Developmental Disabilities Flashcards
What are the common problems that people with autism have?
Deficits in social interactions
Deficits in communication
Repetitive behaviour
Deviant sensory perception (Hyper or hyposensitive)
What causes autism?
Autism is a multifactorial disorders involving genetic and environmental factors.
Majority of cases affect males
What are the features of Autism Spectrum Disorder?
It is a broad spectrum
Involves deficits in social interaction
Affects communication
Patients typically have repetitive or restricted interests
How does autism affect social interaction?
Poor eye contact
Ability to read facial expressions
Difficulty with social reciprocity and appropriate peer interactions
How does autism affect communication?
Difficulty with sensory stimuli
Communicating their wants and needs, understanding expectations, feeling anxious, and behaving appropriately and cooperatively
What kinds of repetitive behaviors and restricted interests do people wit autism typically have?
Repetitive body movements
Using objects in a repetitive manner rather than the way they are intended
Difficulty with transitions and changes in routine
May insist on following rituals or sequences
Focused interest in specific topics or objects
Sensitive to sensory input
What positive qualities are typical of people with ASD?
Honest
Forthright
Liked by adults
Kind
Reliable
Observant of details
Determined
Likely to know and remember specific information
What psychiatric conditions are commonly associated with ASD?
Cognitive impairment (25 - 40%)
ADHD (18 - 57%)
Depression/anxiety (17 - 62%)
Bipolar disorder (2 - 8%)
Epilepsy (30%)
Sleep difficulty (44 - 89%)
What problems do people with ASD typically have in day to day life?
Difficulty feeding and sleeping
What are the characteristics of ASD?
Inability to relate to people
Unable to interpret language/nuance of language
Can be associated with epilepsy
May not like physical contact (deviant sensory perception)
Lack of response
Usually immersed in activity that interests them
Variable ability to form emotional relationships
Very attuned to rituals, lists, routines
Changes to routines - highly disruptive if you change their normal routine
Eye contact is difficult
What are the characteristics of someone with aspergers syndrome?
Brighter children often with higher IQs
Love facts
Very verbal
Reduced social skills
Socially delayed/atypical
Hidden disability
How common is Asperger’s syndrome?
1 - 300 children
What sensitivities and fears do patients with ASD typically experience?
Texture - how things feel in the mouth
Scent - Dental smells (office, materials, gloves, masks, etc)
Noises - Drill, radio, phone
Clothing - tags in shirt, seams on socks
Fears - Fire, spiders, etc
People with ASD typically communicate non-verbally. What should dentists look for when treating them?
Change in behaviour (carers may report or you may have to ask)
Not eating/drinking
More withdrawn
How are ADHD and ASD related?
People with ADHD are impulsive, hyperactive, poor mood regulation, can’t focus, can’t sort out what to attend to, and know what to do but can’t manage to do it.
People with ASD are often not impulsive or hyperactive and their mood is regulated. They only are able to focus on a task if they like it and can’t sort out what to attent to if there are too many verbal instructions.
Medications can help with ADHD but not so much ASD
What dental problems are typically associated with ASD?
Bruxism
Non-nutritive chewing
Tongue thrusting
Self-injury
Erosion
Xerostomia
Hypergag reflex
Epilepsy common in these patients so gingival hyperplasia due to phenytoin is also common. Seizures can cause trauma
Oral habits such as cheek and lip biting are more common as well as bruxism and self mutilation.
Are dental caries and perio more common in ASD?
ASD itself does not increase the risk but patients typically have more cariogenic diets and poor OH.
Perio is more common due to poor OH and epilepsy medications.
How should OHI be given to patients with ASD?
Tell-Show-Do
Often respond well to advanced preparation or pre-teaching
Knows what to expect during a visit
Use pictures or objects to help explain what will occur. Use simple language
Practicing certain aspects of a procedure before experiencing them in dental office
What sensory techniques can be used to help patients wit ASD?
Reduce exposure to some stimuli and increase exposure to others
Headphones to block out external noises
Wearing a weighted vest or a lead apron (makes some people feel more secure)
What do desensitization techniques do for a patient with ASD?
Series of short visits to the dentist to practice a specific behaviour. End visit on a positive note.
Eg Walk into the office then walk back out, next step sit in the chair for half a minute, then count teeth, etc. This will take effort and time and will allow long term trust to be built with patient.
Communication points to consider with patietns with ASD:
ASD individuals don’t look at you all the time because it’s hard to look and listen
Give time for them to answer questions because they have slower processing time and need more time to formulate a logical response
Pressure creates a stock standard answer to get them out of trouble
Don’t generalise from one situation to the next. Autism is very different from one patient to the next
Organisation is a nightmare. Everything should be in one place.
Limited and specific choices. Use closed ended questions, difficulty problem solving.
Be clear, concise and very specific with choices. Abstract thinking is difficult for these patients.
Avoid verbal overload. ASD people are typically visual learners. Verbal takes longer to process and retain.
Avoid verbal arguments. Focus on what they should be doing.
