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3 Special Care Dentistry > Intellectual Impairment > Flashcards

Intellectual Impairment Flashcards

1
Q

What is a learning disability?

A

A reduced intellectual ability and difficulty with everyday activities

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2
Q

What is intellectual impairment?

A

Problems with general mental abilities that affect learning, problem solving and judgement; and communication and independent living

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3
Q

What global terms are used to describe intellectual impairment in health and social care?

A

Person with additional care needs
Person with additional support needs
Person who requires special care

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4
Q

What is eugenics?

A

A movement that sought to improve the human race by encouraging those with desirable traits to reproduce more and those with undesirable traits to reproduce less

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5
Q

What social and policy changes were made in 1990?

A

The transfer of residents to smaller homes in the community with a change in emphasis and responsibility for care and support from health to social services
60% of adults with a learning disability now live with their families

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6
Q

What is an impairment?

A

A problem in body function or structure

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7
Q

What is activity limitation?

A

A difficulty encountered by an individual in executing a task or action

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8
Q

What is participation restriction?

A

A problem experienced by an individual in involvement in life situations

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9
Q

Describe the social model for disability?

A

Disability is caused by the way society is organised, rather than by a person’s impairment or difference

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10
Q

Describe the medical model for disability?

A

The medical model of disability says people are disabled by their impairments or differences
These impairments or differences should be fixed or changes by medical and other treatments

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11
Q

What is an impairment?

A

Any loss or abnormality of psychological, physiological or anatomical structure or function
Considered to occur at the level of organ or system function

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12
Q

What is a disability?

A

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being

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13
Q

What are the barriers to a social model?

A

Segregated social provision
Inflexible organisational procedures and practices
Inaccessible information
Inaccessible transport
Negative cultural representations

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14
Q

Give examples of syndromes associated with learning disabilities

A

Down’s syndrome
Autism spectrum syndrome
Prayer Willi syndrome

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15
Q

What is Down’s syndrome?

A

A neurodevelopmental disorder of genetic origin affecting chromosome 21

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16
Q

What is the prevalence of Down’s syndrome?

A

1 in every 700 births

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17
Q

What medical features are those with Down’s syndrome more likely to have?

A

Congenital heart defects
Alzheimer’s disease
Epilepsy
Diabetes mellitus
Thyroid disease

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18
Q

What dental disease are those with Down’s syndrome more likely to have?

A

Periodontal disease

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19
Q

Describe Prader Willi disease

A

Affects chromosome 15
1 in every 15,000 births

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20
Q

What poses a barrier to treatment in ASC?

A

Sensory atypical such as bright lights, noise, touch and toothbrushing

21
Q

What is cerebral palsy and describe its prevalence?

A

1 in 400 affected
Neurological condition that affects movement and coordination
Does not mean you have a learning disability

22
Q

What are the barriers to oral healthcare in those with learning disabilities?

A

Access
Individual characteristics
Pain recognition
Attitudes, skills and knowledge of staff
Transition

23
Q

Describe how individual characteristics can be a barrier to dental care

A

Difficulties making it difficult to undertake oral hygiene - not understanding importance, sensory problems, limited communication
Dependence upon family carers or supporters to support with oral care
Anxiety

24
Q

Describe how access is a barrer to dental care

A

Not having a regular dentist
Cost of treatment
Difficulties with transport
Relying on carers to make and support with appointments

25
Q

Describe how pain recognition and response is a barrier to dental care

A

Some with learning disabilities find it difficult to communicate that they are in pain or to describe the source

26
Q

Describe how attitudes, skills and knowledge of dental staff are barriers to dental care

A

Many dentist are not confident and unwilling to treat patients with learning disabilities
Lack of knowledge
It can be challenging to provide dental treatment to people who struggle to understand what is being done and may be uncooperative

27
Q

Describe how transition is a barrier to dental care?

A

Transition between children and adult health services can be a difficult process and they may be vulnerable at this time

28
Q

What supports can be used for patients with ASC?

