Children with Special Needs

Question 1

What are “special needs”?

Answer 1

Huge range of diagnoses and disabilities
Individuals who require special help or care
In children the main causes of disability are genetic and congenital
4.3% of the paediatric population.

Question 2

Who looks after the teeth of children with a mild disability?

Answer 2

GDS
Non specialist led PDS
Specialist service for access to treatment planning or advanced behaviour management.

Question 3

Who looks after the teeth of children with a moderate to severe disability?

Answer 3

Specialist led PDS
HDS
Shared care HDS/GDP or PDS/GDP.

Question 4

What are the dental implications for children with special needs?

Answer 4

Fewer teeth
More untreated dental caries
Greater prevalence of periodontal disease
Dental fear and anxiety
More barriers to delivery of dental care.

Question 5

What are the impacts of dental disease in children with special needs?

Answer 5

Delayed diagnosis
Delayed management
More multidisciplinary planning
Greater risk of pain/sepsis
Reduce quality of life.

Question 6

How do you manage saliva drooling?

Answer 6

Speech and language therapy (improve lip seal and swallow)
Pharmacology (scopolamine/hyoscine patch, botox injections)
Surgical.

Question 7

What are some barriers to mouth care for a child and adult?

Answer 7

Child- Manual dexterity issues, involuntary movements, oral aversion, gag reflex issues, challenging behaviour and sensory issues

Adult- manual dexterity issues, anxiety/fear, revulsion/aversion to body fluids, unable to access oral cavity, exhaustion and lack of time.

Question 8

What are some barriers to dietary changes?

Answer 8

Atypical food clearance
Food holding/regurgitation
Restricted/limited diet
Pureed foods
Fortified foods
Sugary medicines
Food treats used as rewards.

Question 9

What are the four categories of types of disability?

Answer 9

Physical
Medical
Sensory
Mental.

Question 10

What is cerebral palsy?

Answer 10

Most common physical disability in childhood
It affects movement and posture
Occurs from brain damage before during or shortly after birth
People with CP may also have visual, hearing, learning, speech and epilepsy.

Question 11

What are the three types of cerebral palsy?

Answer 11

Spastic
Athetoid
Ataxic Rigid Mixed.

Question 12

What are the dental features and considerations of a Cerebral Palsy patient?

Answer 12

Poor OH
Gingival hyperplasia
Enamel hypoplasia
Bruxism
Malocclusion
Dental trauma
Drooling
Access
Uncontrollable movements
Enhanced gag reflex.

Question 13

What is the normal incisal relationship for a cerebral palsy patient?

Answer 13

Class 2.

Question 14

What are barriers to regular dental attendance for a Cerebral Palsy patient?

Answer 14

Other appointments- collaborate and plan

Challenging behaviour- empathise, understanding, reassure, support, plan ahead etc

Parking- plan ahead, DDA 1995, EA 2010

Frequent illness- empathise and support

Parental attitudes- influence positive change and promote good knowledge.

Question 15

What are barriers to mouth care for a Cerebral Palsy patient?

Answer 15

Manual dexterity issues
Involuntary movements
Oral aversion
Gag reflex issues
Challenging behaviour
Sensory issues.

Question 16

What are barriers to dietary change for a patient with Cerebral Palsy?

Answer 16

Atypical food clearance
Food holding
Restricted diet
Pureed foods
Fortified foods
Sugary medicines
Food treats used as rewards.

Question 17

What are some solutions to dietary changes in a patient with Cerebral Palsy?

Answer 17

Collaborate, empathise, don’t judge, support, understand
Consider additional mouth care
Consider prescribing toothpastes
Set achievable realistic goals
Work with other health care professionals.

Question 18

Why is advanced prevention important for CF patients?

Answer 18

They might not be able to absorb foods properly which leads to malnutrition.

Question 19

What is a congenital heart defect?

Answer 19

Congenital heart disease means a heart condition or defect that develops in the womb, before a baby is born. There are many different types of congenital heart disease. For example, a baby’s heart valves may not be properly formed or there may be holes between the chambers of their heart
Occurs in 8 per 1000 live births
Most common is VSD.

Question 20

What is the most common congenital heart defect?

Answer 20

VSD.

Question 21

What are the dental aspects of CHD?

Answer 21

Susceptibility to infective endocarditis
Possible increased bleeding tendency if on warfarin or aspirin
Higher risk under GA
Careful use of adrenaline containing LA
Liaison with medical colleagues.

Question 22

What are some oral symptoms of paediatric cancer patients?

