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BDS3 Paediatric Dentistry > Dentistry for Children with Special Needs > Flashcards

Dentistry for Children with Special Needs Flashcards

1
Q

What are ‘special needs’?

A
  • Huge range of diagnoses and disabilities

- Individuals who rewquire special help or care

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2
Q

In children , what are the main causes of disability? (2)

A

Genetic and congenital

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3
Q

What % of the paediatric population have special needs?

A

4.3%

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4
Q

Who might look after the teeth of children with a mild disability? (3)

A
  • General dental service (enhanced capitation fee)
  • Non-specialist led public dental service
  • Specialist service for access to treatment planning or advanced behaviour management
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5
Q

Who might look after the teeth of children with a moderate/severe disability? (3)

A
  • Specialist led PDS
  • Hospital dental service
  • Shared care HDS/GDP or PDS/GDP
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6
Q

What are possible dental implications for children with speical needs? (5)

A
  • Fewer teeth (because there can be delayed care)
  • More untreated dental caries (can be due to sugary medication)
  • Greater prevalence of periodontal disease
  • Dental fear and anxiety (this may have been precipitated by medical appointments rather than dental appointments)
  • More barriers to delivery of dental care
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7
Q

What are the impacts of dental diseadse in children with special needs? (5)

A
  • Delayed diagnosis (they might have a different perception of pain or may be due to the parents having difficulty in accessing the right level of care for them)
  • Delayed management (can be difficult to look in their mouth)
  • Takes more multidisciplinary planning
  • Greater risk of pain/sepsis (because there is a delay in getting care)
  • Reduced quality of life
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8
Q

What questions might you need to ask yourself when thinking about the impact of dental disease on children with special needs? (5)

A
  • What is getting in the way of this child’s wellbeing?
  • Do I have everything I need to help this child or young person?
  • What can I do now to help this child or young person?
  • What can my agency/profession do to help this child or young person?
  • What additional help, if any, may be needed from others?
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9
Q

What prevention can we encourage for a patient with special needs? (4)

A
  • Ensure regular dental visits
  • Provision of good mouth care
  • Safe eating and drinking habits
  • High carues risk?
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10
Q

What are out dental aims for a child with special needs to support with normal oral function? (3)

A
  • Eating
  • Speech development
  • Promote self esteem:
  • Maintain good appearance
  • Confidence to smile
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11
Q

Saliva/drooling can affect a lot of children with special needs. What are the problems of this? (5)

A
  • Undiagnosed caries
  • Social embarrassment
  • Parental upset
  • Skin irritation
  • Aspiration risk
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12
Q

What are the ways we can help patients to support them in the management or normal oral function? (3)

A

Speech and language therapy:

  • Improve lip seal
  • Improve swallow

Pharmacology:

  • Scopolamine/hyoscine patch
  • Botox injections

Surgical

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13
Q

What are possible barriers to oral care for children with special needs? (6)

A
  • Manual dexterity issues
  • Involuntary movements
  • Oral aversion
  • Gag reflex issues/patients with high aspiration risk
  • Challenging behaviour (child attending CAMHS)
  • Sensory issues
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14
Q

What are possible barriers to oral care for children with special needs in relation to their parents? (6)

A
  • Manual dexterity issues
  • Anxiety/fear
  • Revulsion/aversion to bodily fluids
  • Unable to access oral cavity
  • Exhaustion
  • Not a priority/lack of time
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15
Q

Give examples of types of disability? (4)

A
  • Physical
  • Medical
  • Sensory
  • Mental
  • There is overlap in some of these categories and some patient’s will fall into more than one
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16
Q

Give examples of physical disabilities? (3)

A
  • CP, Spina bifida, muscular dystrophy
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17
Q

Give examples of medical disabilities? (3)

A
  • Cardiac defect
  • Oncology
  • Bleeding disorders
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18
Q

Give examples of sensory disabilities? (3)

A
  • Blind
  • Deaf
  • Autistic spectrum disorder
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19
Q

Give examples of mental disabilities? (2)

A
  • Impaired learning ability

- ASD

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20
Q

What is the most common physical ability in childhood?

A
  • Cerebral palsy
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21
Q

What does cerebral palsy affect?

A

It affects movement and posture

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22
Q

How does cerebral palsy occur?

