Intellectual Impairment and Dentistry Flashcards
1
Q
Dental services should be provided in a way that…? (3)
A
- Recognises everyone as an individual
- Recognises that everyone has a right to participate in decisions that affect their lives
- Provides the amount of support necessary to enable everyday living, including adequate health care
2
Q
What are the barriers to oral health that someone with a learning disability might face? (4)
A
- User/carer
- Professional service providers
- Physical barriers
- Cultural issues
3
Q
What are the benefits for primary care access for people with an intellectual impairment? (6)
A
- Learning disability is more common in families of a lower SES
- Proximity - financial, work, transport for person +/- carer
- Relationships may already be established
- Family members may attend practice
- Longitudonal care - prevention and follow up
- Equal opportunities to services
4
Q
What can make going to a dental surgery for treatment easier for a person with an intellectual impairment?(6)
A
- Preparation
- Social stories (autism)
- Hospital/health passport
- Pre-visit (scout the place out)
- Multiple visits with slow progress
- Liase with community disability nurse/team for help
5
Q
On arrival, what can make it easier for a patient with an ontellectual impairment? (3)
A
Timing of appointment for you ans the patient
- Start of session - not running late
- Give yourself time
- Best time of day for the patient (missing activity/routine/best mood/medications)
- Take patient straight into the surgery
- Limit time spent in the waiting room
6
Q
How would we use verbal communication when communicating with someone with an intellectual impairment?
A
- Speak naturally and clealry
- Ask to repeat the information of you don’t understand
- Ask questions that can be answered yes or no if possible
- Don’t lead patient responses
- Allow enough time to communicate with your patient as they may speak more slowly
- Don’t interrupt or finish your patient’s sentences - wait for them to finish
- Repeat the question if they don’t understand
7
Q
What adjuncts to communication can we use with a person with an intellectual impairment? (6)
A
- Makaton
- Picture boards
- Letter boards
- Talking mats
- Draw
- Write
8
Q
We want to create the right atmosphere for a patient with an intellectual impairment. How would we do this? (6)
A
- Non threatening environment
- Friendly
- Acclimatise - multiple visits
- Consider augmentive techniques - relaxation/music
- Can be fun, singing + laughing
- Nut don’t lookse control
9
Q
On examination of a person with an intellectual impairment we want to gain access to the mouth. How might we do this? (6)
A
- Bedi shield
- Open wide mouth rests
- Toothbrush
- Mirror
- Good light
- Head support - ask consent
10
Q
What is a bedi sheild?
A
- It is made of plastic and you put it on your finger and you have to get the person open - you then stick it in between their occlusion and the person will rest or bite down on that piece of plastic
- These have been known to fracture inside the mouth
11
Q
What is clinical holding and when should it take place?
A
- IT is where you help to support the person if they are unable to co-operate
Should only take place:
- If patient consents
- If no capacity is deemed of benefit - patient may present a safety risk to them and others
- Unplanned emergencies, where any patient presents a significant risk
- Always record in the notes and justify
- Has to be of benefit and in the patients best interest
- It is a form of restraint and needs to be scrutinised fully
12
Q
What do we want to find out in the medical history of someone with an intellectual impairment? (4)
A
Medical conditions:
- Epilepsy
- Psychiatric conditions
- Congenital defects in other systems - down’s syndome and congenital heart defect
- Liase with colleagues
13
Q
What do we want to find our in the social history of someone with an intellectual impairment? (4)
A
- Living arrangements
- Support
- Transport
- Likes/dislikes
14
Q
What do we need to do in terms of capacity for someone with an intellectual impairment? (6)
A
- Assess
- Principles
- What can they understand and comprehend
- What about retention
- Each decision is specific
- POA, Welfare guardian or nearest relative
15
Q
What do we need to do in terms of treatment planning for a person with an intellectual impairment? (6)
A
- Individual
- Co-operation
- Holistic
- Oral health -risk factors
- The complexity of treatment provided may be influenced by the severity of the learning disability
- Realistic
16
Q
What are dental risk factors that may be associated with intelectual impairment? (7)
A
- Poor motor control
- Imbrication of teeth
- Lack of cleansing
- Pouching and limited food clearance
- Mouth breathing -> reduced saliva
- Medications
- Rewarding - less common (- Used to be if someone with an intellectual impairment did something good they would be rewarded with something sweet - this make caries rates go through the roof)
17
Q
What us pouching?