Answer 22

Mucosal/gingival haemorrhage
Gingival enlargement
Mouth and throat infections
Immunosupression
Thrombocytopenia
Oral mucositis
Developing dentition.

Question 23

What can happen to developing teeth during cancer treatment?

Answer 23

The growth of the teeth can be retarded with reduced roots.

Question 24

What are the most common inherited bleeding disorders?

Answer 24

Von Willebrand’s disease
Haemophilia A
Haemophilia B
For invasive dental treatment they will get factors, then treatment will take place, then they go back to the hospital to be observed for five hours.

Question 25

What are the most common acquired bleeding disorders?

Answer 25

Warfarin therapy for CHD | Chemotherapy induced thrombocytopenia.

Question 26

What is an example for a communication aid for a visual impaired child?

Answer 26

Braille.

Question 27

What is an example for a communication aid for a hearing impaired child?

Answer 27

BSL interpreting service, hearing loops.

Question 28

What is an example for a communication aid for an ASD child?

Answer 28

Makaton, board-maker pictures, widget symbols.

Question 29

What is a definition of a learning diability?

Answer 29

A state of arrested or incomplete development of mind.

Question 30

What is the IQ classification for mild/moderate/severe and profound learning disability?

Answer 30

Mild 50-70 Moderate 35-49 Severe 20-34 Profound <20.

Question 31

What is autism?

Answer 31

Lifelong neurodevelopmental disorder which effects social interaction, social communication and limited/restricted patterns in behaviour.

Question 32

What are some related conditions to ASD?

Answer 32

``` ADHD Downs syndrome Dyslexia Dyspraxia Learning disability Epilepsy GI issues Sleep disorder. ```

Question 33

What is the breakdown in percentages of an ASD child's verbal communication?

Answer 33

7% words 33% vocal tone 60% facial expression and body language.

Question 34

Name 3 examples of non-verbal communication aids for an ASD child?

Answer 34

Makaton PECS Widget symbols.

Question 35

What do ASD children like and dislike in the surgery?

Answer 35

Likes- computer, taps and dental control units Dislike- touch, dental light, noise, smells, textures, tastes.

Question 36

How can you prepare for an ASD child before they come to the surgery?

Answer 36

Obtain a profile of the likes and dislikes from the parent/school Send out social story explaining dental journey using PECS Send out a plastic mirror Be ready on time or phone them when ready De-clutter.

Question 37

What are some dental features of Down's syndrome?

Answer 37

``` Maxillary hypoplasia Class 3 occlusion Macroglossia Anterior open bite Hypodontia/microdontia Predisposition to periodontal disease. ```

Question 38

What are some medical problems for a Down's syndrome patient?

Answer 38

Cardiac defect Leukaemia Epilepsy Alzheimer's/dementia.

Question 39

What are some examination options for a child with ASD?

Answer 39

``` Knee to knee On parents lap In wheelchair Standing up Sitting or lying on the floor, whilst brushing teeth Restraint (ensure informed consent). ```

Question 40

What are some aids for toothbrushing?

Answer 40

Finger brushes | Chew on a toothbrush while you brush the other side.

Question 41

What are some recommended toothbrushes for a child with autism?

Answer 41

Oranurse (contains fluoride, no flavour and non-foaming) | Duraphat too- for high caries children with special needs for supervised use age 10 plus.

Question 42

Whar are the different types of conscious sedation?

Answer 42

Inhalation sedation- selection criteria is the same as non-special needs patients but should be avoided in those undergoing Bleomycin therapy (High 02) and those with musculoskeletal disorders IV sedation- with midazolam can be of benefit in some anxious special needs adolescents and is protective in those with epilepsy Consider the help of an anaesthetist in ASA 3 and above.

Question 43

What are some indications and considerations for GA during dental treatment?

Answer 43

I- no co-operation and extensive treatment C- joint cases, medical pre-assessment, ASA 3 and 4 will require specialist anaesthetist.

Question 44

How do you obtain consent from a child for GA?

Answer 44

Usually parents will sign the consent form for younger children Teenagers deemed "gillick" competent may sign the consent form and agreeing to treatment at the pre-assessment appointment and then refuse treatment on the day. No treatment undertaken Age 16 olds and over- a conversation is needed to ensure if appropriate an adult with incapacity certificate is available.

Question 45

What are the acts in the UK that protect and support vulnerable adults?

Answer 45

AWI (Scotland) Act 2000 Disability Discrimination Act 1995 Equality Act 2010.