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BDS3 Special Care Dentistry > Intellectual impairment > Flashcards

Intellectual impairment Flashcards

1
Q

What is the MENCAP definition of Learning disability?

A
  • Reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
  • E.g. household tasks, socialising or managing money
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2
Q

What 3 areas doe DSM define Intellectual disability as?

A
  • Social skills
  • Conceptual skills
  • Practical skills
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3
Q

What IQ does WHO classify severity of intellectual disability?

A

Mild - IQ range 50-69
Moderate - IQ 35-49
Severe - IQ 20-34
Profound - IQ under 20

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4
Q

What two areas are affected with intellectual disability?

A
  • Intellectual functioning e.g. learning and judgment
  • Adaptive functioning e.g. activities of daily life like communication
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5
Q

What percentage of the population are Intellectual disability?

A
  • 1% of pop
  • Of those 85% have mild intellectual disability
  • Makes more likely than females
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6
Q

What labels would you use to describe learning disability?

A
  • Person with an intellectual impairment
  • Person with a learning disability
  • Person with a learning difficulty

Person/ people first

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7
Q

What is impairment? *Exam

A
  • In context of health experience Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function
  • Impairment considered to occur at level of organ or system function
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8
Q

What is disability?

A
  • In the context of health experience a disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in manner or within range considered normal for a human being
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9
Q

What does WHO classify activity limitation as?

A
  • Difficulty encountered by individual in executing task or action
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10
Q

What does WHO classify participation restriction as?

A
  • a problem experienced by an individual in involvement in life situations
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11
Q

What are the causes of Learning disability?

A
  • Preconception (Parental genotype, maternal health)
  • Pre-natal (Chromosomal genetic, infection)
  • Perinatal (Prematurity injury)
  • Postnatal (Untreated genetic disorders, infection, trauma)
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12
Q

What are some syndromes associated with learning disability?

A
  • Downs Syndrome
  • Prader Willi Syndrome
  • Angelman Syndrome
  • Autism Spectrum Syndrome
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13
Q

What is Down’s syndrome?

A
  • Most common due to full trisomy of chromosome 21 (95%)
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14
Q

What is the greatest risk factor for DS?

A
  • Advanced maternal age
  • Women over age of 35 and continues to increase
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15
Q

What other medical features are present with Down’s syndrome?

A
  • Congenital Heart Defects
  • Alzheimer’s Dementia
  • Epilepsy
  • Leukaemia
  • Hearing impairment
  • Diabetes Mellitus
  • Ceoliac Disease
  • Thyroid Disease
  • Intellectual Impairment
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16
Q

Why are people with Down’s syndrome more likely to get periodontal disease?

A
  • Oral hygiene reduced
  • Oral function reduced
  • Impaired migration of gingival fibroblasts
  • Periodontal pathogens
  • Saliva
  • Impaired neutrophil chemotaxis
  • Unregulated production of inflammatory mediators
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17
Q

What are some presentations of Prader Willi?

A
  • Chromosome 15
  • 1 in 15,000 affected
  • Desire to eat food all the time
  • Resticted growth leading to short stature
  • Reduced muscle tone (hypotonia)
  • Learning difficulty (but may have lack of normal IQ)
  • Lack of sexual development
  • Behavioural problems like tantruma
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18
Q

What is ASD/ASC?

A
  • Complex developmental condition, behaviourally defined, that includes a range of possible developmental impairments in reciprocal social interaction and communication, and also a stereotyped, repetitive or limited behavioural repertoire.
  • Sensory differences may also presenting feature
  • Very common
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19
Q

ASD/ASC and dentistry?

A
  • Sensory atypia is barrier to treatment
  • Many hypersensitive to multitude of stimulus
  • Toothbrushing and prevention has multiple sensory triggers
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20
Q

Who is included in the Learning disability team?

A
  • Medical Dr
  • Psychiatry
  • Social Work
  • Specialist nurse
  • Occupational therapy
  • Nutrition/dietician
  • SLT
21
Q

How should dental services be provided?

A
  • Recognise everyone as individual
  • Recognise everyone has right to participate in decision that affects lives
  • Provide amount of support necessary to enable everyday living, including adequate health acre
22
Q

What are some individual characteristics that are barriers for oral healthcare?

A
  • Limited mobility to brush teeth
  • Sensory problems don’t like being touched
  • Dependent on carers or family members
  • Females have higher anxiety
23
Q

What are some access issues that are barriers for oral healthcare?

A
  • Not having reg dentist
  • Hard to get NHS dentist
  • Cost
  • Long delays for more complex needs
24
Q

What are some other barriers for oral healthcare?

A
  • Difficult to communicate
  • Dentists unconfident with people with LD and don’t want to treat
  • Transition between children and adult hard to process
25
Q

How can we help people with lD with getting to the surgery?

A
  • Preparation *
  • Social stories ( ASD)
  • Hospital / Health Passport
  • Pre-visit (Scout the place out)
  • Multiple visits with slow progress
  • Liaise with Community Disability Nurse / Team for help
26
Q

How can visual supports be useful for people with LD?

A
  • Individuals with autism often benefit from
    visual supports and schedules.
  • The following visual schedule outlines the
    steps necessary for a dental visit.
27
Q

What should you do on arrival?

