Intellectual Impairment Flashcards
Define a learning disability
‘A significantly reduced ability to understand new or complex information, to learn new skills, and with a reduced ability to cope independently which started before adulthood’
What is eugenics?
Philosophical and social movement sought to improve human race
Positive eugenics = desirable traits to reproduce more
Negative = discourage those with undesirable traits to reproduce less
What are some possible causes of learning disability
Genetics and genotype
Infection
Maternal health
Nutrition
Toxic agents
Premature birth
Sensory social deprivation
What is Down’s syndrome?
Neurodevelopmental disorder of genetic origin affecting chromosome 21
What are some clinically associated diseases with Down’s syndrome?
Congenital heart disease
Alzheimer’s and dementia
Diabetes
Coeliac
Epilepsy
What dental implications can Down’s syndrome have?
Reduced ability to carry out oral hygiene
Decreased oral function
Impaired migration of gingival fibroblasts
Unregulated production of inflammatory mediators
- increased risk of periodontal disease
What are some characteristics of prader-willi syndrome?
Chromosome 15
- aka downy stoddart syndrome
Constant desire to eat
Restricted growth
Reduced muscle tone
Lack of sexual development
Behavioural problems
Learning difficulties
What typically presents in those with ASD?
A range of possible developmental impairments in reciprocal social interactions and communications and also a stereotyped, repetitive or limited behavioural repertoire
What dental implications may arise from someone with ASD?
Sensory atypia
- sounds of handpiece
- feeling of air in 3in1
- bright light from the dental unit
The hypersensitivity along with multiple stimuli in the clinic can act as a trigger
What is cerebral palsy?
Neurological condition affecting movement and co-ordination
Results in muscle stiffness or floppiness
Random uncontrolled movements
Balance issues
Not always a learning difficulty component
What are some individual characteristics that are barriers to dental care for those with learning difficulties?
Cognitive, physical or behavioural difficulties
- not understanding need for oral hygiene or treatment
- limited mobility
- sensory issues
Dependence on others
- lack of care giver training
- limited awareness of dental services available
What features of dental practices and medical practices alike may inhibit access to those with learning difficulties?
Not having regular dentist
Difficulty getting NHS dentist
Cost of treatment can be high
Complex referral systems
Longer delays for those with specific needs
What are some overall barriers to access for those with learning difficulties?
Individual characteristics
Access
Pain, recognition and response
Attitudes, skills and knowledge of dental staff
Transition between health services
Why might pain recognition and response be a barrier?
Those with LD may find it hard to communicate they’re in pain or the source
Untreated pain is often manifested in behaviour that can be challenging
Give some ways to acclimatise someone with a LD to a dental environment
- pre-visit to get acclimatised
- multiple visits with slow progress to build rapport
- visual supports (good with autism)
- book start of session so not running late and person has less time waiting in room
- speak clearly and naturally so you can be understood
- create the right atmosphere with no triggers
What behaviour might someone with a LD in pain convey?
Aggression / irritability
Altered facial expression, mobility, balance
Confusion
Restlessness or changes in sleep
When is clinical holding justified?
If patient consents
If no capacity and is deemed of benefit - pt may be safety risk to themselves
Unplanned emergencies with significant risk
Always record In notes and justify
What are the risks factors often coupled with those with learning disabilities?
- frequent sugar intake
- polypharmacy causing xerostomia
- GORD
- lower socio-economic Status
- difficult access to dental care and cooperation and understanding
- sensory sensitivity
- pouching of food / medications etc
What is the prevalence of oral disease like in those with LDs?
- higher periodontal disease and gingivitis
- increased rate of missing teeth and edentulism
- increased amount of plaque
What is SIB? How might it be treated?
Self-injurious behaviour
Symptomatic relief
Drugs e.g. diazepam
Selective removal of anterior teeth causing the SIB
Oral appliances
What might cause drooling?
Issues swallowing
Poor neuromuscular control
Tongue thrust
Jaw instability
How treats drooling?
Techniques to improve posture
Monitor oral complications
How might one treat bruxism or erosion?
Construct splints - relies on compliance
High fluoride low abrasion toothpaste
Duraphat varnish
Dentine bonding agents
Reduce acidic drinks and foods
If a patient is non compliant, what are some ways a patient might be brought round to treatment, or some ways treatment can be completed on pt
Behavioural management
- through acclimatisation
- relaxation
- tell, show, do
- multiple short appts
Conscious sedation
General anaesthea
What are the risks associated with GA?
Death
- 1/100k to 1/200k
Brain damage
Vomiting and nausea
Delayed recovery
Risk rises with age
Airway latency
Bladder issues
Anaphylaxis
When is GA good?
When significant volume of treatment is needed
Uncooperative patient
Significant medical complexity of patient
