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PAEDS FLASHCARDS > DENTAL CARE FOR THE SPECIAL NEEDS CHILD > Flashcards

DENTAL CARE FOR THE SPECIAL NEEDS CHILD Flashcards

1
Q

what are the three categories of impairment

A

INTELLECTUAL IMPAIRMENT (learning disability) - genetic disorders, problems during pregnancy, problems during child birth, illness or injury
PHYSICAL IMPAIRMENT - cerebral palsy, spina bifida, muscular dystrophy
sensory - visual impairment/blindness, hearing impairments/deafness

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2
Q

what can intellectual impairment be split into…

A

intellectual disability - this is below average level of intelligence or mental cognitive ability and a lack of skills necessary for day to day living (downs syndrome and fragile X syndrome)
learning disability - children can be of normal intelligence but have difficulty in learning in specific skills (dyslexia, autism, ADHD)

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3
Q

list some of the causes of intellectual impairment (6)

A
  • downs syndrome
  • fragile x syndrome
  • autism/schizophrenia
  • dyslexia
  • ADHD
  • emotional disorders
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4
Q

what are the features of downs syndrome in a child(7)

A
  • it is a chromosomal disorder - trisomy. an extra copy of chromosome (3 instead of usual 2)
  • these patients are susceptible to a variety of other disorders eg cardiac disease
  • large tongue, large chubby fingers and hands
  • delayed exfoliation of primary teeth
  • enamel hypoplasia
  • congenitally absent teeth
  • high sysceptibility to perio disease
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5
Q

what is the management for a patient with downs syndrome (3)

A
  • PREVENTION programme is the most important factor
  • OH often poor - may need to modify a toothbrush
  • often access to the childs mouth is difficult - tx plan may need to be modified for ACHIEVABLE treatment.
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6
Q

what are the features of fragile X syndrome (10)

A
  • a genetic disorder - faulty X chromosome, gene makes protein responsible for brain development
  • LARGELY undiagnosed
  • more commonly affects males and impairment more pronounced
  • INTELECTUALLY IMPAIRED
  • prominent, broad forehead
  • large ears
  • prominent jaw
  • crowding and high arched palate
  • hypodontia
  • scoliosis
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7
Q

what is the management of a patient with fragile x syndrome

A
  • PREVENTION AGAIN
  • patient may have problems understanding or tolerating LA, treatment etc
  • treatment plan adjustment - assess what the patient can cope with.
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8
Q

list some of the features/characteristics associated with autism

A
  • an early onset - 30 months
  • profound adaptive problems in thinking, language and social relationships
  • cause unknown, but thought to be prenatal, not social
  • they have routines and rituals
  • the world may feel overwhelming
  • they like familiarity - same operator, same surgery, appointments that suits the patients routines etc.
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9
Q

describe what we mean when an autistic child has difficulty with SOCIAL COMMUNICATION

A

verbal and non - verbal communication - difficulty interpreting facial expressions/tone of voice, jokes and sarcasm. they often take things to the extreme or quite literal.

we can sometimes use alternative means of communication for an AUTISTIC CHILD called MAKATON (visual symbols)

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10
Q

what are the signs and symptoms of a pt with schizophrenia (9)

A

signs :
- social withdrawal, slow development
- hostility or suspiciousness
- lowered personal hygiene
- flat, expressionless gaze
- inability to cry or express joy
- inappropriate laughter or crying
- depression
- oversleeping or insomnia
- odd/irrational statements

SYMPTOMS
- hallucinations
- delusions
- muddled thoughts
- behavioural changes

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11
Q

what is the management of autism/schizophrenia

A
  • prevention
  • tx must be limited to what the patient can tolerate
  • dont keep patient waiting
  • short treatment session
  • hosp admission highly undesirable
  • NATIONAL AUTISTIC SOCIETY
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12
Q

what are the symptoms/features of dyslexia

A
  • usually problems with COGNITION - difficulty processing or holding info
  • can var in severity - from mild to profound
  • main problem is understanding things
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13
Q

what is the management of dyslexia

A
  • may need little or no adjustment
  • take treatment at a slow pace so pt understands
  • explain procedures in simple terms ie no written communication with jargon or complicated language
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14
Q

what are the symptoms/signs/ features of ADHD

A
  • difficulty staying still
  • chaotic behaviour
  • has difficulty responding to your requests to eg sit in chair or open mouth
  • likely to have problems in maintaining oral hygiene at home
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15
Q

what is the management of ADHD

A
  • short appointments
  • keep tasks simple and of short duration
  • keep taking breaks from patients mouth (esp with handpieces and sharp instruments)
  • parental support often required - distract or encouragement to focus
  • FIRMER management often required
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16
Q

what are some signs/symptoms/features of a patient with an emotional disorder & the management

