dentistry for children with disabilities

Question 1

how does the Equality Act 2010 define disability?

Answer 1

physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities

Question 2

what % of children in the UK have a disability?

Answer 2

6

Question 3

what are the 3 main causes of disability?

Answer 3

genetic factors
developmental e.g. ijury, infection
unknown cause

Question 4

what are the 4 classifications of disability?

Answer 4

intellectual/behavioural
physical
sensory
medically compromised

Question 5

people with autism spectrum disorder (ASD) may struggle with which tasks?

Answer 5

social communication
social interaction
repetitive and restrictive behaviour
sensitivity difficulties
extreme anxiety

Question 6

what are the presentations of downs syndrome?

Answer 6

physical features- large tongue, mid facial hypoplasia
learning difficulty
increased predisposition to cardiac defects, leukaemia, epilepsy

Question 7

what causes cerebral palsy?

Answer 7

brain damage either during fetal life, the birth process or during the first few months of infancy

Question 8

what are the symptoms of cerebral palsy?

Answer 8

delays in motor skills development
poor control over hand and arm movement
weakness
abnormal walking
difficulties swallowing
excessive drooling

Question 9

what are the 3 types of cerebral palsy?

Answer 9

spastic
ataxic
dyskinetic

Question 10

whereabouts in the brain do each of the types of cerebral palsy effect?

Answer 10

spastic- cortex
ataxic- cerebellum
dyskinetic- basal ganglia

Question 11

what are the 3 types of spastic cerebral palsy?

Answer 11

diplegia- muscle stiffness mainly in the legs
hemiplegia- affects only one side of the body
quadriplegia- affects all 4 limbs, the trunk and the face

Question 12

how does ataxic cerebral palsy present?

Answer 12

difficulty with coordination and balance

Question 13

how does dyskinetic cerebral palsy present?

Answer 13

uncontrollable movements of the hands, arms, feet and legs, making it difficult to sit and walk

Question 14

what are the dental considerations of cerebral palsy?

Answer 14

difficulty tolerating dental treatment
increased rate of malocclusion
increased risk of dental trauma
high prevalence of bruxism
poor oral hygiene
pathological oral reflexes
calculus if peg fed
periodontal disease
hyperplastic gingivitis
self mutilation
unsafe swallow

Question 15

what is the most common childhood cancer?

Answer 15

leukaemia

Question 16

which components of the blood does leukaemia effect?

Answer 16

lymphocytes
myeloid cells including neutrophils

Question 17

how does leukaemia present?

Answer 17

pallor (lack of red blood cells)
increased bleeding/brusing (lack of platelets)
infection (lack of functioning white blood cells)

Question 18

how does leukaemia affect white blood cells?

Answer 18

white blood cells production gets out of control and the cells continue to divide in the bone marrow, but do not mature

Question 19

what are the oral manifestations of leukaemia?

Answer 19

gingival swelling
ulceration
spontaneous gingival bleeding
unusual mobility of teeth
petechiae
mucosal pallor
herpetic infections
candidiasis

Question 20

what cancer therapies could lead to oral complications?

Answer 20

surgery to the head and neck
chemotherapy
radiotherapy to the head and neck
bone marrow transplant

Question 21

what is chemotherapy?

Answer 21

cytotoxic drugs with selective toxicity to rapidly dividing cancer cells

Question 22

what are the short term relevant effects of chemotherapy?

Answer 22

effect on mucous membrane- mucositis
effect on bone marrow ( decreased neutrophils= increased infection risk, decreased platelets= increased bleeding risk)

Question 23

what are the long term relevant effects of chemotherapy?

Answer 23

affects developing dentition- enamel hypoplasia/microdontia/ thin roots

Question 24

what is the aim of radiotherapy?

Answer 24

to deliver lethal doses of radiation to the tumour while minimising the dose to the surrounding tissues

Question 25

what are the short term relevant effects of radiotherapy?

Answer 25

oral mucosa -mucositis most severe at 2-4 weeks salivary glands- decreased flow/increased velocity (often permanent) direct damage to taste buds- loss/alteration to taste (leads to an altered diet)

Question 26

what are the long term relevant effects of radiotherapy?

