Dental care for the medically compromised child Flashcards
What is the WHO definition of health?
a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity
What is the medical model?
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’
What is the social model?
It is society which disables people with impairment by its failure to include them
What is an impairment as seen by medical model?
Loss or abnormality of physiology or anatomical structure or function
What is an impairment as seen by social model?
The functional limitation within the individual caused by physical, mental or sensory loss
What is a disability as seen by medical model?
Restriction of activity as a consequence of impairment
What is a disability as seen by social model?
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
According to the WHO international classification of functioning, disability and health,
what is the b520 classification about?
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
According to the WHO international classification of functioning, disability and health,
what is the b280 classification about?
Sensation of pain
Sensation of unpleasant feeling indicating potential or actual damage to some body structure
Functional pain
Odontogenic pain
How many disabled people are there in the UK?
8.7 million
8% with physical disability are wheelchair users
How much of the population have a disability, how many have a profound or multiple disabilities?
20/1000 have a mild or moderate learning disability and
3-4 for every 1000 have a profound or multiple disabilities
What % of people with learning disabilities have a carer >65
25%
What does a person with cerebral palsy have problems with?
normal brain function but difficulties with muscle control
Lack of oxygen to the brain at birth
What is challenging behaviour?
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
What are the dental aspects for treating a disabled child?
Makes treatment potentially dangerous
More at risk of dental disease
Compliance with personnel care
Compliance with treatment
In what disabilities would the patient be at greater risk of dental disease?
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
Which disabilities in children may have problems with personnel care?
Autism
ADHD - dont like rules and short attention span
Which disabilities in children may have problems with compliance with treatment?
Learning delay - cant allow treatment if dont understand
ADHD
Cerebral palsy
Did you know?
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
According to DBOH, what is the professional intervention to children with special needs
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
What is the prevalence of autistic spectrum disorder
31-47 per 1000
3:1 males:females
What do people with autistic spectrum disorder have difficulties with?
Social interaction
Communication
Inflexibility in thinking and behaviour
What are people with adhd like?
Hyperactive
inattentive
compulsive
What is the prevalence of ADHD Male: Female?
3:1
What do 1/3 of people with ADHD also have?
another disorder - motor, defiant, bipolar disorder
What is the management for people with ADHD?
medications
behaviour modifications
lifestyle changes and counselling
What causes down syndrome?
3 copies of chromosome 21
What is the typical appearance of someone with down syndrome?
upslanting palpebral fissure
simian fold
reduced muscle tone
in what ways does having down syndrome affect dental treatment?
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
Orally, what is special about people with down syndrome
less caries
More perio disease
delayed eruption
macroglossia
What is the prevalence of cerebral palsy?
1.3:1 male:female
2 in 1000 births
What causes cerebral palsy? what does this lead to?
Damage to motor control centres in the brain
abnormal muscle tone
What can cerebral palsy also affect?
cognition
epilepsy
What do you need to remember with special needs?
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
