Dental care for the medically compromised child

Question 1

What is the WHO definition of health?

Answer 1

a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity

Question 2

What is the medical model?

Answer 2

A problem of the person, she is disabled because she has epilepsy
Medical care/treatment is seen as the main issue
The focus is on cure and rehabilitation through medical intervention
‘the personal tragedy theory of disability’

Question 3

What is the social model?

Answer 3

It is society which disables people with impairment by its failure to include them

Question 4

What is an impairment as seen by medical model?

Answer 4

Loss or abnormality of physiology or anatomical structure or function

Question 5

What is an impairment as seen by social model?

Answer 5

The functional limitation within the individual caused by physical, mental or sensory loss

Question 6

What is a disability as seen by medical model?

Answer 6

Restriction of activity as a consequence of impairment

Question 7

What is a disability as seen by social model?

Answer 7

The loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical or social barriers

Question 8

According to the WHO international classification of functioning, disability and health,
what is the b520 classification about?

Answer 8

Caring for body parts
Looking after parts of the body that require more than washing and drying e.g. skin, face, teeth, scalp,nails and genitals
Having special toothbrushes for people with; rheumatoid arthritis or aperts syndrome

Question 9

According to the WHO international classification of functioning, disability and health,
what is the b280 classification about?

Answer 9

Sensation of pain
Sensation of unpleasant feeling indicating potential or actual damage to some body structure
Functional pain
Odontogenic pain

Question 10

How many disabled people are there in the UK?

Answer 10

8.7 million

8% with physical disability are wheelchair users

Question 11

How much of the population have a disability, how many have a profound or multiple disabilities?

Answer 11

20/1000 have a mild or moderate learning disability and

3-4 for every 1000 have a profound or multiple disabilities

Question 12

What % of people with learning disabilities have a carer >65

Answer 12

25%

Question 13

What does a person with cerebral palsy have problems with?

Answer 13

normal brain function but difficulties with muscle control

Lack of oxygen to the brain at birth

Question 14

What is challenging behaviour?

Answer 14

Behaviour such as intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy,
Or behaviour that is likely to seriously limit or deny access to the use of ordinary community services

Question 15

What are the dental aspects for treating a disabled child?

Answer 15

Makes treatment potentially dangerous
More at risk of dental disease
Compliance with personnel care
Compliance with treatment

Question 16

In what disabilities would the patient be at greater risk of dental disease?

Answer 16

Cleft lip and palate - dental abnormalities, different swallowing mechanism so fluid composition different, lip can make it more difficult to get toothbrush in
Down syndrome - lower caries rate because alteration saliva, high risk of perio because alternative lymphocyte
Cerebral palsy intellectual impairment loss of gross control of muscles

Question 17

Which disabilities in children may have problems with personnel care?

Answer 17

Autism

ADHD - dont like rules and short attention span

Question 18

Which disabilities in children may have problems with compliance with treatment?

Answer 18

Learning delay - cant allow treatment if dont understand
ADHD
Cerebral palsy

Question 19

Did you know?

Answer 19

Children and adolescents with special healthcare needs are almost twice as likely to have unment oral healthcare needs as then peers without
They have higher levels of diease and less likely to be accessing care
Also socio-economical, racial, cultural issues with accessing care and attitudes to disability

Question 20

According to DBOH, what is the professional intervention to children with special needs

Answer 20

apply fluoride varnish to teeth 3-4 times yearly 2.2% fluoride
Prescribe fluoride supplement and advise re maximising benefit
Reduce recall interval
investigate diet and adopt good diet advice
Ensure medication is sugar free

think: fluoride and sealants prevention

Question 21

What is the prevalence of autistic spectrum disorder

Answer 21

31-47 per 1000

3:1 males:females

Question 22

What do people with autistic spectrum disorder have difficulties with?

Answer 22

Social interaction
Communication
Inflexibility in thinking and behaviour

Question 23

What are people with adhd like?

Answer 23

Hyperactive
inattentive
compulsive

Question 24

What is the prevalence of ADHD Male: Female?

Answer 24

3:1

Question 25

What do 1/3 of people with ADHD also have?

Answer 25

another disorder - motor, defiant, bipolar disorder

Question 26

What is the management for people with ADHD?

Answer 26

medications
behaviour modifications
lifestyle changes and counselling

Question 27

What causes down syndrome?

Answer 27

3 copies of chromosome 21

Question 28

What is the typical appearance of someone with down syndrome?

Answer 28

upslanting palpebral fissure
simian fold
reduced muscle tone

Question 29

in what ways does having down syndrome affect dental treatment?

Answer 29

Reduced IQ - more difficult to understand treatment
Congenital heart disease - mitral valve - infective endocarditis
Gastric reflux
Thyroid dysfunction
Immune deficiency increased risk of leukaemia
Atlanto-axial instability - head needs to be well supported when taking GA

Question 30

Orally, what is special about people with down syndrome

Answer 30

less caries
More perio disease
delayed eruption
macroglossia

Question 31

What is the prevalence of cerebral palsy?

Answer 31

1.3:1 male:female

2 in 1000 births

Question 32

What causes cerebral palsy? what does this lead to?

Answer 32

Damage to motor control centres in the brain

abnormal muscle tone

Question 33

What can cerebral palsy also affect?

Answer 33

cognition

epilepsy

Question 34

What do you need to remember with special needs?

Answer 34

poorer dental health 
problems with access
complex needs  
Dental health one of many priorities 
Can make treatment potentially dangerorus 
More at risk of dental diease 
Compliance with personnel care
Compliance with treatment