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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
Q

What are dental features and considerations of CP

A 
poor OH
gingival hyperplasia
enamel hypoplasia
bruxism
malocclusion
dental trauma
drooling/saliva
access
uncontrollable movements 
enhanced gag reflex
26
Q

What are barriers to regular attendance

A

other appintments

challenging behaviour

parking / access

frequent illness

parental attitudes

27
Q

What are barries to dietary changes

A 
atypical food clearance
food holding/regurgiation
restricted/limited diet
pureed food
fortified foods
sugary medicine
food treats used as rewards
28
Q

What are medical conditions

A 
cardiac malformations
epilsepsy
renal
diabetes
CF
oncology
haemophilia
presumed adrenal insufficiency
29
Q

What is the most common congenital heart defect

A

VSD

30
Q

What is the etiology of congenital heart defects

A

congenial rubella, CMV, maternal drug misuse

syndromes - down, marfan, noonan, elhers-danlos

31
Q

What are the dental aspects of congenital heart defects

A

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
Q

What are paediatric oncology oral symptoms

A

mucosal/gingival hemorrhage

gingival enlargement

mouth and throat infections

immunosuppression

thrombocytopenia

oral mucositis

developing dentition

33
Q

What are most common bleeding disorders

A

VW disease
hawmophilia A
hemophilia B

34
Q

What does the cover in bleeding disorders depend on

A

will depend on subtype of disease in Vw and severity of disease in hemophilia

35
Q

How may bleeding disorders be acquired

A

warfarin

chemotherapy induced thrombocytopenia

36
Q

What are communication aids for visual impairment

A

braille

37
Q

What are communication aids for hearing impairment

A

BSL, interpreting service, hearing loops

38
Q

What are communication aids for ASD

A

marathon, board maker, PECS, widget symbols

39
Q

What is a learning disability

A

significant impairment of intellectual adaptive and social functioning

40
Q

What is the IQ classification for learning disabilities

A

mild is 50-70
moderate is 35-49
severe is 20-34
profound is <20

41
Q

What is autism

A

lifelong neurodevelopment disorder (spectrum disorder)

42
Q

What are the 3 areas those with autism struggle with

A

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
Q

What are related conditions do autism

A 
ADHD
down syndrome
dyslexia
dyspraxia
learning disability
epilepsy
GI issues
sleep disorder
44
Q

What are things those with autism like in surgery

A

computer
water tap
dental controls

45
Q

What are things those with autism dislike in surgery

A 
touch
dental light
noise
smells
textures
tastes
46
Q

How can we prepare for those with autism

A

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
Q

What are dental features of down syndrome

A 
maxillary hypoplasia
class III occlusion
macroglossia
anterior open bite
hypodontia/microdontia
predisposition to periodontal disease
48
Q

What are the learning problems for down syndrome

A

a spectrum

autism

49
Q

What are the medical problems for down syndrome

A

cardiac defect
leukaemia
epilepsy
alzheimer’s /dementia

50
Q

What are the examination options

A

knee to knee
on parents lap
wheelchair
standing up
sitting or lying on floor whilst brushing teeth
restraint (ensure finromed consent gained)

51
Q

What are aids for toothbrushing

A

finger props

open wide disposable mouth rest

52
Q

What are recommended toothpastes

A

oraNurse toothpaste
contains fluoride
no flavour
non foaming

53
Q

What is the selection criteria for IS

A

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
Q

What are aims of GA

A

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
Q

What are indications for GA

A

no cooperation

extensive tx

56
Q

What are considerations for GA

A

joint cases
medical preassessment
ASA III and IV will require specialist anesthetist

57
Q

What are the staging for GA

A 
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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