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dentistry for children with disabilities Flashcards

1
Q

how does the Equality Act 2010 define disability?

A

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

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2
Q

what % of children in the UK have a disability?

A

6

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3
Q

what are the 3 main causes of disability?

A

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

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4
Q

what are the 4 classifications of disability?

A

intellectual/behavioural
physical
sensory
medically compromised

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5
Q

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

A

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

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6
Q

what are the presentations of downs syndrome?

A

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

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7
Q

what causes cerebral palsy?

A

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

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8
Q

what are the symptoms of cerebral palsy?

A

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

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9
Q

what are the 3 types of cerebral palsy?

A

spastic
ataxic
dyskinetic

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10
Q

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

A

spastic- cortex
ataxic- cerebellum
dyskinetic- basal ganglia

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11
Q

what are the 3 types of spastic cerebral palsy?

A

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

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12
Q

how does ataxic cerebral palsy present?

A

difficulty with coordination and balance

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13
Q

how does dyskinetic cerebral palsy present?

A

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

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14
Q

what are the dental considerations of cerebral palsy?

A

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

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15
Q

what is the most common childhood cancer?

A

leukaemia

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16
Q

which components of the blood does leukaemia effect?

A

lymphocytes
myeloid cells including neutrophils

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17
Q

how does leukaemia present?

A

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

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18
Q

how does leukaemia affect white blood cells?

A

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

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19
Q

what are the oral manifestations of leukaemia?

A

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

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20
Q

what cancer therapies could lead to oral complications?

A

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

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21
Q

what is chemotherapy?

A

cytotoxic drugs with selective toxicity to rapidly dividing cancer cells

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22
Q

what are the short term relevant effects of chemotherapy?

A

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

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23
Q

what are the long term relevant effects of chemotherapy?

A

affects developing dentition- enamel hypoplasia/microdontia/ thin roots

24
Q

what is the aim of radiotherapy?

A

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

25
Q

what are the short term relevant effects of radiotherapy?

A

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)

26
Q

what are the long term relevant effects of radiotherapy?

A

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

27
Q

what are the 2 classifications of congenital cardiac defects?

A

cyanotic
acyanotic

28
Q

what is a cyanotic congenital cardiac defect?

A

when deoxygenated blood is able to enter the systemic circulation

29
Q

what is an acyanotic congenital cardiac defect?

A

normal levels of oxyhaemoglobin in the systemic circulation

30
Q

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

A

ventricular septal defect

31
Q

what is the most common cyanotic congenital cardiac defect?

A

tetralogy of Fallot

32
Q

what are the dental implications of congenital cardiac defects?

A

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

33
Q

what is infective endocarditis?

A

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)

34
Q

what is the morbidity rate of infective endocarditis

A

5-40%

35
Q

name 5 patients at risk of infective endocarditis

A
  1. acquired valvular heart disease with stenosis or regurgitation
  2. hypertrophic cardiomyopathy
  3. previous infective endocarditis
  4. structural congenital heart disease
  5. valve replacement
36
Q

what are the most common inherited bleeding disorder conditions?

A

Von Willebrand’s disease
haemophilia A
haemophilia B

37
Q

what are the 3 ways in which bleeding disorders act?

A

mediate platelet adhesion
mediate platelet aggregation
carrier of factor VIII

38
Q

name two causes of inherited bleeding disorders

A

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

39
Q

which types of haemostasis do bleeding disorders affect?

A

primary
secondary
tertiary

40
Q

what is primary haemostasis?

A

vasoconstriction after injury
platelet plug formation

41
Q

what is secondary haemostasis?

A

formation of fibrin through coagulation cascade

42
Q

what is tertiary haemostasis?

A

fibrinolysis
formation of plasminogen, then plasmin

43
Q

what is Von Willebrand disease?

A

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

44
Q

what is haemophilia?

A

lack of clotting factors= increased bleeding tendency

45
Q

which type of haemophilia affects factor VIII

A

haemophilia A

46
Q

which type of haemophilia affects factor IX?

A

haemophilia B

47
Q

how are mild, moderate and severe haemophilia classfied?

A

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

48
Q

what are the dental implications of haemophilia?

A

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

49
Q

what factors will alter haemostatic cover?

A

type of haemophilia
severity of haemophilia
treatment required

50
Q

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

A

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

51
Q

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

A

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

52
Q

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

A

non foaming/flavour free toothpaste e.g. oranurse

53
Q

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

A

age 10 years

54
Q

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

A

age 16 years

55
Q

explain the use of this toothbrush

A

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

paediatrics (5 decks)

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