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BDS3 - Special Care Dentistry > intellectual impairment > Flashcards

intellectual impairment Flashcards

1
Q

what is a learning disability

A
  • is a reduced intellectual ability and difficulty with everyday activities
  • can be intellectual, but also levels of self-care and levels of understanding
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2
Q

what does intellectual disability involve problems with

A
  • general mental abilities that affect functioning in 2 areas
  • intellectual functioning = such as learning, problem solving
  • adaptive functioning = activities of daily life such as communication and independent living
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3
Q

how much of the population does intellectual disability affect

A
  • 1%
  • and of those 85% have mild intellectual disability
  • males more likely
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4
Q

what is the difference between learning difficulty and learning disability

A
  • difficulty is something like dyslexia

- very different to disability

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5
Q

what is eugenics

A
  • a philosophical and social movement which sought to improve the human race
  • basically a principle whereby we improve the human race by removing those who are not good
  • eugenic = well born
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6
Q

what is positive eugenics

A
  • encouraging those with ‘desirable traits’ to reproduce more
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7
Q

what is negative eugenics

A
  • discouraging those with ‘undesirable traits’ to reproduce less
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8
Q

what is Lennox hospital

A
  • opened in 1936
    • Number of atrocious acts that are speculated to have taken palce here
    • Those with impairment or disability were taken away from society and taken to this hospital where they were attempted to be corrected
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9
Q

what led to the closure of these institutions

A
  • the concept of normalisation, reinforced by legislation
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10
Q

what is the different between impairment and disability

A
  • impairment = any loss or abnormality of psychological, physiological or anatomic structure or function
  • disability = any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being
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11
Q

what does the WHO describe impairment and disability as

A
  • impairment = problem in body function or structure

- disability = an umbrella term, covering impairments, activity limitations, and participation restrictions

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12
Q

what is the social model of disability

A
  • Disability is caused by the way society is organised, rather than by a person’s impairment or difference
  • Social organisation (for example, work practices, buildings or products) that takes little or no account of people who have impairments and/or
  • Social organisation that creates segregated and second-rate provision (for example, segregated welfare provision, transport, employment, education and leisure facilities)
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13
Q

what is the medical model of disability

A
  • The medical model of disability says people are disabled by their impairments or differences
  • Under the medical model, these impairments or differences should be ‘fixed’ or changed by medical and other treatments
  • Healthcare practices partly responsible
  • Saying they have a problem, and are going to fix it
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14
Q

what are barriers to social model

A
  • segregated social prevision
  • inflexible organisational procedure and practises
  • inaccessible information
  • inaccessible buildings
  • inaccessible transport
  • negative cultural representations
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15
Q

what are the heredity causes of a preconception learning disability

A
  • parental genotype
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16
Q

what is the environmental cause of preconception learning disability

A
  • maternal health
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17
Q

what is the heredity cause of pre-natal learning disability

A
  • chromosomal

- genetic

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18
Q

what is the environmental cause of pre-natal learning disability

A
  • infection
  • maternal health
  • nutrition
  • toxic agents
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19
Q

what are the environmental causes or perinatal learning disability

A
  • prematurity

- injury

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20
Q

what are the heredity causes of postnatal learning disability

A
  • untreated genetic disorders
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21
Q

what are the environmental causes of postnatal learning disability

A
  • infection
  • trauma
  • toxic agents
  • nutrition
  • sensory social deprivation
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22
Q

what is the association between ASD and learning disability

A
  • not everyone with ASD has a learning disability, there is an association however
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23
Q

what syndromes can be associated with a learning disability

A
  • autistic spectrum disorders
  • downs syndrome
  • cerebral palsy
  • fragiel X syndrome
  • prader willis
  • PKU
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24
Q

what is Down syndrome

A
  • neurodevelopment disorder of the genetic origin affecting chromosome 21
  • most commonly it is due to full trisomy of chromosome 21 (95%)
  • small number of cases it is due to mosaicism
  • ## occurs in 1 in 700 births
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25
Q

what has resulted in less DS births

A
  • antenatal screening and subsequent termination
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26
Q

