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BDS3 CLINICAL Paeds > 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 require special help or care

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2
Q

Who looks after the teeth of children with mild disability

A

GDS (enhanced capitation fee)
non specialist led PDS
specialist service for access to tx planning or advanced behavior management

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3
Q

Who looks after teeth of children with moderate/severe disability

A

specialist led PDS
HDS
shared care HDS/GDP or PDS/GDP

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4
Q

What are the dental implications for children with special needs

A 
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
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5
Q

What group are at well known risk of periodontal disease

A

Down Syndrome

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6
Q

Why may these children have delayed diagnosis

A

due to different perceptions of pain and parents may find it difficult finding correct level of care for child

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7
Q

What questions should we ask when lookin at the impact of dental disease in children with special needs

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 perosn

What additional help, if any, may be needed from others

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8
Q

How can we ensure they get the best prevention

A

ensuring regular dental visits
provision of good mouth care
safe eating and drinking habits
high caries risk

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9
Q

What are the dental aims

A

support with normal oral function

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10
Q

What aspects do we need to provide help with normal function

A

eating
speech development
promote self esteem
saliva drooling

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11
Q

How can we promote these children self esteem

A

maintain good appearance

confidence to smile

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12
Q

What can saliva and drooling lead to

A

social embarrassment
parental upset
skin irritation
aspiration risk

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13
Q

What is the management of saliva drooling

A

SLT
pharmacology
surgical

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14
Q

What are the SLT aims for saliva drooling

A

improve lip seal

improve swallow

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15
Q

What is the pharmacology used for saliva drooling

A

scopolamine/hyoscine patch

botox injection

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16
Q

What are barriers to mouth care for children

A 
manual dexterity issues (cerebral palsy)
involuntary movements (cerebral palsy)
oral aversion
gag reflex issues
challenging behavior 
sensory issues (autism(
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17
Q

What are barriers to mouth care from parents perspective

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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18
Q

Wha are the types of disability

A

physical
medical
sensory
mental

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19
Q

What are examples of physical disability

A

CP, spina bifida, muscular dystrophy

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20
Q

What are examples of medical disability

A

cardiac defect/oncology

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21
Q

What are examples of sensory disability

A

blind, deaf, ASD

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22
Q

What are examples of mental disability

A

impaired learning ability

ASD

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23
Q

What does cerebral palsy affect

A

movement and posture

may have visual hearing, learning, speech and epilepsy

24
Q

What is the cause of CP

A

occurs from brain damage before during or shortly after birth

25
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 ```
26
What are barriers to regular attendance
other appintments challenging behaviour parking / access frequent illness parental attitudes
27
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 ```
28
What are medical conditions
``` cardiac malformations epilsepsy renal diabetes CF oncology haemophilia presumed adrenal insufficiency ```
29
What is the most common congenital heart defect
VSD
30
What is the etiology of congenital heart defects
congenial rubella, CMV, maternal drug misuse syndromes - down, marfan, noonan, elhers-danlos
31
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
32
What are paediatric oncology oral symptoms
mucosal/gingival hemorrhage gingival enlargement mouth and throat infections immunosuppression thrombocytopenia oral mucositis developing dentition
33
What are most common bleeding disorders
VW disease hawmophilia A hemophilia B
34
What does the cover in bleeding disorders depend on
will depend on subtype of disease in Vw and severity of disease in hemophilia
35
How may bleeding disorders be acquired
warfarin | chemotherapy induced thrombocytopenia
36
What are communication aids for visual impairment
braille
37
What are communication aids for hearing impairment
BSL, interpreting service, hearing loops
38
What are communication aids for ASD
marathon, board maker, PECS, widget symbols
39
What is a learning disability
significant impairment of intellectual adaptive and social functioning
40
What is the IQ classification for learning disabilities
mild is 50-70 moderate is 35-49 severe is 20-34 profound is <20
41
What is autism
lifelong neurodevelopment disorder (spectrum disorder)
42
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
43
What are related conditions do autism
``` ADHD down syndrome dyslexia dyspraxia learning disability epilepsy GI issues sleep disorder ```
44
What are things those with autism like in surgery
computer water tap dental controls
45
What are things those with autism dislike in surgery
``` touch dental light noise smells textures tastes ```
46
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
47
What are dental features of down syndrome
``` maxillary hypoplasia class III occlusion macroglossia anterior open bite hypodontia/microdontia predisposition to periodontal disease ```
48
What are the learning problems for down syndrome
a spectrum | autism
49
What are the medical problems for down syndrome
cardiac defect leukaemia epilepsy alzheimer's /dementia
50
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)
51
What are aids for toothbrushing
finger props | open wide disposable mouth rest
52
What are recommended toothpastes
oraNurse toothpaste contains fluoride no flavour non foaming
53
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
54
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
55
What are indications for GA
no cooperation | extensive tx
56
What are considerations for GA
joint cases medical preassessment ASA III and IV will require specialist anesthetist
57
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 ```

BDS3 CLINICAL Paeds (14 decks)

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