Intellectual Impairment Flashcards
1
Q
What is a learning disability?
A
reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
2
Q
What are the three core criteria for a learning disability?
A
- lower intellectual ability
- usually IQ less than 70
- significant impairment of social or adaptive function
- onset in childhood
3
Q
What is an intellectual disability?
A
- problems with general mental abilities that affect functioning in two areas
- intellectual functioning (learning, problem solving)
- adaptive functioning (communication, independent living)
4
Q
How does the social model consider disability?
A
- disability is caused by the way society is organised rather than by a person’s impairment or difference
- how can society be made fairer through reasonable adjustments to make life normal for all?
5
Q
How does the medical model consider disability?
A
- disability caused by impairments and differences
- focus of fixing impairments
- moves away from patient centred
6
Q
What barriers are faced by the social model?
A
- segregated social provision
- inflexible organisational procedures and practices
- inaccessible information
- inaccessible buildings
- inaccessible transport
- negative cultural representations
7
Q
What are the causes of learning disability?
A
- preconception
- heredity
- parental genotype - environmental
- maternal health
- heredity
- pre-natal
- heredity
- chromosomal genetic - environmental
- infection
- maternal health
- nutrition
- toxic agents
- heredity
- perinatal
- environmental
- prematurity
- injury
- environmental
- postnatal
- heredity
- untreated genetic disorders (PKU) - environmental
- infection
- trauma
- toxic agents
- nutrition
- sensory social deprivation
- heredity
8
Q
What syndromes are associated with learning disability?
A
- Down’s syndrome
- Prader Willi syndrome
- autism spectrum syndrome
- fragile x syndrome
- tuberous sclerosis
- Turners syndrome
- Rett syndrom
- velocardio facial syndrome
- Williams syndrome
9
Q
What is Down’s syndrome?
A
- neurodevelopment disorder of genetic origin
- affecting chromosome 21
- usually full trisomy of 21
- sometimes mosaicism of 21
- sometimes inherited chromosomal rearrangement of 21
- signs
- growth failure
- broad face, short nose slanting eyes
- congenital heart disease
- small arched palate, big wrinkled tongue, dental anomalies
- abnormal ears
- flat back of head
- epilepsy
- hearing impairment
- intellectual impairment
- periodontal disease
- oral hygiene and function altered
- impaired migration of gingival fibroblasts
- saliva and periodontal pathogens altered
- impaired neutrophil chemotaxis
- unregulated production of inflammatory mediators
10
Q
What is Trader Willi syndrome?
A
- chromosome 15
- constant desire to eat food
- restricted growth
- reduced muscle tone
- learning difficulties
- behavioural problems
- temper tantrums
- stubbornness
11
Q
What is autism spectrum disorder?
A
- complex developmental condition
- behaviourally defined
- social interactions and communication altered
- sensory differences
- continuum of minimal severe categorical diagnosis
- dental treatment challenging
- especially those with sensory atypia
- hypersensitive to bright lights, noise and touch
12
Q
What is cerebral palsy?
A
- neurological condition affecting movement and coordination
- muscle stiffness or floppiness
- muscle weakness
- random uncontrolled body movements
- balance and coordination problems
- does not necessarily mean there is a learning disability
13
Q
What barriers to learning disabilities place on access to oral healthcare?
A
- access
- not having a regular dentist
- difficulties getting an NHS dentist
- cost
- service delays
- transport challenges
- individual characteristics
- cognitive, physical and behavioural difficulties
- dependence upon family, carers or paid support workers
- anxiety
- pain recognition
- challenge communicating
- attitudes, skills and knowledge of staff
- professionals do not feel confident
- some unwilling to provide treatment
- transition
- child to adult services
14
Q
How can getting to the dental surgery be made easier for those with learning difficulties?
A
- preparation
- social stories
- particularly for those with ASD
- hospital/health passport
- pre-visit
- become familiar with location
- multiple visits with slow progress
- lease with community disability nurse and team
15
Q
What are visual supports used for?
A
- useful for patients with autism
- visual schedule outlining steps necessary for a dental visit
- can be given before appointment to reduce the element of unknown
16
Q
How can arrival to the dental surgery be made easier for those with learning difficulties
A
- appointment at start of session so not running late
- ensure appointment times are long enough
- discuss the best time of day for patient
- missing activities
- routine
- best mood
- medications
- take patient straight into the surgery
- limit time spent in waiting room
17
Q
How may pain be communicated by non-verbal patients?
A
- agression
- changes in body language
- altered facial expression
- changes to mobility or balance
- changes to mood (tearfulness, irritability, withdrawal)
- changes to appetite or vocalisation
- confusion
- restlessness or changes to sleep pattern
18
Q
What adjuncts to communication may be utilised?
