intellectual impairment Flashcards
what is a learning disability
- is a reduced intellectual ability and difficulty with everyday activities
- can be intellectual, but also levels of self-care and levels of understanding
what does intellectual disability involve problems with
- 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
how much of the population does intellectual disability affect
- 1%
- and of those 85% have mild intellectual disability
- males more likely
what is the difference between learning difficulty and learning disability
- difficulty is something like dyslexia
- very different to disability
what is eugenics
- 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
what is positive eugenics
- encouraging those with ‘desirable traits’ to reproduce more
what is negative eugenics
- discouraging those with ‘undesirable traits’ to reproduce less
what is Lennox hospital
- 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
what led to the closure of these institutions
- the concept of normalisation, reinforced by legislation
what is the different between impairment and disability
- 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
what does the WHO describe impairment and disability as
- impairment = problem in body function or structure
- disability = an umbrella term, covering impairments, activity limitations, and participation restrictions
what is the social model of disability
- 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)
what is the medical model of disability
- 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
what are barriers to social model
- segregated social prevision
- inflexible organisational procedure and practises
- inaccessible information
- inaccessible buildings
- inaccessible transport
- negative cultural representations
what are the heredity causes of a preconception learning disability
- parental genotype
what is the environmental cause of preconception learning disability
- maternal health
what is the heredity cause of pre-natal learning disability
- chromosomal
- genetic
what is the environmental cause of pre-natal learning disability
- infection
- maternal health
- nutrition
- toxic agents
what are the environmental causes or perinatal learning disability
- prematurity
- injury
what are the heredity causes of postnatal learning disability
- untreated genetic disorders
what are the environmental causes of postnatal learning disability
- infection
- trauma
- toxic agents
- nutrition
- sensory social deprivation
what is the association between ASD and learning disability
- not everyone with ASD has a learning disability, there is an association however
what syndromes can be associated with a learning disability
- autistic spectrum disorders
- downs syndrome
- cerebral palsy
- fragiel X syndrome
- prader willis
- PKU
what is Down syndrome
- 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
what has resulted in less DS births
- antenatal screening and subsequent termination
what is the greatest risk factor for DS
- 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
what are the medical features of DS
- congenital heart diseae
- alzheimers dementia
- epilepsy
- leukaemia
- hearing impairments
- diabetes mellitus
- coeliac disease
- thyroid disease
- intellectual impairment
what dental disease can be associated with DS
- oral hygiene
- oral function
- impaired migration of gingival fibroblasts
- saliva
- periodontal pathogens
- immune system related factors
- impaired neutrophil chemotaxis
what is cerebral palsy
- 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
what is Prader Willis
- 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
what are the berries to oral healthcare
- user/carer
- professional service providers
- physical barriers
- cultural issues
in what families is learning disability more common
- those of a lower socioeconomic status
what are the benefits of primary care access
- proximity,
- relationships may already be established
- family members may attend practice
what are some specialist services
- special care dentistry
- blend of services necessary
- risk of neglect of care if mainstreaming
- referral
- complex cases = SCD
- advice
how can we prepare for patient coming into surgery
- 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
when is best for patients to come to surgery
- start of a session
- don’t be late for them as can cause stress
what ar key points about verbal communication
- 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
what are some adjuncts to communication
- makaton
- picture boards
- letter boards
- talking mats
- draw
- write
how can you create the right atmosphere for the patient
- non-threatening environment
- friendly
- acclimatise
- consider augmentative techniques
what can help you get access to the mouth
- 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
what is clinical holding
- 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
what needs to be known about medical history
- a diagnosis?
- medical conditions = epilepsy, psychiatric conditions, congenital defect in other systems
- liaise with other colleagues
what needs to be known about social history
- living arrangement
- support
- transport
- likes/dislikes
what are risk factors for oral health for patients with learning disability
- poor motor control
- imbrication of teeth
- lack of cleansing
- pouching and limits food clearance
- mouth breathing - reduced saliva
- medications
- rewarding = less common now
how can treatment complexity be influenced
- by the severity of the learning disability
what prevention can be used
- toothpastes = need to be careful they won’t eat the toothpaste
- toothbrush advice
what is self-injurious behaviour
- self-biting or hands, arms, lips and tongue
what can self-injurious behaviour be linked to sometimes
- cerebral palsy
- autism
- tourettes
- leach-Nyan syndrome
- profound neuro-disability
- exaggerated or abnormal oral reflex, habit, pain and/or frustrations
what are some treatment strategies for SIB
- 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
how can drooling happen
- difficulty moving saliva to the back of the throat
- poor mouth closure
- jaw instability
- tongue thrusting
- increased saliva production is very rare
how can you treat bruxism/NCTSL
- 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
what is some advice for erosion
- 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
what can be done for dry mouth
- 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
what can be done for feeding problems
- 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
what can be given to alter diet
- thickeners and taster
what do thickeners do
- make food easier to swallow to prevent aspiration
what are some tasters
- honey, jam, chocolate
what needs to be considered if thinking about using LA
- ability to cooperate
- volume of treatment
- type of treatment
- behavioural techniques and patient management
what is good about conscious sedation
- reduces fear and anxiety, augmenting pain control
- more flexible than GA = less risk with it
- available in primary care
what is a problem about conscious sedation
- need for IV access
- need to maintain airway - keep breathing
- level of understanding is necessary
what are the pros of using GA
- comprehensive care
- potentially more controllable environment if medical diseaes
- opportunity for joint working
- aftercare and monitoring
what are the cons of using GA
- 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
what are the indications of using GA
- a clear inability to co-operate with the provision of dental care using other patient management techniques
what does GA require
- 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
what is the 3 fold role of dental practitioner
- 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
