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paediatrics > dental care for the special needs child > Flashcards

dental care for the special needs child Flashcards

1
Q

how does paediatric dentistry define those with special needs?

A

those with chronic physical, development, emotional and behavioural needs require more extensive dental needs

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2
Q

does prevalence of disease differ in certain disability groups?

A

yes e.g p disease and Down syndrome

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3
Q

do tx need to be modified for certain special needs children?

A

yes- depending on patients capabilities e.g cerebral palsy

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4
Q

when does an impairment become a disability?

A

when a child cannot carry out the normal activities of their peer group

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5
Q

what categories of impairment are there? give examples of each

A

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

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6
Q

describe intelectual disabilites?

A
  • below average level of intelligence and lack of skills necessary for day to day living

e.g Down syndrome

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7
Q

describe learning difficulties?

A

-normal level of intelligence but difficulty with particular skills

e.g adhd, dyslexia

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8
Q

give examples of conditions causing intellectual difficulties

A

-Down syndrome
-fragile x syndrome
-autism/schizophrenia
-dyslexia
-adhd
-emotional disorders

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9
Q

what causes Down syndrome?

A

trisomy 21- extra copy of chromosome 21
3 instead of 2

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10
Q

what are common features with down syndrome?

A

-large tongue
-chubby fingers/hands
-hypoplastic teeth
-delayed exfoliation of primary teeth
-congenital hypodontia
-high susceptibility to p. disease

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11
Q

what is the most important factor of dental management for ds patients?

A

PREVENTION

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12
Q

how else do you manage ds patients in dental setting?

A

-poor OH- may require toothbrush modification
-difficulty accessing mouth-larger tongue

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13
Q

what kind of condition if fragile x syndrome?

A

-genetic disorder

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14
Q

what does fragile x syndrome cause?

A

-faulty X chromosome
-faulty FMRP gene which is responsible for protein that allows for brain development

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15
Q

what are features of fragile X syndrome?

A

-crowded teeth
-large ears
-large forehead
-logn face
-prominent jaw
-high arch palate

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16
Q

how does fragile X syndrome affect dental care?

A

-difficulty understanding or tolerating treatments
-focus on prevention

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17
Q

what is key to patients with autism?

A

familiarity- same operator and surgery
-often stick to routines/rituals

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18
Q

what difficulties to those with autism face?

A

-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

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19
Q

what visual help may someone with autism use?

A

makaton visual symbols

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20
Q

what are the signs of someone with schizophrenia?

A

-hostile
-deterioration in personal hygiene
-emotionless gaze
-inappropriate laughter
-depression
-insomonia

21
Q

what are the symptoms of someone with schizophrenia?

A

-hallucinations
-delusions
-behavioural changes
-muddled thoughts

22
Q

how do you manage autism/schrizophrenia in dental setting?

A

-on time appts
-short appts
-limit tx to what pt can tolerate on the day

23
Q

what is the main problem of someone with dyslexia in a dental setting?

A

-understanding- difficulty processing or retaining information

24
Q

how do you manage someone with dyslexia?

A

-very simple verbal and written explanation of tx with absolutely no jargon

25
Q

what does ADHD stand for?

A

attention deficit hyperactivity disorder

26
Q

how can adhd affect dental tx?

A

-difficulty sitting still/opening mouth
-difficulty following requests

27
Q

how do you manage someone with adhd in a dental setting?

A

-short appts
-short tx
-continuous breaks from mouth being open
-encouragement from parents
-distraction
-firmer management

28
Q

how can emotional disorders affect dentistry?

A

-eating disorders can lead to toothier (bulimia)
-focus on prevention

29
Q

what is the main aim when dealing with intellectually impaired children?

A

acclimatisation- always start of simple and build trust/cooperation before moving on
-focus on prevention and parental support
-will take time

30
Q

what are good aids for operators when treatmting patients with intellectual difficulties/

A

-fidget toys
-bedi shield to protect finger

31
Q

how can physical impairments affect movement?

A

-impaired movement
-uncontrolled movement

32
Q

what are examples of physical impairments?

A

-cerebral palsy
-spina bifida
-muscular dystrophy

33
Q

what is cerebral palsy?

A

-neurological disorder which affects movement and coordination

-due to damage of cerebrum before or after birth- controls movement, learning, memory and communications skills

34
Q

what is spina bifida?

A

-when the spinal cord and overlying vertebrae are poorly formed at birth- lower limb paralysis

35
Q

what is muscular dystrophy?

A

diseases which lead to progressive atrophy and weakening of skeletal muscles- causing disability and deformity

36
Q

what are the dental implications of physical impairments?

A

-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

37
Q

how do you manage those with physical impairment?

A

-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

38
Q

what forms of sensory impairment is there?

A

-visual
-hearing

39
Q

how can visual impairments affect dental care?

A

-OHI affected- cannot see plaque removal
-trust- cannot see instruments being used
-operating light may cause sensitivity to those visually impaired

40
Q

how can operators aid those who are visually impaired?

A

-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

41
Q

what may those with hearing impairments use?

A

-hearing aids
-sign language

42
Q

what are dental challanges of someone with hearing impairments?

A

-communication
-may be more sensitive to vibratory sounds of instruments- uncomfortable

43
Q

how do you manage those with hearing impairments?

A

-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

44
Q

discuss prevention and tx on those with impairments?

A

-aggressive early prevention is essential as treatment should be avoided due to difficulties for both the operator and the patient.

45
Q

how does parental support affect OH?

A
  • it is important to be realistic
    -educate parent/carer on OH to assist with any at home OH advice
46
Q

discuss plaque control for those with impairments

A

-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

47
Q

discuss fluoride use for those with impairments

A

-duraphat may be prescribed as mild risk of fluorosis and systemic ingestion is outweighed by benefits of high fluoride tp

48
Q

discuss diet for those with impairments

A

-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

paediatrics (13 decks)

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