A
  • It occurs from brain damage before, during or shortly after birth
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23
Q

Apart from defects in movement and posture, how else might cerebral palsty affect the body? (5)

A
  • People wiht CP may also have visual, hearing, learning, speech and epilepsy
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24
Q

How can cerebral palsy be classified?

A
  • Can be classified purely by how it affects the limbs or it can be classified by other things e.g. spastic, athetoid, ataxic etc
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25
Q

How is someone with monoplegic cerebral palsy affected?

A
  • Involves only one limb
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26
Q

How is someone with paraplegic cerebral palsy affected?

A
  • Involves lower extremities
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27
Q

How is someone with hemiplegic cerebral palsy affected?

A
  • Involved one upper and one lower limb on same side
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28
Q

How is someone with double hemiplegic cerebral palsy affected?

A
  • Involves alll limbs but mainly arms
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29
Q

How is someone with diplegic cerebral palsy affected?

A
  • Involves all limbs but mainly legs
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30
Q

How is someone with quadriplegic cerebral palsy affected?

A
  • Involves all limbs equally
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31
Q

Give examples of dental features of cerebral palsy? (10)

A
  • Poor oral hygiene
  • Gingival hyperplasia (esp if on epilepy or a medication that might cause it)
  • Enamel hypoplasia
  • Bruxism
  • Maolcclusion
  • Dental trauma
  • Drooling/saliva
  • Access
  • Uncomfortable movements
  • Enhanced gag reflex
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32
Q

Can be really challenging for people with cerebral plasy to brush their teeth. Hoe can we make this easier for them?

A
  • We can take impressions of their hands and shape the toothbrush for them
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33
Q

People with cerebral palsy tend to have a head forward posture. Why is it very important when we are treating them that we do not try to change it?

A
  • Because this is a posture that means they don’t swallow their saliva and end up with aspirations - so we treat them in a head neutral position
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34
Q

One possible barrier to regular dental attendence for children with special needs is that they may have other appointments. What is a solution to this problems?

A
  • Collaborate and plan with other departments/professions
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35
Q

One possible barrier to regular dental attendence for children with special needs is that they may have challenging behavious/anxiety. What is a solution to this problems?

A
  • Emphasise, be understanding, reassure support, appropriately acclimatise, risk assess, plan ahead
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36
Q

One possible barrier to regular dental attendence for children with special needs is parking/access to the building. What is a solution to this problems?

A
  • Plan ahead
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37
Q

One possible barrier to regular dental attendence for children with special needs is frequent illness. What is a solution to this problems?

A
  • Emphasise and support
38
Q

One possible barrier to regular dental attendence for children with special needs is the parents attitiudes. What is a solution to this problems?

A
  • Influence positive change, promote good knowledge
39
Q

What are possible barriers to dietary changes in children with special needs? (7)

A
  • Atypical food clearance
  • Food holding/regurgitation
  • Restriced/limited diet
  • Pureed food
  • Fortified foods
  • Sugary medicines
  • Food treats used as rewards
40
Q

What are possible solutions to the barries to dietary changes in children with special needs? (5)

A
  • Collaborate, emphathise, don’t judge, support, understand
  • consider additional mouth care
  • Consider 2800ppm paste
  • Set achievable realistic goals
  • Work with other healthcare professionals
41
Q

Give examples of medical conditions that children with special needs might have? (8)

A
  • Cardiac malformations
  • Epilepsy
  • Renal
  • Diabetes and other metabolic disorders
  • Cystic fibrosis
  • Oncology
  • Haemophilia and other coagulopathies
  • Presumed adrenal insudfficiency
42
Q

Why are children with cystic fibrosis at an increased caries risk?

A
  • Due to being on repeated antibiotics and some of the enzymes that they take
  • Will be asked to have a high nutritional content due to the fact they won’t be able to absorb food correctly - so they might end up with malnutritions
43
Q

How common are congenital heart defects?

A

Occirs in 8 per 1000 live births

44
Q

What % of children with congenital heart defect have other congenital abnormalities?

A

20%

45
Q

What is the aetiology of congential heart defects?

A

Aetiology mostly unknown:

  • Congenital rubella, CMV, material drug missuse
  • Syndromes - down, Marfan, Noonan, Elhers-Danlos
46
Q

What is the most common congenital heart defect?