Answer 26

malocclusion increased risk of soft tissue neoplasm risk of osteoradionecrosis effects to developing dentition- hypodontia, microdontia, enamel hypoplasia, defects of root formation

Question 27

what are the 2 classifications of congenital cardiac defects?

Answer 27

cyanotic acyanotic

Question 28

what is a cyanotic congenital cardiac defect?

Answer 28

when deoxygenated blood is able to enter the systemic circulation

Question 29

what is an acyanotic congenital cardiac defect?

Answer 29

normal levels of oxyhaemoglobin in the systemic circulation

Question 30

what is the most common type of acyanotic congenital cardiac defect?

Answer 30

ventricular septal defect

Question 31

what is the most common cyanotic congenital cardiac defect?

Answer 31

tetralogy of Fallot

Question 32

what are the dental implications of congenital cardiac defects?

Answer 32

medications which increase bleeding tendency higher risk of general anaesthetic careful use of adrenaline containing LA increased risk of enamel hypoplasia risk of infective endocarditis resulting from an oral bacteraemia

Question 33

what is infective endocarditis?

Answer 33

when bacteria enter the bloodstream, cause a bacteraemia and then adhere and multiply on the damaged heart surface results in inflammation of the endocardium (inner layer of the heart)

Question 34

what is the morbidity rate of infective endocarditis

Answer 34

5-40%

Question 35

name 5 patients at risk of infective endocarditis

Answer 35

1. acquired valvular heart disease with stenosis or regurgitation 2. hypertrophic cardiomyopathy 3. previous infective endocarditis 4. structural congenital heart disease 5. valve replacement

Question 36

what are the most common inherited bleeding disorder conditions?

Answer 36

Von Willebrand's disease haemophilia A haemophilia B

Question 37

what are the 3 ways in which bleeding disorders act?

Answer 37

mediate platelet adhesion mediate platelet aggregation carrier of factor VIII

Question 38

name two causes of inherited bleeding disorders

Answer 38

use of blood thinning medication e.g. warfarin/aspirin chemotherapy induced thrombocytopenia

Question 39

which types of haemostasis do bleeding disorders affect?

Answer 39

primary secondary tertiary

Question 40

what is primary haemostasis?

Answer 40

vasoconstriction after injury platelet plug formation

Question 41

what is secondary haemostasis?

Answer 41

formation of fibrin through coagulation cascade

Question 42

what is tertiary haemostasis?

Answer 42

fibrinolysis formation of plasminogen, then plasmin

Question 43

what is Von Willebrand disease?

Answer 43

inherited deficency of von willebrand factor can also be low levels of factor 8 present

Question 44

what is haemophilia?

Answer 44

lack of clotting factors= increased bleeding tendency

Question 45

which type of haemophilia affects factor VIII

Answer 45

haemophilia A

Question 46

which type of haemophilia affects factor IX?

Answer 46

haemophilia B

Question 47

how are mild, moderate and severe haemophilia classfied?

Answer 47

mild - >5% activity moderate- 1-5% activity severe- <1%

Question 48

what are the dental implications of haemophilia?

Answer 48

require enhanced dental caries prevention treatment should be performed within the hospital dental service in close liaison with haematology

Question 49

what factors will alter haemostatic cover?

Answer 49

type of haemophilia severity of haemophilia treatment required

Question 50

what are the impacts of dental disease in children with disabilities?

Answer 50

increased risk of dental caries delayed diagnosis delayed managemtn need for multidisciplinary planning pain/infection can be difficult to manage health risk posed by dental infection risks posed by dental infection risks posed by dental treatment

Question 51

why are children with special needs often at an increased risk of dental decay?

Answer 51

use of sugar containing medicine limited diet/difficulty brushing difficulty managing caries

Question 52

how can you help a child with sensory impairments to brush their teeth?

Answer 52

non foaming/flavour free toothpaste e.g. oranurse

Question 53

at what age can a high risk child be prescribed 2800ppm fluoride toothpaste?

Answer 53

age 10 years

Question 54

at what age can a high risk child be prescribed 5000ppm fluoride toothpaste?

Answer 54

age 16 years

Question 55

explain the use of this toothbrush

Answer 55

Dr Marman's toothbrush brushes lingual/buccal and occlusal surfaces at the same time may be helpful where brushing is a challenge