Dental Care for Special Needs Children Flashcards
Children who require special consideration for dental treatment with physical or learning disability is defined by the academy if paediatric dentistry as:
- those with chronic, physical, developmental, behavioural or emotional conditions
- they usually have limitations on daily activities and require more extensive dental and medical services
What are categories of impairment?
- intellectual - genetic disorders, problems during pregnancy/child birth, illness or injury, or none of these
- physical - cerebral palsy, spina bifida, muscular dystrophy
- sensory - visual impairment and blindness, deafness and hearing impairments
What is intellectual impairment?
Intellectual disability: below average level of intelligence or mental cognitive ability and a lack of skills necessary for day to day living (down’s syndrome, fragile X)
Learning disability: children can be of normal intelligence but have difficulty in learning specific skills (dyslexia, autism, ADHD)
What are the features of down’s syndrome?
- chromosomal disorder - trisomy 21 (extra or partial copy of chromosome 21)
- susceptible to congenital heart disease and a variety of other disorders
- prone to periodontal disease, added risk as plaque control is difficult in these patients
- large tongue, chubby fingers and hands, - toothbrushing can be difficult
- delayed exfoliation of primary teeth - associated with congenitally absent teeth or teeth becoming ectopic
- hypoplastic teeth - abnormal development of enamel - absence or poor quality enamel
Management: Prevention is most important factor - may need to modify toothbrush to support manual dexterity
What is fragile X syndrome?
- genetic disorder - faulty X chromosome, gene makes protein responsible for brain development
- largely undiagnosed in past, more commonly affects males
- intellectually impaired/learning disabilities
- management most importantly prevention
- patients may have problems understanding/tolerating LA, treatment etc
- short appointments more frequently may be beneficial
- treatment plan adjustment - assess what patient can cope with
Give an overview of autism:
What is makaton?
- usually early onset but may take much longer to diagnose
- profound adaptive problems in thinking, language and social relationships
- cause unknown, but thought to be prenatal, not social - MMR link completely discredited
- routines and rituals very important to patient
- world may feel overwhelming
- familiarity - same operator/surgery, appointments that suit patients routine
- difficulty with social communication, interaction and imagination
Makaton: language for patients who struggle with verbal communication, reading and writing, visual symbols to communicate - a form of sign language
What is asperger’s syndrome?
-similarities with autism, but less problems with speaking and are often of average or above average intelligence
- do not usually have the accompanied learning disability associated with autism, but may have specific learning difficulties
- these may include dyslexia and dyspraxia or other conditions such as an association between ADHD and epilepsy
What are signs and symptoms of schizophrenia?
Rare in children due to difficult diagnosis:
- social withdrawal, slow development
- hostility and suspiciousness
- deterioration of personal hygiene
- flat, expressionless gaze
- inability to cry or express joy
- inappropriate laughter or crying
- depression, oversleeping, insomnia
- odd or irrational statements
- hallucinations, delusions, muddled thoughts, behavioural changes
How should you manage patients with autism/schizophrenia?
- prevention
- treatment must be limited to what the patient can tolerate
- dont keep patient waiting
- short treatment sessions
- hospital admission highly undesirable
What is dyslexia and how should we manage this?
- main problem understanding reading and writing
- usually causes problems with cognition - difficulty processing or holding information
- can vary in severity - mild to profound
Management: may need little or no adjustment - take treatment at a slow pace
- explain procedures in simple terms i.e. no written communication with jargon or complicated language
What is ADHD?
Attention Deficit Hyperactivity Disorder
- difficulty staying still outwith norm of child without ADHD
- unpredictable, chaotic behaviour
- has difficulty responding to requests e.g. sit in chair, open mouth
- likely to have problems maintaining OH at home
Management:
- short appointments
- keep tasks simple and of short duration
- keep taking breaks from patients mouth
- parental support often required to distract or encourage patient to cooperate
What is physical impairment and give examples of conditions?
- varying degrees of physical impairment, restricted movement and/or uncontrolled movement
- spina bifida
- cerebral palsy
- muscular dystrophy
What is cerebral palsy?
- neurological condition that affects movement and coordination (not progressive)
- damage to brain before or after birth (cerebrum) - part of brain that controls muscles and responsible for communication skills, memory and ability to learn
Causes: - infection in early pregnancy
- difficult or premature birth
- bleeding in foetus brain
- abnormal brain development in foetus
What is spina bifida?
What is muscular dystrophy?
Spina bifida: vertebrae overlying spinal cord poorly formed, remains unfused at birth
- may be due to low levels of folic acid during pregnancy
- management = prevention
Muscular dystrophy: group of muscle diseases which present as progressive atrophy and weakness of skeletal muscles which result in disability and deformity
- prevention is key in management
- mainly rely on parent/carer to provide OH
What are some dental challenges faced in physically impaired children?
- gag and cough reflexes
- hypoplastic or hypomineralised teeth –> hypersensitive
- access to mouth, either limited opening or uncontrolled patient movement (cerebral palsy)
- manoeuvring of a wheelchair
- transferring to a dental chair
- excessive saliva - some severely disabled children do not have a swallow reflex
- self-inflicted intra=oral wounds
