Dentistry for children with special needs Flashcards
What are ‘special needs’
huge range of diagnoses and disabilities
individuals who require special help or care
Who looks after the teeth of children with mild disability
GDS (enhanced capitation fee)
non specialist led PDS
specialist service for access to tx planning or advanced behavior management
Who looks after teeth of children with moderate/severe disability
specialist led PDS
HDS
shared care HDS/GDP or PDS/GDP
What are the dental implications for children with special needs
fewer teeth more untreated dental caries greater prevalence of periodontal disease dental fear and anxiety more barriers to delivery of dental care delayed diagnosis of dental caries delayed management more multidisciplinary planning greater risk of pain and sepsis reduce QoL
What group are at well known risk of periodontal disease
Down Syndrome
Why may these children have delayed diagnosis
due to different perceptions of pain and parents may find it difficult finding correct level of care for child
What questions should we ask when lookin at the impact of dental disease in children with special needs
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 perosn
What additional help, if any, may be needed from others
How can we ensure they get the best prevention
ensuring regular dental visits
provision of good mouth care
safe eating and drinking habits
high caries risk
What are the dental aims
support with normal oral function
What aspects do we need to provide help with normal function
eating
speech development
promote self esteem
saliva drooling
How can we promote these children self esteem
maintain good appearance
confidence to smile
What can saliva and drooling lead to
social embarrassment
parental upset
skin irritation
aspiration risk
What is the management of saliva drooling
SLT
pharmacology
surgical
What are the SLT aims for saliva drooling
improve lip seal
improve swallow
What is the pharmacology used for saliva drooling
scopolamine/hyoscine patch
botox injection
What are barriers to mouth care for children
manual dexterity issues (cerebral palsy) involuntary movements (cerebral palsy) oral aversion gag reflex issues challenging behavior sensory issues (autism(
What are barriers to mouth care from parents perspective
manual dexterity issues anxiety fear revulsion/aversion to bodily fluids unable to access oral cavity exhaustion not a priority / lack of time
Wha are the types of disability
physical
medical
sensory
mental
What are examples of physical disability
CP, spina bifida, muscular dystrophy
What are examples of medical disability
cardiac defect/oncology
What are examples of sensory disability
blind, deaf, ASD
What are examples of mental disability
impaired learning ability
ASD
What does cerebral palsy affect
movement and posture
may have visual hearing, learning, speech and epilepsy
What is the cause of CP
occurs from brain damage before during or shortly after birth
What are dental features and considerations of CP
poor OH gingival hyperplasia enamel hypoplasia bruxism malocclusion dental trauma drooling/saliva access uncontrollable movements enhanced gag reflex
What are barriers to regular attendance
other appintments
challenging behaviour
parking / access
frequent illness
parental attitudes
What are barries to dietary changes
atypical food clearance food holding/regurgiation restricted/limited diet pureed food fortified foods sugary medicine food treats used as rewards
What are medical conditions
cardiac malformations epilsepsy renal diabetes CF oncology haemophilia presumed adrenal insufficiency
What is the most common congenital heart defect
VSD
What is the etiology of congenital heart defects
congenial rubella, CMV, maternal drug misuse
syndromes - down, marfan, noonan, elhers-danlos
What are the dental aspects of congenital heart defects
susceptibility to infective endocarditis
possible increasing bleeding tendency if on warfarin or aspirin
high risk under GA
careful use of adrenaline containing LA
liaison with medical colleagues
What are paediatric oncology oral symptoms
mucosal/gingival hemorrhage
gingival enlargement
mouth and throat infections
immunosuppression
thrombocytopenia
oral mucositis
developing dentition
What are most common bleeding disorders
VW disease
hawmophilia A
hemophilia B
What does the cover in bleeding disorders depend on
will depend on subtype of disease in Vw and severity of disease in hemophilia
How may bleeding disorders be acquired
warfarin
chemotherapy induced thrombocytopenia
What are communication aids for visual impairment
braille
What are communication aids for hearing impairment
BSL, interpreting service, hearing loops
What are communication aids for ASD
marathon, board maker, PECS, widget symbols
What is a learning disability
significant impairment of intellectual adaptive and social functioning
What is the IQ classification for learning disabilities
mild is 50-70
moderate is 35-49
severe is 20-34
profound is <20
What is autism
lifelong neurodevelopment disorder (spectrum disorder)
What are the 3 areas those with autism struggle with
difficulties with communication and language
difficulties in forming relationships with other people
a limited pattern of behavior and obsessive resistance to small changes in familiar surroundings
What are related conditions do autism
ADHD down syndrome dyslexia dyspraxia learning disability epilepsy GI issues sleep disorder
What are things those with autism like in surgery
computer
water tap
dental controls
What are things those with autism dislike in surgery
touch dental light noise smells textures tastes
How can we prepare for those with autism
obtain a profile of the 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
What are dental features of down syndrome
maxillary hypoplasia class III occlusion macroglossia anterior open bite hypodontia/microdontia predisposition to periodontal disease
What are the learning problems for down syndrome
a spectrum
autism
What are the medical problems for down syndrome
cardiac defect
leukaemia
epilepsy
alzheimer’s /dementia
What are the examination options
knee to knee
on parents lap
wheelchair
standing up
sitting or lying on floor whilst brushing teeth
restraint (ensure finromed consent gained)
What are aids for toothbrushing
finger props
open wide disposable mouth rest
What are recommended toothpastes
oraNurse toothpaste
contains fluoride
no flavour
non foaming
What is the selection criteria for IS
same as those with no special needs but should be avoided in those undergoing bleomycin therapy (high O2) and those with musculoskeletal disorders
IV sedation with midazolam can be of benefit in some anxious special needs adolescents and is protective in those with epilepsy
What are aims of GA
atrautmic anesthetic induction e.g oral midazolam
complete comprehensive dental tx
eliminate pain and infection
establish a basis for continued preventive care
short, uncomplicated recovery
What are indications for GA
no cooperation
extensive tx
What are considerations for GA
joint cases
medical preassessment
ASA III and IV will require specialist anesthetist
What are the staging for GA
consultant paaediatric dentist dental nurses medical reassessment nurses day surgery/ward doctors and nurses play specialists anesthetists medical consultants anesthetic assistants theatre nurses recovery staff