A

eg eating disorder
- may have particular dental relevance eg toothwear
MANAGEMENT
- prevention should always be first and foremost

17
Q

what is a bedi mouth shield

A

a specialised mouth prop that allows home carers & health professionals to clean or examine the teeth of those in their care

18
Q

what are the features/causes of cerebral palsy

A
  • a neurological condition that affects movement and coordination
  • damage to BRAIN before or after birth (cerebrum) - part of the 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 the foetus

19
Q

what are the dental challenges of physically impaired children

A
  • gag and cough reflexes
  • hypoplastic or hypomineralised teeth - hypersensitive
  • access to the mouth, either limited opening or uncontrolled patient movement
  • manoevouring a wheelchair
  • transferring the pt into the dental chair
  • excessive saliva as decreased swallowing ie moisture control difficult here
  • self inflicted oral wounds (factitious)
20
Q

what are the management strategies for physically impaired patients (10)

A
  • AGGRESSIVE prevention
  • operative intervention EARLY
  • modify treatment plan if necessary
  • patients may require sedation or GA to carry out treatment
  • if GA or sedation, tx should be RADICAL ie xla any teeth of a poor prognosis or potentially poor prognosis to reduce the risk of a repeat GA
  • may need modification of a toothbrush
  • electric/power tb
  • specialist surgeries may have special lifting equipment, or equipment for placing wheelchair in a supine position (wheelchair platform).
  • wheelchair accessible dental units
  • if poss carry out all tx at a single visit - if pt can cope with this
21
Q

what are the 2 types of sensory impairment in a patient

A
  • blindness and visual impairment
  • deafness and hearing impairment
22
Q

what are the dental challenges of a blind/visually impaired patient

A
  • the pt cannot see you, or any equipment you are using - TRUST
  • oral hygiene may be impaired
  • patients may be sensitive to operating light
23
Q

what are the management strategies for a blind/visually impaired pt

A
  • dental treatment should be achievable as normal
  • tell, feel, do eg placing instruments in mouth
  • try to keep a low reassuring voice
  • take time to explain the feel and texture of OH aids
  • always address the patient, not the the parent/carer
  • do not shout at your blind patient - THEY ARE NOT DEAF!!!
24
Q

what are the dental challenges of a deaf/hearing impaired patient

A
  • communication
  • patients with hearing impairments may find the vibratory sensation of the dental handpieces and ultrasonic scalers very uncomfortable.
25
Q

what is the management of a deaf/hearing impaired patient

A
  • find out early on the extent of the patients impairment and record this
  • use visual aids where necessary (flashcards, books, props)
  • always use positive body language and sit directly in front of the child when communicating
  • consider full face visor in place of mask
    -do not assume patient or parent (who may also be deaf) can read/write english proficiently - BSL is normally 1st language
  • interpereter required if patient cannot lip read or speak
26
Q

why would we carry out prevention/oral hygiene rather than treatment on an impaired child

A
  • may be that the treatment physically compromises eg IE
  • treatment may just not be possible eg severe cerebral palsy
  • therefore, aggressive prevention must be undertaken in ALL CASES!!!!!!!
  • some children with disabilities may have complex health issues and related oral health issues
27
Q

prevention and oral hygiene - ways we can introduce keeping on top of PLAQUE CONTROL in an impaired child

A
  • if patient is able to brush there own teeth, parent/carer should supervise them
  • an electric/powered TB should be considered
  • if pt cannot brush there own teeth, carer should be given specific instructions and demonstration - needs a great deal of commitment from carer
  • a modified handle may help pt to grip toothbrush more effectively
  • chemical agents eg chlorohexadine may be used on gauze swabs etc if patient cannot tolerate toothbrush/toothpaste in mouth
28
Q

prevention and oral hygiene - ways we can control DIET in an impaired child

A
  • spoiling can be a problem for all children - those with impairments seem to be more so
  • cariogenic medicines - less of an issue today. Sugar free alternatives widely available
  • dietry advice should follow the same guidelines as for other children

PAEDS FLASHCARDS (10 decks)

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