Disability and Oral Health II Flashcards
The case mix helps to identify people who may need special care - what does the case mix look at?
Communication Co-operation Med status Oral risk factors Access Legal and ethical barriers
How are oral risk factors labelled?
O - minimal risk factors
A - moderate risk factors
B - severe risk factors
C - extreme risk factors
Moderate oral risk factors?
Can comply with most aspects of delivering better oral health Brushes once daily with F toothpaste Good OH hindered by malocclusion/manual dexterity Diet not well controlled Average 1-2 new carious lesions per yr Course of tx following period of neglect Soft tissue abnormality Physical disability - Arthritis - Parkinson's/huntingdon's Mild learning disablity Dental phobia Severe gag reflex Visual impairment
Severe oral risk factors?
Extensive support to achieve some aspects of delivering better oral health Does not brush regularly with F toothpaste Poor OH Relies on 3rd party for OH measures Cariogenic diet resulting in uncontrolled caries Altered salivation Access to oral cavity severely restricted Enlarged uncontrollable tongue Homeless Profound learning disability Bells palsy Stroke Down's syndrome Severe arthritis Advanced dementia Phenytoin
Extreme oral risk factors?
Unable to comply with any aspects of delivering better oral health High calorie supplementation PEG feeding Regular sugar containing medication Severe xerostomia Unable to brush effectively due to challenging behaviour/co-operation Cystic fibrosis - high calorie diet Percutaneous endoscopic gastrostomy (PEG) feeding Methadone user IV opioid abuse Severe sjogren's High dosage anti-psychotic drugs Osteoradionecrosis MRONJ Advanced oral carcinoma
How to overcome barriers to oral health?
Teach carer/family support for OH measures 1500ppm F toothpaste, 5000ppm F 22,600ppm F varnish Regular topical F applications Artificial saliva Change medication Diet advice Brushing = modify toothbrush, electric Unflavoured non-foaming toothpaste - oranurse
How is access to oral care labelled?
O - unrestricted
A - moderately restricted
B - severely restricted
C - domiciliary required
Moderately restricted access?
Can access but need support Difficulty in attending due to impairment and accessing chair Wheelchair user Appt arranged with carer Mobile surgery required History of poor attendance
Paraplegia Frail elderly Homeless Substance misusers Med condition - O2 supplementation, severe angina Institutionalised
Severely restricted access?
Pt requires staff to arrange transport
Pt who cannot transfer out of wheelchair
Specialised equipment required to attend surgery e.g. ambulance, hoist
Modified dental chair
Paraplegia
Profound learning disability
Profound cerebral palsy
Domiciliary care required for access?
Housebound Lives in care home Hospitalised Chaotic lifestyle/socially impaired Those legally unable to attend
Frail elderly Paraplegia Profound learning disability Long term hospitalisation Secure units Prison Mental health
How to overcome access barriers?
Disability discrimination acts Ramps Lower counters Ground floor access Lift Disabled toilet Parking Signposting Handrails Disabled toilets Ambulance/taxi/wheelchair taxi Mobile dental surgery Wheelchair transfer or tippers Hoists Domiciliary care - Portable dental chair, unit, operating light
How are legal and ethical barriers to care labelled?
O - none
A - some difficulties
B - moderate difficulties
C - multi-professional consultation
Legal and ethical issues - A - some difficulties?
Adopted children Children in need Divorced parents Elderly in care Confused and frail elderly Best interest decision not requiring additional correspondence
Legal and ethical issues grade B moderate difficulties?
Children in foster care
Looked after children
Parental responsibility required clarification
Financial responsibility requires clarification
Fluctuating capacity to consent - mental health, dementia
Consultation with other professionals/carers to determine patient’s best interests
Best interests decision requires additional correspondence with carers/relatives
Children in and out of local authority care Children in secure units Psychiatric illness Post CVA Adult learning disability
What is done for more complex legal and ethical concerns?
Best interest meeting
Case conference
Metal capacity act
