dental care for the special needs child Flashcards
how does paediatric dentistry define those with special needs?
those with chronic physical, development, emotional and behavioural needs require more extensive dental needs
does prevalence of disease differ in certain disability groups?
yes e.g p disease and Down syndrome
do tx need to be modified for certain special needs children?
yes- depending on patients capabilities e.g cerebral palsy
when does an impairment become a disability?
when a child cannot carry out the normal activities of their peer group
what categories of impairment are there? give examples of each
intellectual (learning disabilities)- e.g problems during pregnancy/child birth or illness/injury
physical disabilities- cerebral palsy, muscular dystrophy
sensory- visual impairment blindness
hearing impairment-deafness
describe intelectual disabilites?
- below average level of intelligence and lack of skills necessary for day to day living
e.g Down syndrome
describe learning difficulties?
-normal level of intelligence but difficulty with particular skills
e.g adhd, dyslexia
give examples of conditions causing intellectual difficulties
-Down syndrome
-fragile x syndrome
-autism/schizophrenia
-dyslexia
-adhd
-emotional disorders
what causes Down syndrome?
trisomy 21- extra copy of chromosome 21
3 instead of 2
what are common features with down syndrome?
-large tongue
-chubby fingers/hands
-hypoplastic teeth
-delayed exfoliation of primary teeth
-congenital hypodontia
-high susceptibility to p. disease
what is the most important factor of dental management for ds patients?
PREVENTION
how else do you manage ds patients in dental setting?
-poor OH- may require toothbrush modification
-difficulty accessing mouth-larger tongue
what kind of condition if fragile x syndrome?
-genetic disorder
what does fragile x syndrome cause?
-faulty X chromosome
-faulty FMRP gene which is responsible for protein that allows for brain development
what are features of fragile X syndrome?
-crowded teeth
-large ears
-large forehead
-logn face
-prominent jaw
-high arch palate
how does fragile X syndrome affect dental care?
-difficulty understanding or tolerating treatments
-focus on prevention
what is key to patients with autism?
familiarity- same operator and surgery
-often stick to routines/rituals
what difficulties to those with autism face?
-difficulties with social communication- often unable to understand facial expressions, jokes, sarcasm
-take things literally
-unable to understand emotions/feeling or express their own
-cannot understand normal etiquette
-difficulty understanding new or unfamiliar situations
what visual help may someone with autism use?
makaton visual symbols
what are the signs of someone with schizophrenia?
-hostile
-deterioration in personal hygiene
-emotionless gaze
-inappropriate laughter
-depression
-insomonia
what are the symptoms of someone with schizophrenia?
-hallucinations
-delusions
-behavioural changes
-muddled thoughts
how do you manage autism/schrizophrenia in dental setting?
-on time appts
-short appts
-limit tx to what pt can tolerate on the day
what is the main problem of someone with dyslexia in a dental setting?
-understanding- difficulty processing or retaining information
how do you manage someone with dyslexia?
-very simple verbal and written explanation of tx with absolutely no jargon
what does ADHD stand for?
attention deficit hyperactivity disorder
how can adhd affect dental tx?
-difficulty sitting still/opening mouth
-difficulty following requests
how do you manage someone with adhd in a dental setting?
-short appts
-short tx
-continuous breaks from mouth being open
-encouragement from parents
-distraction
-firmer management
how can emotional disorders affect dentistry?
-eating disorders can lead to toothier (bulimia)
-focus on prevention
what is the main aim when dealing with intellectually impaired children?
acclimatisation- always start of simple and build trust/cooperation before moving on
-focus on prevention and parental support
-will take time
what are good aids for operators when treatmting patients with intellectual difficulties/
-fidget toys
-bedi shield to protect finger
how can physical impairments affect movement?
-impaired movement
-uncontrolled movement
what are examples of physical impairments?
-cerebral palsy
-spina bifida
-muscular dystrophy
what is cerebral palsy?
-neurological disorder which affects movement and coordination
-due to damage of cerebrum before or after birth- controls movement, learning, memory and communications skills
what is spina bifida?
-when the spinal cord and overlying vertebrae are poorly formed at birth- lower limb paralysis
what is muscular dystrophy?
diseases which lead to progressive atrophy and weakening of skeletal muscles- causing disability and deformity
what are the dental implications of physical impairments?
-poor OH-trouble performing on OH
-difficulty getting on chair
-self-inflicated (factitious) oral wounds
-trouble opening mouth or trouble controlling movement of mouth
-gag/cough reflexes
-hypomineralised/hypoplastic teeth
-excessive saliva
how do you manage those with physical impairment?
-aggressive early prevention-FS/FV
-educate parental support
-may require GA- extract all teeth of poor prognosis to avoid repeat GA
-modify toothbrush-electric?
-special chair for lifting wheelchairs
-perform as much tx as possible- which they can handle
what forms of sensory impairment is there?
-visual
-hearing
how can visual impairments affect dental care?
-OHI affected- cannot see plaque removal
-trust- cannot see instruments being used
-operating light may cause sensitivity to those visually impaired
how can operators aid those who are visually impaired?
-tell, feel, do
-explain procedures before you start
-reassure pt
-give instructions suitable to their sight- e.g large print/brail
-cant see OHI- explain feelings of brushes
-address the patient not carer
-do not shout-they are not deaf
what may those with hearing impairments use?
-hearing aids
-sign language
what are dental challanges of someone with hearing impairments?
-communication
-may be more sensitive to vibratory sounds of instruments- uncomfortable
how do you manage those with hearing impairments?
-document severity
-use visual aids
-sit infront of patient
-speak clearly if they can lip read
-interpretor if first language is BSL
-use full face visor instead of mask
-use positive body language/facial expressions
discuss prevention and tx on those with impairments?
-aggressive early prevention is essential as treatment should be avoided due to difficulties for both the operator and the patient.
how does parental support affect OH?
- it is important to be realistic
-educate parent/carer on OH to assist with any at home OH advice
discuss plaque control for those with impairments
-supervised toothbrushing if able to do it themselves
-educated parent/carer if unable to do it themselves
-electric toothbrush if suitable
-modified toothbrush if needed- e.g moulded to their hand grip
-if cannot tolerate tb/tp- use cholarhexidine on gauze swabs to clean teeth
discuss fluoride use for those with impairments
-duraphat may be prescribed as mild risk of fluorosis and systemic ingestion is outweighed by benefits of high fluoride tp
discuss diet for those with impairments
-likely more spoiled with sweets/sugar than other children
-normal diet advice-reduce frequency and consumption and before bed
-avoid cariogenic medicine- use sugar free alternatives
