8 - Dentistry for children with disabilities Flashcards

1
Q

What are the different classifications of disability?

A
  • intellectual
  • physical
  • sensory
  • medically compromised
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2
Q

What are the clinical implications of social communication with a child with ASD?

Autism spectrum disorder

A
  • 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
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3
Q

What are the clinical implications of routine with a child with ASD?

A
  • 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)
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4
Q

What are the clinical implications of special interests with a child with ASD?

A

Make the effort to learn about their own interests and note of of these in notes to put patient at ease

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5
Q

What are the clinical implications of sensory difficulties with a child with ASD?

A
  • 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
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6
Q

How do you manage a child with ASD in the dental surgery?

A
  • prepare yourself and the patient
  • questionnaire to parent can be useful for first appointment
  • use any sensory aids the child needs
  • keep environment quiet
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7
Q

What are the dental features associated with downs syndrome?

7

A
  • maxillary hypoplasia
  • class III occlusion
  • macroglossia
  • AOB
  • hypdontia
  • microdontia
  • predisposed to periodontal disease (inhibited macrophages and neutrophils)
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8
Q

What are the different types of cerebral palsy?

A
  • spastic
  • ataxic
  • dyskinetic
  • can be mixed
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9
Q

Describe spastic cerebral palsy.

A
  • most common type
  • affects cortex in brain
  • causes increased muscle tone
  • can be described as diplegic, hemiplegic or quadriplegic
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10
Q

Describe ataxic cerebral palsy.

A
  • affects cerebellum
  • coordination and balance are affected
  • difficulty with movements that require lots on control ie writing
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11
Q

Describe dyskinetic cerebral palsy.

A
  • basal ganglia affected
  • cause uncontrollable movements
  • face be affected and person can struggle with swallowing and talking
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12
Q

Define diplegia.

A

paralysis of Legs, arms are less affected or not at all

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13
Q

Define hemiplegia.

A

One side of the body affected and arm is usually more affected than leg

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14
Q

Define quadriplegia.

A

paralysis of All four limbs, trunk and face affected

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15
Q

What are the dental implications for people with cerebral palsy?

A
  • find it hard to remain still and accept dental treatment
  • Class II malocclusion more common
  • increased risk of dental trauma
  • high prevalence of bruxism
  • drooling
  • poor OH
  • unsafe swallowing
  • calculus if peg fed
  • hyperplastic gingivitis
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16
Q

What communication aid is available for those with a visual impairment?

A

Braille

17
Q

What communication aid is available for those with a hearing impairment?

A
  • BSL interpreter
  • hearing loops
18
Q

What is the most common childhood cancer?

A

Acute lymphoblastic leukaemia

19
Q

What are the oral manifestations of ALL?

A
  • gingival swelling
  • ulceration
  • spontaneous gingival bleeding
  • unusual mobility of teeth
  • mucosal pallor
  • herpetic infections
  • candidiasis
20
Q

What are the dental effects of chemotherapy?

A
  • 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
21
Q

What are the dental effects of radiotherapy?

A

Short term
- mucositis
- xerostomia (caries, IO infection and taste disturbance)
- trismus
- candidiasis risk

Long term
- malocclusion
- ORN risk
- increased of soft tissue neoplasm
- affects to developing dentition

22
Q

How are children with cancer looked after in the dental surgery?

A
  • all possible sources of infection should be removed before treatment begins
  • optimal OH important
  • management of mucositis
23
Q

Define a cyanotic Congenital Cardiac Defect.

A

Deoxygenated blood is able to enter the bloodstream

24
Q

Describe an acyanotic CCD.

A

Normal levels of oxygen remain in the blood

25
Q

What is the most common acyanotic CCD?

A

Ventricular septal defect

26
Q

What is the most common cyanotic CCD?

A

Tetralogy of Fallot

27
Q

What CCD is commonly associated with downs syndrome?

A

Atrial septal defect

28
Q

What are the dental implications of CCD?

A
  • 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
29
Q

How should patents at risk of IE be managed?

A
  • optimal OH
  • avoid infection including caries
  • more radical care to ensure mouth is infection free
  • liaise with cardiology for antibiotic prophylaxis
30
Q

What are the most commonly inherited bleeding disorders?

A
  • von Williebrand’s
  • haemophilia A
  • haemophilia B
31
Q

What is von Williebrand’s disease?

A
  • low vWF and factor VIII
  • should receive dental treatment in dental hospital with haemostatic cover
32
Q

What is haemophilia A?

A

Low factor VIII

33
Q

What is haemophilia B?

A

Low factor IX

34
Q

What are the dental implications of haemophilia?

A
  • enhanced caries prevention
  • dental treatment within dental hospital
  • liaison with haematology required before bleeding risk procedures
  • haemostatic cover varies by type, severity and treatment