrenaline containing LA should be used carefully
- risk of enamel hypoplasia
- risk of IE from oral bacteraemia
How should patents at risk of IE be managed?
- optimal OH
- avoid infection including caries
- more radical care to ensure mouth is infection free
- liaise with cardiology for antibiotic prophylaxis
What are the most commonly inherited bleeding disorders?
- von Williebrand’s
- haemophilia A
- haemophilia B
What is von Williebrand’s disease?
- low vWF and factor VIII
- should receive dental treatment in dental hospital with haemostatic cover
What is haemophilia A?
Low factor VIII
What is haemophilia B?
Low factor IX
What are the dental implications of haemophilia?
- enhanced caries prevention
- dental treatment within dental hospital
- liaison with haematology required before bleeding risk procedures
- haemostatic cover varies by type, severity and treatment