A

VSD - Ventricular septal defect

47
Q

What are the dental aspects of a congenital heart defect? (5)

A
  • Susceptibility to infective endocarditis
  • Possible increased bleeding tendency if on warfarin or aspirin
  • Higher risk under GA (always make sure they are seen by a cardiac anaesthetist)
  • Careful use of adrenaline containing LA
  • Liason with medical colleagues
48
Q

In paediatric oncology, how many cases are acute laukaemias?

A
  • About 1/3
49
Q

In paediatric oncology, how many cases are brain tumors?

A
  • About 1/4
50
Q

What % of children with cancer have a 5 year survuval?

A

80%

51
Q

Why is it important to ensure that a paediatric patient with cancer is caries free?

A
  • Because as they go through their treatment there might be a point where they have no neutrophils and can be a disaster if they have any uncared for caries in their mouth
52
Q

What are oral symptoms associated with paediatric oncology? (7)

A
  • Mucosal/gingival haemorrhage
  • Gingival enlargement
  • Mouth and throat infections
  • Immunosuppression
  • Thrombocytopenia
  • Oral mucositis
  • Developing dentition
53
Q

Treatment for oncology can affect the developing dentiton. What might happen?

A
  • When the dentition is forming the treatment can result in retarded and reduced roots - this has implications especially if the child ends uo needing orthodontics and some of these children just won’t get orthodontics because of the complications
54
Q

What are the most common inherited bleeding disorders? (3)

A
  • Von Williebrand’s disease
  • Haemophilia A
  • Haemophilia B
55
Q

What do we require for same management of bleeding disorders in dentistry?

A
  • Multidisciplinary planning
  • WWould want to plan so that all of the treatment that is requiring cover is done at the same time - this is assuming that this is a child that can sit in the dental chair and doesn’t need GA
  • The cover needed will depend on the subtype of the disease in Von Willebrands and severity of the disease in haemophilia
56
Q

What are the most common acquired bleeding disorders? (2)

A
  • Warfarin therapy for CHD
  • Chemotherapy induced thrombocytopenia
  • Safe dental management requires multidisciplinary planning
57
Q

How might a person with a visual impairment communicate?

A

Braille

58
Q

How might a person with a hearing impairment communicate? (2)

A

BLS interpreting service, hearing loops

59
Q

How might a person with ASD communicate? (3)

A
  • Makaton, boardmaker pictures, Widget symbols
60
Q

Give a possible definition of a learning disability? (2)

A
  • A state of arrested or incomplete development of mind… (WHO)
  • Significant impairment or intellectual, adaptive and social functioning
61
Q

What IQ clasification would someone with a mild learning disability have?

A

50-70

62
Q

What IQ clasification would someone with a moderate learning disability have?

A

35-49

63
Q

What IQ clasification would someone with a severe learning disability have?

A

20-34

64
Q

What IQ clasification would someone with a profound learning disability have?

A

<20

65
Q

What is autism?

A
  • A lifelong neurodevelopmental disorder (spectrum disorder)

- They percieve the world slightly differently

66
Q

What can someone with autism have issues with? (3)

A
  • Social interaction
  • Social communication (they might be non-verbal etc)
  • Limited and restricted patterns in behavious (they like things to be predictable and don’t like change)
67
Q

Give examples of conditions that are related to autism spectrum disorder? (8)

A
  • ADHD
  • Down’s syndrome
  • Dyslexia
  • Dyspraxia
  • Learning disability (about 50%)
  • Epilepsy
  • Gastrointestinal issues
  • Sleep disorder (very common in children with autism)
68
Q

What is dyspraxia?

A

A disorder that affects movement and co-ordination

69
Q

What % of verbal communication is through words for people with ASD?

A

7%

70
Q

What % of verbal communication is through vocal tone for people with ASD?

A

33%

71
Q

What % of verbal communication is through facial expression and body language for people with ASD?

