Children with Special Needs Flashcards
What are “special needs”?
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.
Who looks after the teeth of children with a mild disability?
GDS
Non specialist led PDS
Specialist service for access to treatment planning or advanced behaviour management.
Who looks after the teeth of children with a moderate to severe disability?
Specialist led PDS
HDS
Shared care HDS/GDP or PDS/GDP.
What are the dental implications for children with special needs?
Fewer teeth
More untreated dental caries
Greater prevalence of periodontal disease
Dental fear and anxiety
More barriers to delivery of dental care.
What are the impacts of dental disease in children with special needs?
Delayed diagnosis Delayed management More multidisciplinary planning Greater risk of pain/sepsis Reduce quality of life.
How do you manage saliva drooling?
Speech and language therapy (improve lip seal and swallow)
Pharmacology (scopolamine/hyoscine patch, botox injections)
Surgical.
What are some barriers to mouth care for a child and adult?
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.
What are some barriers to dietary changes?
Atypical food clearance Food holding/regurgitation Restricted/limited diet Pureed foods Fortified foods Sugary medicines Food treats used as rewards.
What are the four categories of types of disability?
Physical
Medical
Sensory
Mental.
What is cerebral palsy?
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.
What are the three types of cerebral palsy?
Spastic
Athetoid
Ataxic Rigid Mixed.
What are the dental features and considerations of a Cerebral Palsy patient?
Poor OH Gingival hyperplasia Enamel hypoplasia Bruxism Malocclusion Dental trauma Drooling Access Uncontrollable movements Enhanced gag reflex.
What is the normal incisal relationship for a cerebral palsy patient?
Class 2.
What are barriers to regular dental attendance for a Cerebral Palsy patient?
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.
What are barriers to mouth care for a Cerebral Palsy patient?
Manual dexterity issues Involuntary movements Oral aversion Gag reflex issues Challenging behaviour Sensory issues.
What are barriers to dietary change for a patient with Cerebral Palsy?
Atypical food clearance Food holding Restricted diet Pureed foods Fortified foods Sugary medicines Food treats used as rewards.
What are some solutions to dietary changes in a patient with Cerebral Palsy?
Collaborate, empathise, don’t judge, support, understand
Consider additional mouth care
Consider prescribing toothpastes
Set achievable realistic goals
Work with other health care professionals.
Why is advanced prevention important for CF patients?
They might not be able to absorb foods properly which leads to malnutrition.
What is a congenital heart defect?
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.
What is the most common congenital heart defect?
VSD.
What are the dental aspects of CHD?
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.
What are some oral symptoms of paediatric cancer patients?
Mucosal/gingival haemorrhage Gingival enlargement Mouth and throat infections Immunosupression Thrombocytopenia Oral mucositis Developing dentition.
What can happen to developing teeth during cancer treatment?
The growth of the teeth can be retarded with reduced roots.
What are the most common inherited bleeding disorders?
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.
What are the most common acquired bleeding disorders?
Warfarin therapy for CHD
Chemotherapy induced thrombocytopenia.
What is an example for a communication aid for a visual impaired child?
Braille.
What is an example for a communication aid for a hearing impaired child?
BSL interpreting service, hearing loops.
What is an example for a communication aid for an ASD child?
Makaton, board-maker pictures, widget symbols.
What is a definition of a learning diability?
A state of arrested or incomplete development of mind.
What is the IQ classification for mild/moderate/severe and profound learning disability?
Mild 50-70
Moderate 35-49
Severe 20-34
Profound <20.
What is autism?
Lifelong neurodevelopmental disorder which effects social interaction, social communication and limited/restricted patterns in behaviour.
What are some related conditions to ASD?
ADHD Downs syndrome Dyslexia Dyspraxia Learning disability Epilepsy GI issues Sleep disorder.
What is the breakdown in percentages of an ASD child’s verbal communication?
7% words
33% vocal tone
60% facial expression and body language.
Name 3 examples of non-verbal communication aids for an ASD child?
Makaton
PECS
Widget symbols.
What do ASD children like and dislike in the surgery?
Likes- computer, taps and dental control units
Dislike- touch, dental light, noise, smells, textures, tastes.
How can you prepare for an ASD child before they come to the surgery?
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.
What are some dental features of Down’s syndrome?
Maxillary hypoplasia Class 3 occlusion Macroglossia Anterior open bite Hypodontia/microdontia Predisposition to periodontal disease.
What are some medical problems for a Down’s syndrome patient?
Cardiac defect
Leukaemia
Epilepsy
Alzheimer’s/dementia.
What are some examination options for a child with ASD?
Knee to knee On parents lap In wheelchair Standing up Sitting or lying on the floor, whilst brushing teeth Restraint (ensure informed consent).
What are some aids for toothbrushing?
Finger brushes
Chew on a toothbrush while you brush the other side.
What are some recommended toothbrushes for a child with autism?
Oranurse (contains fluoride, no flavour and non-foaming)
Duraphat too- for high caries children with special needs for supervised use age 10 plus.
Whar are the different types of conscious sedation?
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.
What are some indications and considerations for GA during dental treatment?
I- no co-operation and extensive treatment
C- joint cases, medical pre-assessment, ASA 3 and 4 will require specialist anaesthetist.
How do you obtain consent from a child for GA?
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.
What are the acts in the UK that protect and support vulnerable adults?
AWI (Scotland) Act 2000
Disability Discrimination Act 1995
Equality Act 2010.
