Dental Care for the Special Needs Child Flashcards
when does an impairment become a disability?
when a child is unable to carry out the ‘normal’ activities of their peer group
what are the categories of impairment
intellectual (learning disabilities)
physical
sensory
what is 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 and fragile x syndrome)
what is learning disability?
children can be of normal intelligence but have difficulty in learning specific skills (dyslexia, autism, ADHD)
what are the causes of intellectual impairment?
down’s syndrome
fragile X syndrome
autism/schizophrenia
dyslexia
ADHD
emotional disorders
what are the types of down’s syndrome?
trisomy 21 - extra copy of chromosome 21 ( 3 instead of 2)
translocation - caused by rearranged chromosome material. In this case, there are three 21 chromosomes, just like there are in trisomy 21, but one of the 21 chromosomes is attached to another chromosome, instead of being separate.
mosaic - People with mosaic Down syndrome have some cells with two and some cells with three copies of chromosome 21
what are the features of down’s syndrome?
patients susceptible to a variety of other disorders e.g. cardiac disease
large tongue, large chubby fingers and hands
delayed exfoliation of primary teeth
congenitally absent teeth
hypoplastic teeth
high susceptibility to perio disease
what is fragile X syndrome?
faulty X chromosome, gene makes protein responsible for brain development (FMRP)
a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females. Affected individuals usually have delayed development of speech and language by age 2
what is the management of patients with down’s syndrome?
prevention programme most important
OH may be poor - may need to modify TB
often access to the mouth is difficult, tx plan may need to be modified for achievable tx
what is the management of patients with fragile X syndrome?
prevention
patient may have problems understanding/tolerating LA, tx etc
tx plan with adjustments - assess what patient can cope with
what are common physical features in a fragile x syndrome patient?
prominent broad forehead
large ears
long face
strabismus (squint)
prominent jaw
crowded high arched palate
what are the characteristics of autism?
early onset - 30 mths
profound adaptive problems in thinking, language and social relationships
routines and rituals
world may feel overwhelming
familiarity - same operator/surgery, appointments that suit the patients’ routine etc
may use alternative means of communication e.g. visual symbols - makaton
what is aspergers?
do not usually have the accompanying learning disabilities associated with autism but may have specific learning difficulties
what are the signs of schizophrenia?
social withdrawal, slow development
hostility of suspiciousness
deterioration of personal hygiene
flat, expressionless gaze
inability to cry or express joy
inappropriate laughter or crying
depression
oversleeping or insomnia
odd or irrational statements
what are the symptoms of schizophrenia?
hallucinations
delusions
muddled thoughts
behavioural changes
rare in children often presented in older adults
what is the management of an autistic or schizophrenic patient?
prevention
tx must be limited to what is tolerated
dont keep pt waiting
short tx sessions
hospital admission highly undesirable
(national autistic society)
management of ADHD patients
short appointments
keep tasks simple and of short duration
keep taking breaks from mouth
parental support
firmer management often required
physically impaired children dental challenges
gag and cough reflexes
hypoplastic or hypomineralised teeth - hypersensitive
access to mouth, either limited opening or uncontrolled patient movement
manoeuvring a wheelchair
transferring to dental chair
excessive saliva
self - inflicted intra oral wounds
what is the management for physically impaired patients?
aggressive prevention
operative intervention early
modify tx plan if necessary
patients may require GA
may need TB modified
electric tb?
if possible carry all tx at one visit if pt can cope with this
what are examples of sensory impairment?
blindness and visual impairment
deafness and hearing impairment
instead of tell show do, for blind and visual impaired patient what should you do?
tell feel do
what are the dental challenges of a blind or visually impaired patient?
reinforce stop signals
may be hard to build trust - cant see equipment
may be sensitive to operating light
use a low reassuring voice
depending on the age of the deaf child, english should not be assumed, what other form of language may they use?
BSL
what are the dental challenges associated with deafness and hearing impairment in a patient?
may find vibrations from instruments uncomfortable or may create high frequency with their hearing aid
interpretor required if cannot lip read
use visual aids where necessary (flashcards, books etc)
sit infront of patient when communicating
consider full face visor rather than mask
