Dentistry for Children with Disabilities

Question 1

How can disabilities be categorised?

Answer 1

• intellectual/behavioural
  
  • learning disability
  • autism spectrum disorder
  • Down’s syndrome
• physical
  
  • cerebral palsy
• sensory
  
  • vision impairment
  • hearing loss
• medically compromised
  
  • oncology
  • cardiac
  • haemophilia

Question 2

In what ways can autism affect a person?

Answer 2

• social communication
• social interaction
• repetitive and restrictive behaviour
• over or under sensitivity to light, sound, taste or touch
• extreme anxiety
• meltdowns or shutdowns

Question 3

What strategies can be used to aid those with autism in a dental environment?

Answer 3

• use preferred mode of communication
• use concrete language
• give direct requests
• avoid jokes/sarcasm
• avoid body language, gestures or facial expression without accompanying verbal instruction
• react comply
• explain clearly what is happening, aid with pictures
• check understanding
• allow time for processing
• prepare for the visit
• build appointments into routine
• take into account sensory difficulties for diet advice
• compassion for parents
• note any special interests in clinical records
• find out sensory difficulties
• avoid waiting room, first appointment of the dam

Question 4

What is Down’s syndrome and what are the dental features?

Answer 4

• trisomy 21
  
  • additional copy of chromosome 21
• maxillary hypoplasia
• class III occlusion
• macroglossia
• anterior open bite
• hypodontia/microdontia
• predisposition to periodontal disease
  - due to impair phagocyte function
  - combined with poor oral hygiene

Question 5

What is cerebral palsy?

Answer 5

• non-progressive lesion of motor pathways in developing brain
  
  • due to brain damage in early development
  • abnormalities of movement and posture
• associated with other issues
  
  • learning difficulties
  • epilepsy
  • visual/hearing impairment
  • joint contractures/scoliosis/hip subluxation
  • reflux

Question 6

How many types of cerebral palsy are there?

Answer 6

• 3 types
  
  • spastic
    - cortex of brain damaged
    - increased muscle tone
  • ataxic
    - cerebellum of brain damaged
    - coordination and balance affected
  • dyskinetic
    - basal ganglia of brain damaged
    - uncontrollable movements
• can display one a a combination of types

Question 7

What is spastic cerebral palsy?

Answer 7

• increased muscle tone
  
  • stiffened muscles
  • awkward movements
• described by area of body affected
  
  • diplegia
    - uncontrollable movements mainly legs
  • hemiplegia
    - only one side of the body affected
    - usually arm affected more than leg
  • quadriplegia
    - most severe form
    - affects all four limbs, trunk and face
    - usually cannot walk
    - associated with other developmental disabilities

Question 8

What is ataxic cerebral palsy?

Answer 8

• problems with balance and coordination
  
  • unsteady when walking
  • quick or precise movements challenging

Question 9

What is dyskinetic cerebral palsy?

Answer 9

• problems controlling movement of hands, arms, feet and legs
  
  • difficult to sit and walk
  • uncontrolled, slow or rapid, jerky movements
  • face and tongue can be affected
    - difficulties sucking, swallowing and talking

Question 10

What are the dental considerations of cerebral palsy?

Answer 10

• difficulty tolerating treatment
  
  • cannot lie comfortably
  • may not be able to stay still
• increased rate of malocclusion
  
  • usually class II
  • due to hypotonia of facial muscles, tongue movements
• increased risk of dental trauma
  
  • related to class II malocclusion
  • ambulatory difficulties
• high prevalence of bruxism
• drooling
• poor oral hygiene
  
  • complicated by movement difficulties
• pathological oral reflexes (biting)
• calculus if PEG fed
• hyper plastic gingivitis
• self-mutilation
• unsafe swallow

Question 11

What is leukaemia?

Answer 11

• blood cancer of white blood cells
  
  • lymphocytes
  • myeloid cells
• white blood cell production is out of control
  
  • cells continue to divide in bone marrow but do not mature
  • prevents production of healthy blood cells
• oral manifestations
  
  • gingival swelling
  • ulceration
  • spontaneous gingival bleeding
  • unusual mobility of teeth
  • petechiae
  • mucosal pallor
  • herpetic infections
  • candidosis

Question 12

What are the two types of congenital heart defects?

Answer 12

• cyanotic
  
  • deoxygenated blood able to enter systemic circulation
  • tetralogy of fallot most common
• cyanotic
  
  • normal levels of oxyhaemoglobin in systemic circulation
  • ventricular septal defect most common

Question 13

What is von Willibrand disease?

Answer 13

• inherited deficiency of Von Willibrand factor
  
  • autosomal dominant
• von Willibrand factor (vWF)
  
  • mediates platelet adhesion
  • mediates platelet aggregation
  • acts as a carrier of factor VIII
• von Willibrand disease
  
  • low levels of vWF
  • low levels of factor VIII

Question 14

What is haemophilia?

Answer 14

• lack of clotting factors
  
  • increased bleeding tendency
  • X linked recessive
• haemophilia A
  
  • factor VIII deficiency
• haemophilia B
  
  • factor IX deficiency

Question 15

What considerations must be made for dentistry in children with disabilities?

Answer 15

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