A

60%

72
Q

Give examples of non-verbal communication for children with ASD? (3)

A
  • Makaton
  • PECS (picture exchange communication system)
  • Widget
73
Q

What do people with ASD tend to like in the surgery? (3)

A
  • Computer
  • Water taps
  • Dental unit controls
74
Q

What do people with ASD tend not to like in the surgery? (6)

A
  • Touch
  • Dental light
  • Noise
  • Smells
  • Textures
  • Tastes
75
Q

We as dentist need to be prepared and ensure the patient is prepared when treating a child with ASD. What can we do prior to the appointment to be prepared? (5)

A
  • Obtain a profile of likes and dislikes from the parent or school
  • Send out social story explaining dental journey using PECS
  • Send out a plastic mirror
  • Be ready and on time
  • De-clutter
76
Q

What are common dental features of down’s syndrome? (6)

A
  • Maxillary hypoplasia
  • Class III occlusion
  • Macroglossia
  • Anterior open bite
  • Hypodontia/microdontia
  • Predisposition to periodontal disease
77
Q

What are the potential learning problems people with down’s syndrome can have? (2)

A
  • A spectrum

- Autism

78
Q

What are potential medical problems people with down’s syndrome can have? (4)

A
  • Cardiac defect
  • Leukaemia
  • Epilepsy
  • Alzheimer’s/dementia
79
Q

What are options for a dental exam which can make it easier for a perosn with special needs? (6)

A
  • Knee to knee
  • On parent’s lap
  • In wheelchair
  • Standing up
  • Sitting or lying on floorm whilst brushing teeth
  • Restraint (this is not an option - only thing really would be asking parent to hold their hands while we look in their mouth)
80
Q

Give examples of aids for toothbrushing? (3)

A
  • Finger props
  • Open wide disposable mouth rest
  • 2 sided toothbrush
  • Another thing that is helpful is having 2 toothbrushes and getting the child to chew on one on one side and then you can brush the teeth on the other side
81
Q

What are toothpastes we can recommend to patients with special needs if they do not like normal toothpastes? (2)

A
  • Unflavoured toothpasres that are non foaming

- For high caries children with special needs can give duraphat 2800ppm for supervised use for age 10+

82
Q

Do we need to take anythign into consideration when referring someone with special needs for inhalation sedation?

A
  • Inhalation sedation delection criteria is the same as with ‘non’ special needs patients but should be avoided in those undergoing Bleomycin therapy (high O2) and those with musculo-skeletal disorders
83
Q

When can IV sedation with medazolam be useful in a patient with special needs?

A
  • This can be of benefit in some anxious special needs adolescents and is ‘protective’ in thise with epilepsy
84
Q

When would we consider the help of an anaesthetist for a patient with special needs?

A
  • in ASA III and above (need to be with the hospital service)
85
Q

What are our aims when using GA on a patient with special needs? (5)

A
  • Atraumatic anaesthetic induction (e.g. oral midazolam)
  • Complete comprehensive dental treatment
  • Eliminate pain and infection
  • Establish a basis for continued preventive care
  • Short, uncomplicated recovery
86
Q

What are possible indications to undertake dental treatment under GA for patients with special needs? (2)

A
  • No co-operation

- Extensive treatment

87
Q

What are possible considerations when undertaking dental treatment under GA for patients with special needs? (3)

A
  • Joint cases (we would email everyone else they are seeing and would say that this patient is having GA and would ask if they have anything else they need to do under GA)
  • Medical preassessment
  • ASA III and IV will require specialist anaesthetist
88
Q

When givign dental treatment under GA for a patient with special needs, what staff would be required? (10)

A
  • Consultant paediatric dentist
  • Dental nurses
  • Medical preassessment nurses
  • Day surgery/ward doctors and nurses
  • Play spacialists
  • Anaesthetists
  • Medical consultants
  • Anaesthetic assistants
  • Theatre nurses
  • Recovery staff
89
Q

Who will sign the consent form for children with special needs?

A
  • Usually parents will sign the consent form for younger children
  • Teenagers deemed ‘Gillick’ competent may sign the consent form and agreeing to treatment at the pre assessment appointment and then refuse treatment on the day. No treatment undertaken
  • Age 16 and over: a conversation is needed to ensure if appropriate an adult with incapacity certificate is available
90
Q

What is the legislation we need to know in relation to this topic? (3)

A
  • AWI (Scotland) Act 2000
  • Disability Discrimination Act 1995
  • Equality Act 2010

BDS3 Paediatric Dentistry (9 decks)

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