Children with Disabilities Flashcards
According to the UN Convention, what is the definition of disability?
A disability includes long-term physical, mental, intellectual, or sensory impairments which, in interaction with various barriers, may hinder full and effective participation in society on an equal basis with others.
What percentage of children in the UK have a disability, and what are the main causes?
6% of children aged 0-17 years have a disability. The main causes are:
Genetic factors
Developmental factors (injury, infection)
Parental health during pregnancy
Unknown causes
Disabilities occur among all racial, ethnic, and socioeconomic groups.
What are the four main classifications of disabilities discussed in the lecture?
- Intellectual/behavioral (Learning disability, Autism Spectrum Disorder, Down syndrome)
- Physical (Cerebral Palsy)
- Sensory (Vision impairment, Hearing loss)
- Medically compromised (Oncology, Cardiac, Haemophilia)
What are the key characteristics of learning disabilities?
- Have reduced intellectual ability and difficulty with everyday activities
- Take longer to learn and may need support to develop new skills
- Have difficulty understanding complicated information and interacting with others
- Can have mild, moderate, severe, or profound disabilities
- May have associated conditions like Down Syndrome or Autism
What is Autism Spectrum Disorder (ASD) and how common is it?
ASD is a lifelong developmental disorder affecting communication and interaction with the world. It:
Affects more than 1:100 people in the UK
Has a male:female ratio of 3:1
Is a spectrum, meaning everyone with autism is different
Can require varying levels of support, from little to daily assistance
What are the main clinical implications for dental treatment of patients with ASD regarding social communication?
Key implications include:
- May not speak or have limited language → Use preferred mode of communication (Makaton/visual symbols)
- Take things literally → Use concrete language, direct requests, avoid jokes/sarcasm
- May not understand facial expressions → Avoid body language without accompanying verbal instruction
- May become upset if routine changes > Prep for visit, same people/room/sequence
What are the main dental features associated with Down Syndrome?
The main dental features include:
- Maxillary hypoplasia
- Class III occlusion
- Macroglossia (enlarged tongue)
- Anterior open bite
- Hypodontia/microdontia
- Predisposition to periodontal disease
What are the three main types of Cerebral Palsy and their characteristics?
- Spastic (80%) - Affects cortex, causes increased muscle tone
- Ataxic - Affects cerebellum, impacts coordination/balance
- Dyskinetic - Affects basal ganglia, causes uncontrollable movements
What dental considerations are important for patients with Cerebral Palsy?
Difficulty tolerating dental treatment
Increased rate of malocclusion
Increased risk of dental trauma
High prevalence of bruxism
Drooling
Poor oral hygiene
Pathological oral reflexes (biting)
Calculus if peg fed
Periodontal disease
Hyperplastic gingivitis
Self-mutilation
Unsafe swallow
What are the communication aids for visual impairment, hearing impairment and ASD?
visual = braille
hearing = BSL, hearing loops
ASD = makaton, boardmaker pictures, widget symbols
What are the oral manifestations of ALL?
- Gingival swelling
- Ulceration
- Spontaneous gingival bleeding
- Unusual mobility of teeth
- Petechiae
- Mucosal pallor
- Herpetic infections
- Candidosis
What occurs in acute lymphblastic leukaemia?
what are the signs/symptoms
- White blood cell production gets out of control and the cells continue to divide in the bone marrow, but do not mature.
- These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells.
Can present with
– Pallor
– Increased bleeding/bruising (lack of platelets)
– Infection (lack of functioning WBC)
What are the dental implications of chemotherapy?
short/long term
Short-term effects:
Mucositis
Decreased neutrophils (increased infection risk)
Decreased platelets (increased bleeding risk)
Long-term effects: (developing dentition)
Enamel hypoplasia
Microdontia
Thin roots
What cells do cytotoxic drugs affect?
Cytotoxic drugs with selective toxicity to rapidly dividing cancer cells.
Also affect other rapidly dividing cells including mucous membrane/hair follicle/haemopoietic system
What are the dental implications of radiotherapy?
Short term
*Oral Mucosa –mucositis –most severe at 2-4 weeks
*Salivary glands –decreased flow/increased velocity –often permanent
*Hyposalivsation
*Taste buds –direct damage –loss/alteration to taste = altered diet
Longer term
*Malocclusion
*Increased risk soft tissue neoplasm
*Risk of osteoradionecrosis
*Affects to developing dentition–
Hypodontia/ microdontia/ enamel hypoplasia/ defects of root formation
What should be removed before cancer therapy?
all infectious dental/oral foci
What is provided through childhood cancer treatment?
- Dental support throughout treatment
- Management of dental effects of treatment including mucositis
- Close liaison with oncology team if treatment required
What are the key facts about congenital cardiac defects?
Affects 6-8/1000 births (1:125)
- Strong link with syndromes (50% of Down Syndrome patients have ASD)
- Classified as cyanotic or acyanotic
- Ventricular septal defect is most common acyanotic defect
- Tetralogy of Fallot is most common cyanotic defect
What are the dental implications of congenital cardiac defects?
- Medications which increase bleeding tendency: warfarin or aspirin
- Higher risk of general anaesthetic
- Careful use of adrenaline containing LA
- Increased risk of enamel hypoplasia
- Risk of infective endocarditis resulting from an oral bacteraemia
Who is at risk of bacteriemia?
– Patients with poor oral hygiene
– Dental infection
– Invasive dental procedures
What should patients at risk of IE have?
– Optimal oral hygiene
– Avoid dental infection (close monitoring and early management of caries)
– More radical treatment plans to ensure the mouth is kept free from any oral sources of infection (removal of teeth with deep decay/ Hall crowns contraindicated)
– Liaison with cardiology to explore need for antibiotic prophylaxis prior to invasive procedures
What are the dental implications for patients with cardiac conditions?
- Medications may increase bleeding tendency
- Higher risk with general anesthetic
- Careful use of adrenaline-containing local anesthetic
- Increased risk of enamel hypoplasia
- Risk of infective endocarditis from oral bacteremia
What are the main types of bleeding disorders discussed?
Inherited:
- Von Willebrand’s disease (most common, 1%)
- Haemophilia A (Factor VIII deficiency)
- Haemophilia B (Factor IX deficiency)
Non-inherited:
- Blood thinning medication effects
- Chemotherapy-induced thrombocytopenia
What are the dental implications for patients with bleeding disorders?
Enhanced dental caries prevention needed
Treatment within Hospital Dental Service
Close liaison with hematology required
Haemostatic cover requirements vary by:
Type of bleeding disorder
Severity
Treatment required
What are the impacts of dental disease in children with disabilities?
- Increased risk of dental caries
- Delayed diagnosis
- Delayed management
- Need for multidisciplinary planning
- Pain/infection can be difficult to manage
- Health risk posed by dental infection
- Risks posed by dental treatment
What are the key principles for examining children with disabilities?
- May need examination outside dental chair
- Use toothbrush instead of mirror if needed
- Begin without 3-in-1 air/water
- Multiple visits may be needed for thorough exam
- Maintain consistent routine
- Document successful approaches
What dental findings are more prevalent in children with disabilities?
- Anomalies of tooth number
- Anomalies of tooth size
- Dental trauma
- Periodontal disease
- Calculus accumulation
- Grinding
- Increased risk of dental caries
How should dental care be coordinated for children with special needs?
- General Dental Service (GDS)
- Non-specialist led Public Dental Service (PDS)
- Specialist led PDS
- Hospital Dental Service Choice depends on individual child’s needs and requires coordination between medical and dental teams.