A

Visual supports to outline the steps of the visit

29
Q

What are the signs and symptoms a patient may be in pain?

A

Aggression towards themselves or others
Changes to how they hold and move their body including facial expressions
Changes to mobility or balance
Tearfulness, irritability or withdrawal
Changes to appetite
Confusion
Restlessness

30
Q

Give examples of good verbal communication

A

Speak naturally and clearly
Ask to repeat the information if you don’t understand
Ask yes or no questions
Don’t interrupt or finish patients’ sentences

31
Q

What can be used supplementary to communication?

A

Makaton
Picture boards
Letter boards
Talking mats
Draw
Write

32
Q

What can be used to assist examination?

A

Access to the mouth
Bedi shield
Open wide mouth rests
Toothbrush
Mirror
Good light
Head support

33
Q

What should be included in medical history in those with learning disabilities?

A

If there is a diagnosis
Medical conditions
Epilepsy
Psychiatric conditions
Congenital defects in other systems

34
Q

What should be included in social histories for patients with learning disabilities?

A

Living arrangements
Support
Transport
Likes and dislikes

35
Q

Give examples of risk factors people with learning disabilities often have

A

Frequent sugar intake
Gastroesophageal reflux
Lower income and educational levels
Poor motor condolence
Medications
Pouching and limited food clearance

36
Q

Describe oral disease in those with learning difficulties?

A

Higher levels of periodontal disease
Greater gingival inflammation
Higher plaque levels
Higher numbers of missing teeth

37
Q

How should tooth brushing advice be given to those with learning difficulties?

A

Explain first
Good time of day
Wear gloves
Stand behind slightly to one side
Keep brushing systematic
Encourage the person to do as much as possible

38
Q

What are causes of drooling?

A

Abnormalities in swallowing
Difficulties moving saliva to the back of the throat
Jaw instability
Tongue thrusting

39
Q

How should drooling be treated?

A

Treatment should be started with non-pharmacological and non-surgical methods
There should be careful monitoring for oral complications if pharmacological or surgical treatment is carried out

40
Q

How should bruxism be treated?

A

Construction of splints may be helpful but their success is dependent on patient compliance

41
Q

What advice should be given on erosion?

A

Fluoride mouthwash unless there are swallowing difficulties
Toothpaste which is low in abrasion, low acidity, high fluoride and anti-hypersensitivity
Brushing should be delayed for at least one hour after consuming acidic food or drink
Chew sugar free gum, suck a sugar free lozenge or eat cheese after an acidic meal
Referral to an appropriate dental specialist may be required

42
Q

How can dry mouth be treated?

A

Saliva replacement may be helpful
Use of sugar free chewing gum and sugar free fluids is advised
Mouth should be examined regularly
Fluoride rinses or high fluoride toothpastes
Referral to an appropriate dental specialist may be required

43
Q

How can feeding problems be treated?

A

Good OH should be promoted
An intensive regime should be followed to prevent oral disease
A multi professional approach is advised
Low foaming tooth paste recommended
Therapy to try and reduce oral definsiveness

44
Q

What are the options for behavioural management?

A

Acclimatisation
Tell, show, do
Relaxation
Structured time

45
Q

What are the options for conscious sedation?

A

Inhalation
Intra-nasal
Intra-venous
Nasal
Oral

46
Q

What are the options for general anaesthetic?

A

Out-patient
In-patient

47
Q

When is general anaesthetic utilised?

A

Major intellectual impairment
Multiple disabilities
Dental anxiety/phobia
Medical reasons - control
Uncooperative behaviour

48
Q

What are the risks of GA?

A

Death - 1 in 100,000 or 200,000
Risk increases with age, complexity of surgery or very unwell before procedure
Brain damage
Nausea and vomiting
Lethargy
Delayed recovery

49
Q

When should you refer a patient for a GA?

A

Pain and swelling where no alternatives exist but must be managed acutely
Obvious dental disease when no alternative treatment is possible
A number of years since a reasonable examination where poor oral hygiene and suspicion of disease is present

3 Special Care Dentistry (7 decks)

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