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DMD3 sem 2 > Developmental Disabilities > Flashcards

Developmental Disabilities Flashcards

1
Q

What are the common problems that people with autism have?

A

Deficits in social interactions

Deficits in communication

Repetitive behaviour

Deviant sensory perception (Hyper or hyposensitive)

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2
Q

What causes autism?

A

Autism is a multifactorial disorders involving genetic and environmental factors.

Majority of cases affect males

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3
Q

What are the features of Autism Spectrum Disorder?

A

It is a broad spectrum

Involves deficits in social interaction

Affects communication

Patients typically have repetitive or restricted interests

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4
Q

How does autism affect social interaction?

A

Poor eye contact

Ability to read facial expressions

Difficulty with social reciprocity and appropriate peer interactions

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5
Q

How does autism affect communication?

A

Difficulty with sensory stimuli

Communicating their wants and needs, understanding expectations, feeling anxious, and behaving appropriately and cooperatively

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6
Q

What kinds of repetitive behaviors and restricted interests do people wit autism typically have?

A

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

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7
Q

What positive qualities are typical of people with ASD?

A

Honest

Forthright

Liked by adults

Kind

Reliable

Observant of details

Determined

Likely to know and remember specific information

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8
Q

What psychiatric conditions are commonly associated with ASD?

A

Cognitive impairment (25 - 40%)

ADHD (18 - 57%)

Depression/anxiety (17 - 62%)

Bipolar disorder (2 - 8%)

Epilepsy (30%)

Sleep difficulty (44 - 89%)

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9
Q

What problems do people with ASD typically have in day to day life?

A

Difficulty feeding and sleeping

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10
Q

What are the characteristics of ASD?

A

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

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11
Q

What are the characteristics of someone with aspergers syndrome?

A

Brighter children often with higher IQs

Love facts

Very verbal

Reduced social skills

Socially delayed/atypical

Hidden disability

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12
Q

How common is Asperger’s syndrome?

A

1 - 300 children

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13
Q

What sensitivities and fears do patients with ASD typically experience?

A

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

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14
Q

People with ASD typically communicate non-verbally. What should dentists look for when treating them?

A

Change in behaviour (carers may report or you may have to ask)

Not eating/drinking

More withdrawn

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15
Q

How are ADHD and ASD related?

A

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

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16
Q

What dental problems are typically associated with ASD?

A

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.

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17
Q

Are dental caries and perio more common in ASD?

A

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.

18
Q

How should OHI be given to patients with ASD?

A

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

19
Q

What sensory techniques can be used to help patients wit ASD?

A

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)

20
Q

What do desensitization techniques do for a patient with ASD?

A

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.

21
Q

Communication points to consider with patietns with ASD:

A

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

22
Q

Treatment tips:

A

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

23
Q

How can ASD preventative management of caries and poor OH be improved?

A

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

24
Q

How common is Down Syndrome in Australia?

A

Over 20000 people have it in Australia. 1 in 1000 births

25
Q

What causes Down Syndrome?

A

Extra chromosome 21 due to non dysjunction. Increased risk with increased age of mother typically

26
Q

What are the musculoskeletal features of Down Syndrome?

A

Atlanto-axial instability. 20 - 50% of patients.

Muscle hypotony.

27
Q

What are the cardiovascular features of Down Syndrome?

A

Cardiovascular abnormalities. Ventricular septal defects, mitral valve prolapse, ventricular hypertrophy, pulmonary stenosis, dextro-position of the aorta.

28
Q

What are the respiratory features of Down Syndrome?

A

Respiratory abnormalities. More susceptible to respiratory tract infections, abnormal airway anatomy, and sleep apnoea.

29
Q

What nonmusculoskeletal, cardiovascular, and respiratory defects are present in patients with Down Syndrome?

A

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

30
Q

What is the behaviour of patients with Down Syndrome like typically in the dental chair?

A

Generally tolerate treatment in dental surgery well

Behavioural techniques

Anxiety

31
Q

What are the facial features of Down Syndrome?

A

Midfacial hypoplasia, mandibular prognathism (due to maxillary deficiency)

Smaller frontal and maxillary sinuses

Narrower nasal passage and deviated nasal septum

32
Q

What are the occlusal characteristics of patients with Down Syndrome?

A

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.

33
Q

What are the oral features of Down Syndrome?

A

Relative enlargement of the tongue

Hypotonia of oral muscles

Palate anatomy

34
Q

What are the dental features of Down Syndrome?

A

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.

35
Q

What is the relationship between dental caries and down syndrome?

A

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

36
Q

What is the relationship between periodontal disease and Down Syndrome?

A

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

37
Q

How should patients with Down Syndrome be treated with dental treatment?

A

They generally tolerate treatment well

Receptive to behavioural management techniques.

Can be treated under GA or sedation.

Oral hygiene and frequent recalls needed.

38
Q

What is cerebral palsy?

A

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.

39
Q

What are the types of cerebral palsy?

A

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.

40
Q

How common is intellectual disability in patients with cerebral palsy?

A

Only 30% of patients with cerebral palsy have an intellectual disability

41
Q

What are the features of cerebral palsy?

A

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

42
Q

What are the dental considerations to be made for patients with cerebral palsy?

A

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

DMD3 sem 2 (69 decks)

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