A
  • Give yourself time
  • Start away
  • Do best time of day for the patient
  • Limit time spent in waiting room
28
Q

How can someone communicate pain if not verbal?

A
  • Aggression to you or them
  • Altered facial expression
  • Changes to mobility or balance
  • Change in behaviour like irritability
  • Change’s to appetite
  • Confusion
29
Q

What can you use to help you with communication of nonverbal patient?

A
  • Pain communication toolkit
30
Q

What are adjuncts to communication you can use?

A
  • Makaton
  • Picture Boards
  • Letter Boards
  • Talking Mats
  • Draw
  • Write
31
Q

How can you create the right atmosphere?

A
  • Non threatening environment
  • Friendly
  • Acclimatise with multiple visits
  • Consider relaxation techniques
  • Make it fun
  • Don’t lose control
32
Q

What to do on first visit?

A
  • Keep it simple
  • Don’t expect too much (dentist and patient)
  • Building trust and relationships
33
Q

When should clinical holding take place?

A
  • Only considered if failure of other techniques

Only take place if
- Patient consents
- No capacity and deemed as benefit
- Unplanned emergencies where any pt presents risk
- Always record in notes and justify
- Benefit and in best interests

34
Q

What are people with LD more likely to have in relation to oral disease?

A
  • Less research within primary care
  • More likely to have filled teeth, fewer extractions, more untreated decay than more profound disabilities
  • Fewer dentures provided
  • Increased burden of denture related problems
  • Untreated tooth decay more likely
35
Q

What are some risk factors of oral disease for people with LD?

A
  • Frequent sugar intake
  • Prescription of medications that can reduce saliva flow or increase gingival inflammation
  • Gastroesophageal reflux
  • Lower income and educational levels
  • Difficulty in accessing dental services
  • Being non-oral feeders
  • Reduced dexterity resulting in ineffective tooth brushing
  • Sensory sensitivity, making it difficult to co-operate with oral care
  • Difficulty in understanding the importance of daily oral care
  • Poor motor control
  • Medications
  • Rewarding – less common
  • Higher levels of gum (periodontal) disease
  • Greater gingival inflammation
  • Higher numbers of missing teeth
  • Increased rates of toothlessness (edentulism)
  • Higher plaque levels
  • Greater unmet oral health needs
  • Poorer access to dental services and less preventative dentistry
36
Q

What is self-injurious behaviour linked to?

A
  • Cerebral Palsy
  • Autism
  • Tourettes
  • Lesch-Nyan Syndrome
  • Profound neuro-disability
  • Exaggerated or abnormal oral reflex, habit, pain and/or frustration
37
Q

Why does drooling occur in people with LD?

A
  • Abnormalities in swallowing rather than absence of swallowing
  • Difficulty moving saliva to back of throat
  • Poor mouth closure
  • Jaw instability
  • Tongue thrusting
38
Q

How to treat drooling?

A
  • Multidisciplinary team make individual assessment
  • Technqiues to improve posture
  • Treatment with nonpharmacologucal and non-surgical methods
  • Careful monitoring for oral complications
39
Q

How can bruxism and NCTSL be treated?

A
  • Splints if compliant
  • Opinion sought from dental specialist
40
Q

What is erosion advice?

A
  • Fluoride mouthwash for swallowing difficulties
  • Toothpaste that is low in abrasion, low acidity, high-fluoride and antihypersensitivity
  • Brushing delayed an hour after drink or food
  • Fluoride varnish
  • Referral
  • Chew sugar free gum
41
Q

How is dry mouth treated?

A
  • Saliva replacements may be helpful
  • The use of sugar-free chewing gum and sugarfree fluids is advised ( if possible?)
  • The mouth should be examined regularly
  • Fluoride rinses ( if possible?) or high fluoride
    containing toothpastes are advised
  • Referral to an appropriate dental specialist
    may be required
42
Q

How are feeding problems overcome?

A
  • Individual assessment
  • Good OH promoted
  • Low foaming toothpaste (proenamel)
  • Use of suction toothpaste
  • Therapy to reduce oral defensiveness
43
Q

How are thickeners useful?

A
  • Useful for dysphagia
  • Thickening to prevent aspiration
44
Q

What are the options for LA?

A
  • Behavioural management
  • Conscious sedation
  • GA
45
Q

What are the aims of conscious sedation?

A
  • Reduce fear and anxiety
  • Augmenting pain control
  • Minimise movement and increase safety
46
Q

When is GA utilised?

A
  • Majority Intellectual Impairment
  • Multiple Disabilities
  • Dental anxiety /Phobia
  • Medical reasons – control
  • Behavioural- uncooperative to allow for
47
Q

What is the risk of GA?

A
  • Death 1 in 100,000 to 1 in 200,000
  • Increases with age, complex of surgery, emergency surgery
  • Brain damage, nausea and vomiting, lethargy
  • Increased complexity with increasing co-morbidity
  • Confusion and memory loss
  • Dizziness
  • Sore throat
  • Allergic reaction to anaesthetic
48
Q

What are the dental features of people with Down Syndrome?

A
  • Delayed eruption of teeth
  • Crowded or misaligned teeth
  • Poor oral hygiene
  • Microdontia
  • Class III malocclusion
  • Narrow upper arch and palate
  • Flat facial profile
  • Small maxilla

BDS3 Special Care Dentistry (16 decks)

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