Positive feedback to ensure on the right track, They are perfectionists and so they need to feel like they’re on the right track
Treatment tips:
Avoid prolonged waiting times
Aim for routines (same nurse and dentist perhaps)
Keep instructions short and simple
Minimise staff movements
Minimise external disruptions
Traditional rewards may be inappropriate - use special interests
Behaviour explain with black and white instructions
Visual learners
Oral hygiene - social stories, picture books
ASD is individual and varies from patient to patient
How can ASD preventative management of caries and poor OH be improved?
Involve carer where appropriate
Modified toothbrush
Fluoride in surgery and at home
Reward with non-carious food
Shorter dental recalls
Pit and fissure sealants where possible
How common is Down Syndrome in Australia?
Over 20000 people have it in Australia. 1 in 1000 births
What causes Down Syndrome?
Extra chromosome 21 due to non dysjunction. Increased risk with increased age of mother typically
What are the musculoskeletal features of Down Syndrome?
Atlanto-axial instability. 20 - 50% of patients.
Muscle hypotony.
What are the cardiovascular features of Down Syndrome?
Cardiovascular abnormalities. Ventricular septal defects, mitral valve prolapse, ventricular hypertrophy, pulmonary stenosis, dextro-position of the aorta.
What are the respiratory features of Down Syndrome?
Respiratory abnormalities. More susceptible to respiratory tract infections, abnormal airway anatomy, and sleep apnoea.
What nonmusculoskeletal, cardiovascular, and respiratory defects are present in patients with Down Syndrome?
Compromised immune status/increased infection susceptibility
Hypothyroidism
Diabetes mellitus
GORD
Vision/hearing defects
Delayed development and premature ageing
Higher risk of stroke, epilepsy and seizures
What is the behaviour of patients with Down Syndrome like typically in the dental chair?
Generally tolerate treatment in dental surgery well
Behavioural techniques
Anxiety
What are the facial features of Down Syndrome?
Midfacial hypoplasia, mandibular prognathism (due to maxillary deficiency)
Smaller frontal and maxillary sinuses
Narrower nasal passage and deviated nasal septum
What are the occlusal characteristics of patients with Down Syndrome?
Skeletal class 3: Maxillary deficiency and relative mandibular prognathism
Malocclusions result of skeletal and environmental influences
Down Syndrome is not a contraindication for orthodontic treatment.
What are the oral features of Down Syndrome?
Relative enlargement of the tongue
Hypotonia of oral muscles
Palate anatomy
What are the dental features of Down Syndrome?
Delay and altered eruption sequence
Hypodontia; anodontia very occasionally.
Impacted canines and premolars
Teeth commonly have morphological variations: Microdontia, reduced crown:root ratio, peg-shaped lateral incisors and shovel-shaped incisors, and taurodontism
Hypoplasia/hypocalcification
Down Syndrome itself doesn’t increase risk of dental caries. Used to be more common in patients with Down Syndrome but it’s decreasing with improved oral hygiene
Halitosis and bruxism.
What is the relationship between dental caries and down syndrome?
Down Syndrome itself doesn’t increase risk of dental caries. Used to be more common in patients with Down Syndrome but it’s decreasing with improved oral hygiene
What is the relationship between periodontal disease and Down Syndrome?
Increased risk of perio
High incidence of early onset
Increased risk attributed toa number of factors such as change in host immunity, unfavourable crow:root ratio, and ligamentous laxity
95% of patients will have periodontal disease by age of 35. Can be seen as early as 6 - 15 years of age.
Early loss of teeth seen due to the unfavourable crown:root ratio
How should patients with Down Syndrome be treated with dental treatment?
They generally tolerate treatment well
Receptive to behavioural management techniques.
Can be treated under GA or sedation.
Oral hygiene and frequent recalls needed.
What is cerebral palsy?
Heterogenous group of non-progressive motor conditions.
Caused by chronic brain injuries
Injury occurs during brain development. Can be prenatally, perinatally, or during the first few years of life.
It is the most common cause of physical disability in childhood.
What are the types of cerebral palsy?
Cerebellum: Affects movement and muscle tone. Ataxic cerebral palsy. Shaking movements and speech affected.
Motor cortex: Affects the balance and posture. Typically spastic cerebral palsy (overactive muscles)
Basal ganglia: Affects coordination. Dyskinetic causing involuntary movements.
How common is intellectual disability in patients with cerebral palsy?
Only 30% of patients with cerebral palsy have an intellectual disability
What are the features of cerebral palsy?
Seizures
Spasticity of muscles with contractures
Hyperreflexia
Reflux
Malocclusion (Class 2, narrow palate, anterior open bite, croosbite)
Poor lip seal
Mouth breathing
Drooling/impaired swallow reflex
Tongue thrust
Enamel hypomineralisation and hypoplasia
What are the dental considerations to be made for patients with cerebral palsy?
Ensure high volume suction being used to prevent aspiration of fluid.
Sitting patient upright may be necessary for visibility
Dysphagia is common for these patients so food may need to be modified with sugars. Sugars increase caries.
Access to dental surgery may be difficult due to wheelchair bound.
Obtain a good history and background to assess level of independence, medical history, and GP/speech pathologist/physiotherapist/OT, and other carers