A
- makaton
- picture boards
- letter boards
- talking mats
- drawing
- writing
19
Q
What are the oral risk factors associated with a learning disability?
A
- frequent sugar intake
- prescription medications
- reduced saliva flow
- gingival inflammation
- lower income and educational levels
- difficulty accessing dental services
- non-oral feeders
- reduced oral hygiene
- reduced dexterity, poor motor control
- sensory sensitivity
- difficulty understanding importance
- tooth wear
- acidic environment
- imbrication of teeth
- pouching and limited food clearance
- food held in buccal sulcus
- mouth breathing
- reduced saliva
20
Q
What oral diseases are associated with learning disabilities?
A
- higher levels of periodontal disease
- greater gingival inflammation
- higher numbers of missing teeth
- increased edentulism
- higher plaque levels
21
Q
What self-injurious behaviour may be exhibited by those with learning disabilities and what conditions are they associated with?
A
- self biting of hands, lips, arms and tongue
- cerebral palsy
- autism
- tourettes
- leach-nyan syndrome
22
Q
How is self-injurious behaviour managed?
A
- symptomatic relief
- reassurance for patients, parents and carers
- monitoring of the situation
- distraction
- when behaviour is observed
- pharmacological treatment
- haloperidol
- diazepam
- carbamazepine
- behavioural psychology
- positive reinforcement
- construction of oral appliances
- extraction of specific anterior teeth
- transfer of behaviour to other area
- orthographic surgery
- creation of open bite
- prevent behaviour
23
Q
How can drooling be related to learning difficulties?
A
- abnormalities in swallowing
- rather than absence in swallowing
- dysphagia
- difficulties moving saliva to the back of the throat
- neuromuscular control
- poor mouth closure
- jaw instability
- tongue thrusting
- posture
24
Q
What can non-carious tooth surface loss be a result of and hoe can it be managed
A
- bruxism
- grinding
- sensory
- stress-induced (reassurance)
- reflux
- acidic environment
- poor oral clearance
- medications
- drinks
25
Q
What advice can be given for erosion
A
- fluoride mouthwash
- low abrasion, low acidity, high fluoride, anti-sensitivity toothpaste
- delay brushing for an hour after consumption of acidic food or drink
- professional fluoride varnish application
- use of dentine bonding agents
- reduce intake of acidic drinks and foods
- chew sugar free gum, such sugar free lozenge or eat cheese after an acidic meal
26
Q
What advice can be given for dry mouth?
A
- saliva replacements
- sugar free chewing gum and sugar free fluids
- regular dental appointments
- fluoride rinses
- high fluoride toothpastes
27
Q
What advice can be given for dry mouth?
A
- saliva replacements
- sugar free chewing gum and sugar free fluids
- regular dental appointments
- fluoride rinses
- high fluoride toothpastes
28
Q
What dental advice can be given to those with feeding problems?
A
- promotion of good oral hygiene
- low foaming toothpaste
- sensory issues
- when uncreased risk of dysphagia
- SLS free (oranurse, pronamel)
- suction toothbrush beneficial
- diet alterations
- thickeners to prevent aspiration
- tasters to make more appealing
29
Q
What are the options for conscious sedation?
A
- inhalation
- requires toleration of nose piece
- nasal
- midazolam
- IV line subsequently placed
- intravenous
- midazolam
- oral
- medication placed in diluting juice
- dosages can be difficult
30
Q
What are the risks of general anaesthetic?
A
- death
- brain damage
- nausea and vomiting
- lethargy
- shivering
- confusion and memory loss
- bladder problems
- sore throat
- allergic reaction
31
Q
What are the stages of general anaesthetic assessment and planning?
A
- referral
- patient assessment
- full history
- medical reports
- dental examination and investigations
- dental treatment planning
- additional procedures
- bloods
- endoscopy
- imaging
- anaesthetic pre-assessment
- consent
- admission
- communication within teams
- pre-operative anxiolytics
- anaesthetic conduct
- airway management
- throat pack
32
Q
When may a GA assessment be required?
A
- pain and swelling where no alternatives exist for acute management
- obvious dental disease when no alternative treatment modality is available
- number of years since a reasonable examination in presence of poor oral hygiene and suspicion of disease
33
Q
What is the purpose of safeguarding?
A
- preventing harm and promoting welfare
- protecting individuals from harm
34
Q
What are the roles of the dental practitioner in regards to safeguarding?
A
- recognise adults at risk
- respond in acute services to inform other services
- record and report in detail information obtained
- remain calm and reassure the individual
- seek further information