what is the greatest risk factor for DS

A
  • advanced maternal age
  • women over the ager of 35 are more likely to have a child with DS with the risk continuing to increase with advancing age
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27
Q

what are the medical features of DS

A
  • congenital heart diseae
  • alzheimers dementia
  • epilepsy
  • leukaemia
  • hearing impairments
  • diabetes mellitus
  • coeliac disease
  • thyroid disease
  • intellectual impairment
28
Q

what dental disease can be associated with DS

A
  • oral hygiene
  • oral function
  • impaired migration of gingival fibroblasts
  • saliva
  • periodontal pathogens
  • immune system related factors
  • impaired neutrophil chemotaxis
29
Q

what is cerebral palsy

A
  • 1 in 400 affected
  • neurological conditions that affect movement and co-ordination
  • muscle stiffness or floppiness = hypotonia
  • muscle weakness
  • random and uncontrolled body movements
  • balance and co-ordination problems
  • defined by movement, limbs affected or severity
30
Q

what is Prader Willis

A
  • chromosome 15
  • 1 in 15,000 affected
  • constant desire to eat food = never full, link from brain to stomach not working so don’t feel full
  • restricted growth, leading to short stature
  • reduced muscle tone = hypotonia
  • learning difficulties
  • lack of sexual development
  • behavioural problems, such as temper tantrums or stubbornness
31
Q

what are the berries to oral healthcare

A
  • user/carer
  • professional service providers
  • physical barriers
  • cultural issues
32
Q

in what families is learning disability more common

A
  • those of a lower socioeconomic status
33
Q

what are the benefits of primary care access

A
  • proximity,
  • relationships may already be established
  • family members may attend practice
34
Q

what are some specialist services

A
  • special care dentistry
  • blend of services necessary
  • risk of neglect of care if mainstreaming
  • referral
  • complex cases = SCD
  • advice
35
Q

how can we prepare for patient coming into surgery

A
  • social stories = pictures, prepare patient before they come in
  • hospital/health passport = good to get information before you even have patient into surgery
  • pre-visit = scout the place
  • multiple visits with slow progress
  • liaise with community disability nurse/team for help w
36
Q

when is best for patients to come to surgery

A
  • start of a session

- don’t be late for them as can cause stress

37
Q

what ar key points about verbal communication

A
  • speak naturally and clearly
  • ask to repeat information
  • ask yes or no questions
  • don’t lead patient responses
  • allow enough time to communicate with your patient
  • don’t interrupt or finish patient’s sentences
38
Q

what are some adjuncts to communication

A
  • makaton
  • picture boards
  • letter boards
  • talking mats
  • draw
  • write
39
Q

how can you create the right atmosphere for the patient

A
  • non-threatening environment
  • friendly
  • acclimatise
  • consider augmentative techniques
40
Q

what can help you get access to the mouth

A
  • Bedi sheild = made of plastic and put finger to get patient to open mouth and then patient bites down on it, bu they are known to fracture
  • open wide mouth rests = patient opens mouth and place it in horizontal then turn it vertical to get wider open = less likely to break
41
Q

what is clinical holding

A
  • considered if other techniques fail
  • should only take place if patient consents
  • always record in notes and justify
  • is a form of restraint and needs to be scrutinised fully
  • controversial subject
42
Q

what needs to be known about medical history

A
  • a diagnosis?
  • medical conditions = epilepsy, psychiatric conditions, congenital defect in other systems
  • liaise with other colleagues
43
Q

what needs to be known about social history

A
  • living arrangement
  • support
  • transport
  • likes/dislikes
44
Q

what are risk factors for oral health for patients with learning disability

A
  • poor motor control
  • imbrication of teeth
  • lack of cleansing
  • pouching and limits food clearance
  • mouth breathing - reduced saliva
  • medications
  • rewarding = less common now
45
Q

how can treatment complexity be influenced

A
  • by the severity of the learning disability
46
Q

what prevention can be used

A
  • toothpastes = need to be careful they won’t eat the toothpaste
  • toothbrush advice
47
Q

