children with special needs Flashcards
AAPD definition of special healthcare needs
any physical, developmental, mental, sensory, behavioural, cognitive or emotional impairment or limiting condition
- that requires medical managment, healthcare intervention or use of specialised services or programmes
why are children with special needs of moderate caries risk automatically?
1) poor hygiene
- lack ability to understand and assume responsibility for oral care
- unable to cooperate with preventive OH practices
- oral sensory issues (eg cant stand having things in mouth)
2) diet
- medications are sucrose laced
- frequent meals will increase caloric intake
3) tooth defects
- sometimes associated with some conditions like AI and epidermolysis bullosa
4) others
- barriers to care eg transportation
- financial issues
general management for dental appointments
1) scheduling
- should give enough time to establish rapport with patient and parent in order to dispel anxiety
- but keep appointments shorter
2) dental office access
- should be barrier free
- wider doorway for wheelchair
3) behavioural management
- techniques to be employed based on age, cognitive level
4) other techniques
- be sure to use people first language
- video tour of clinic
- downloable forms of materials
what is the definition of intellectual disability
characterised by
- deficits in intellectual: IQ <70 (2 SDs below mean)
- deficits in adaptive functioning
defn of global developmental delay
intellectual and adaptive impairment in infants and children < 5yo, when they fail to meet expected developmental milestones
risk factors for cerebral palsy
- abnormal pre/peri natal history, especially hx of prematurity
- low birth weight
- multiple gestation
- infection
definition, cause and types of CP
CP is a heterogenous group of conditions involving permanent non progressive central motor dysfunction that affects muscle tone, posture and movement
caused by abnormalities of developing foetal brain resulting from variety of causes eg infection, premature birth
types
- spastic: increased muscle tone and stiff tight muscles
- dyskinetic: uncontrollable movements
- ataxic: difficulties with balance and coordination
- mixed
implications of CP on dentistry
uncontrolled body movements so
- gentle restraints
- should use mouth props
- give frequent breaks
- suggest brushing aids
watch out for increased risk of falls and aspiration
be aware of associated medical conditions
implications of ADHD on dentistry
1) might have decreased unstimulated salivary flow which is a potential side effect of meds eg methylphenidate which is a CNS stimulant
2) poor toothbrushing
3) tend to have increased snacking frequency
4) increased risk of accidental injuries
5) might have behavioural challenges to manage
defn of autism and cause, risk factors
is a biologically based neurodevelopmental disorder with unclear aetiology, thought to be genetic factors that alter brain development
risk factors
- parental age
- envt toxic exposures
- perinatal insults
characteristics of ASD and what syndrome is it associated with
characterised by:
- persistent deficits in social communication and interaction
- restricted, repetitive patterns of behaviour, interests and activities
associated with fragile X syndrome
dental problems faced by child with ASD
1) perio
2) caries or erosion bc might have unique preference for food and unique eating habits, or are rewarded with certain foods by therapists
3) damaging oral habits like
- bruxism
- pica (eating non food items)
- self injurious behaviours
clinical features of down syndrome
- most common chromosome abnormality in liveborn infants
features
- oblique palpebral fissures
- epicanthal folds (skin folds of upper eyelid cover inner corner of eye)
- low set small ears
- transverse palmar crease
- short neck
oral manifestations of down syndrome
- large protruding tongue
- narrow palate
- tooth anomalies like hyper/hypodontia, microdontia, delayed eruption
- perio disease (they are at increased susceptibility due to immunodeficiency)
what systemic problems are associated with down syndrome
- intellectual disability
- behavioural and psychiatric: ADHD, ASD
- GIT: increased risk of anomalies
- endocrine (thyroid dysfunction, type I DM)
- hematologic: Increase risk of leukaemia
- growth: short stature, obesity
- immunodeficiency: defects in chemotaxis, T&B cells -> can cause candida
- atlantoaxial instability: C1 and C2 are excessively mobile and may lead to subluxation of cervical spine
- CVD
might be arterioventricular septal defect (AVSD), VSD or ASD
syndromes with cardiac problems
- down syndrome (ASD, VSD, AVSD)
- marfan syndrome (mutation in FBN1 gene, limits bodys ability to make proteins to build CT. long arms, fingers)
when is AB prophy required by AHA 2001 guidelines
if cardiac condition associated with highest risk of adverse outcomes from endocarditis
- prosthetic cardiac valve
- previous IE
- congenital heart disease
- cardiac transplant recipient with cardiac valvulopathy
and for dental procedures that involve:
- manipulation of gingiva/ periapical region of teeth
- perf of oral mucosa
what drug to give for AB prophy for children
- amox is standard, 50mg/kg, orally, 1h before procedure
if unable to take oral meds then
- ampicillin 50mg/kg IM or IV
- cefazolin or ceftriaxone 50mg/kg IM or IV
if allergic to penicillin then
- azithro or clarithro 15mg/kg
- doxy, 2.2mg/kg for <45kg and 100mg for >45kg
if allergic to penicillin and unable to take oral meds then
- cefazoline/ ceftriaxone 50mg/kg IM or IV
why is clindamycin no longer given for ab prophy
due to adverse GI effects like diarrhoea and vomit
what are 3 categories of cardiac diseases and what stuff falls under which
1) cyanotic (means that there is deoxygenation in the systemic circulation)
- transposition of great vessels (when the aorta and pulmonary artery are switched, is rare)
- tetralogy of fallot
2) non cyanotic
- ASD
- VSD
- patent ductus arteriosus
3) pulmonary venous congestion/ pulmonary blood flow
- coarctation of aorta (defect in which part of the aorta is narrower than usual)
- aortic valve stenosis
- mitral valve stenosis
what makes up the tetralogy of fallot
1) VSD
2) pulmonic stenosis (narrowing of pulmonary valve)
3) right ventricular hypertrophy
4) overriding aorta (when aorta is positioned directly over a VSD instead of over a left ventricle)
meds to avoid in asthmatics
- aspirin and NSAIDs bc the shunting effect will induce bronchoconstriction
- narcotics (opioids) and barbiturates
- erythromycin interacts with theophylline in asthma meds -> can cause cardiac arrhythmias
what meds might epileptic kids be on and what are the dental implications
1) phenytoin
- gingival hypertrophy
2) valproic acid
- thrombocytopenia
3) phenobarbitals
- these potentiate sedatives
- might cause anemia but rare
4) carbamazepine
- leukopenia (reduce WBC)
- aplastic anemia (rare)
- drug interactions (erythromycin increases it levels)
difference between intrinsic and extrinsic pathways in the context of bleeding
intrinsic = respond to internal damage of vascular endothelium
extrinsic = respond to external trauma
