Dental Care for the Special Needs Child

Question 1

when does an impairment become a disability?

Answer 1

when a child is unable to carry out the ‘normal’ activities of their peer group

Question 2

what are the categories of impairment

Answer 2

intellectual (learning disabilities)
physical
sensory

Question 3

what is intellectual disability?

Answer 3

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)

Question 4

what is learning disability?

Answer 4

children can be of normal intelligence but have difficulty in learning specific skills (dyslexia, autism, ADHD)

Question 5

what are the causes of intellectual impairment?

Answer 5

down’s syndrome
fragile X syndrome
autism/schizophrenia
dyslexia
ADHD
emotional disorders

Question 6

what are the types of down’s syndrome?

Answer 6

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

Question 7

what are the features of down’s syndrome?

Answer 7

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

Question 8

what is fragile X syndrome?

Answer 8

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

Question 9

what is the management of patients with down’s syndrome?

Answer 9

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

Question 10

what is the management of patients with fragile X syndrome?

Answer 10

prevention
patient may have problems understanding/tolerating LA, tx etc
tx plan with adjustments - assess what patient can cope with

Question 11

what are common physical features in a fragile x syndrome patient?

Answer 11

prominent broad forehead
large ears
long face
strabismus (squint)
prominent jaw
crowded high arched palate

Question 12

what are the characteristics of autism?

Answer 12

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

Question 13

what is aspergers?

Answer 13

do not usually have the accompanying learning disabilities associated with autism but may have specific learning difficulties

Question 14

what are the signs of schizophrenia?

Answer 14

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

Question 15

what are the symptoms of schizophrenia?

Answer 15

hallucinations
delusions
muddled thoughts
behavioural changes
rare in children often presented in older adults

Question 16

what is the management of an autistic or schizophrenic patient?

Answer 16

prevention
tx must be limited to what is tolerated
dont keep pt waiting
short tx sessions
hospital admission highly undesirable
(national autistic society)

Question 17

management of ADHD patients

Answer 17

short appointments
keep tasks simple and of short duration
keep taking breaks from mouth
parental support
firmer management often required

Question 18

physically impaired children dental challenges

Answer 18

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

Question 19

what is the management for physically impaired patients?

Answer 19

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

Question 20

what are examples of sensory impairment?

Answer 20

blindness and visual impairment
deafness and hearing impairment

Question 21

instead of tell show do, for blind and visual impaired patient what should you do?

Answer 21

tell feel do

Question 22

what are the dental challenges of a blind or visually impaired patient?

Answer 22

reinforce stop signals
may be hard to build trust - cant see equipment
may be sensitive to operating light
use a low reassuring voice

Question 23

depending on the age of the deaf child, english should not be assumed, what other form of language may they use?

Answer 23

BSL

Question 24

what are the dental challenges associated with deafness and hearing impairment in a patient?

Answer 24

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