what is self-injurious behaviour

A
  • self-biting or hands, arms, lips and tongue
48
Q

what can self-injurious behaviour be linked to sometimes

A
  • cerebral palsy
  • autism
  • tourettes
  • leach-Nyan syndrome
  • profound neuro-disability
  • exaggerated or abnormal oral reflex, habit, pain and/or frustrations
49
Q

what are some treatment strategies for SIB

A
  • symptomatic relief
  • reassurance
  • distraction
  • pharmacological Treatment
  • behavioural psychology such as positive reinforcement
  • construction of oral appliances
  • extraction of specific anterior teeth, but that could transfer the SIB to another area of the mouth
  • orthognathic surgery to create an open bite and prevent SIB
50
Q

how can drooling happen

A
  • difficulty moving saliva to the back of the throat
  • poor mouth closure
  • jaw instability
  • tongue thrusting
  • increased saliva production is very rare
51
Q

how can you treat bruxism/NCTSL

A
  • construction of splints may be helpful but their success is dependent on patient compliance
  • an opinion should be sought from an appropriate dental specialist if required
52
Q

what is some advice for erosion

A
  • fluoride mouthwash unless there are swelling difficulties
  • toothpaste which is low in abrasion, low acidity, high fluoride
  • brushing should be delayed for at least one hour after consuming acidic food or drink
  • professional application of varnish
  • dentine bonding agents
  • referral to an appropriate dental specialist
  • reduce or eliminate intake of carbonated and acidic drinks and acidic fruits
  • chew sugar-free gum, suck a sugar-free sweet
53
Q

what can be done for dry mouth

A
  • saliva replacment
  • the use of sugar-free chewing gum and sugar-free fluid is advised
  • the mouth should be examined regularly
  • fluoride rinses or high fluoride containing toothpaste are advised
54
Q

what can be done for feeding problems

A
  • Individual assessment should be carried out
  • Good oral hygiene should be promoted
  • An intensive regime should be followed to prevent oral disease
  • A multi-professional approach is advised
  • A low foaming toothpaste is recommended
  • The use of a suction toothbrush can be of benefit
  • Therapy should be carried out to try and reduce oral defensiveness
  • If the mouth is healthy, then we know that is they do aspirate, they are less likely to get pneumonia
55
Q

what can be given to alter diet

A
  • thickeners and taster
56
Q

what do thickeners do

A
  • make food easier to swallow to prevent aspiration
57
Q

what are some tasters

A
  • honey, jam, chocolate
58
Q

what needs to be considered if thinking about using LA

A
  • ability to cooperate
  • volume of treatment
  • type of treatment
  • behavioural techniques and patient management
59
Q

what is good about conscious sedation

A
  • reduces fear and anxiety, augmenting pain control
  • more flexible than GA = less risk with it
  • available in primary care
60
Q

what is a problem about conscious sedation

A
  • need for IV access
  • need to maintain airway - keep breathing
  • level of understanding is necessary
61
Q

what are the pros of using GA

A
  • comprehensive care
  • potentially more controllable environment if medical diseaes
  • opportunity for joint working
  • aftercare and monitoring
62
Q

what are the cons of using GA

A
  • risk of death, brain damage
  • need support for 24 hours after
  • organisation of procedure
  • complex restorative dental treatment
  • teeth of dubious prognosis removed
  • difficult working environment
  • no improvement in coping mechanism
63
Q

what are the indications of using GA

A
  • a clear inability to co-operate with the provision of dental care using other patient management techniques
64
Q

what does GA require

A
  • Systematic assessment - Full History and Consent
  • Ideally seen by the dentist who will perform GA
  • Anaesthetist assessment prior to treatment session
  • Admissions Protocol
  • Treatment – what is possible under GA?
  • Post op – medical issues in/out patient, someone to look after them
65
Q

what is the 3 fold role of dental practitioner

A
  • recognise = identify adult at risk
  • respond = mange the acute situation and inform other services as required
  • record = document and report in detail the information obtained

BDS3 - Special Care Dentistry (19 decks)

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