A
- Pouching is where people will knowingly or unknowingly leave food in the buccal sulcus and that food will sit there for hours and that leaves substrate for bacteria
18
Q
What toothbrushing advice would we give to a person with an intellectual impairment? (8)
A
- Explain first
- Good time of day/night - relaxed
- Carer should wear gloves
- Stand behind the person, slightly to one side
- May vary according to what is more comfortable for the client and carer
- Adapted toothbrush?
- Keep brushing systematic
- Encourage the person to do as much as possible
19
Q
Self biting of hands, arms, lips and tongue can be linked to a lot of conditions. Give examples of these? (6)
A
- Cerebral pasly
- Autism
- Tourettes
- Lesch-Nyan syndrome
- Profound neuro-disability
- Exaggerated or abnormal oral reflex, habit, pain and/or frustration
20
Q
What are treatment strategies for people who may be likely to show self-injurious behaviour? (8)
A
- Symptomatic relief
- Reassurance for patients, parents and carers with monitoring of the situation
- Distraction when SIB is observed
- Pharmacological treatment e.g. Haloperidol, Diazepam and Carbamazepine
- Behavioural psychology such as positive reinforcement
- Construction of oral appliances
- Extraction of specific anterior teeth, although this may transfer the SIB to another area of the mouth rather than resolve the behaviour
- Orthognathuc (jaw surgery) to create an open bite and prevent self-injurous behaviour
21
Q
What things can increase a persons risk of drooling? (5)
A
- Abnormalities in swallowing - rather than to absence of swallowing
- Difficulties moving saliva to the back of the throat
- Poor mouth closure
- Jaw instability
- Tongue thrusting
22
Q
How might we treat drooling? (4)
A
- A multidisciplinary team should make an individual assessment
- Techniques designed to improve posture should be implemented
- Treatment should be started with non-pharmological and non-surgical methods
- There should be careful monitoring for oral complications if surgical or pharmalogical treatment is carried out
23
Q
How might we treat bruxism?
A
- Construction of plints may be helpful but their success is dependent on patient compliance
- An opinion should be sought from an appropriate dental specialist if required
24
Q
Hoe can erosion be caused? (4)
A
- Grinding
- Reflux
- Medications
- Drinks
25
If someone has erodion, what advice would you give them? (8)
- Fluoride mouthwashes unless there are swallowing difficulties
- Toothpaste which is low in abrasion, low acidity, high-fluoride and anti-hypersensitivity
- Brushing should be delayed for agt least one hour after consuming acidic food or drink
- Professional application of fluoride varnish is advised
- Dentine bonding agents may be of value
- Referral to an appropriate dental specialist may be advised
- Reduce or eliminate intake of carbonated and acidic drinks and acidic fruits, or include as part of regular meal times
- Chew sugar-free gum, suck a sugar free lozenge or eat cheese after an acidic meal
26
What advice would we give a patient with a dry mouth? (5)
- Saliva replacement may be helpful
- The use of sugar-free chewing gum and sugar-free fluids is advised
- The mouth should be examined regularly
- Fluoride rinses or high fluoride containing toothpastes are advised
- referral to an appropriate dental specialist may be required
27
What advice would we give a patient with feeding problems? (7)
- Individual assessment should be carried out
- Good oral hygiene should be promoted
- An intensive regime should be followed to prevent oral disease
- A mulit professional approach is advised
- A low foaming toothpate is recommended
- The use of a suction toothbrush can be of benefit
- Therapy should be carried out to try to reduce oral defensiveness
28
When treating someone with an intellectual impairment and wanting to use LA what do we need to consider? (4)
- Their ability to co-operate
- The volume of treatment
- The type of treatment - is it realistic
- Behavioural techniques and patient management
29
What are the aims of sedation?
The aims of sedation include reducing fear and anxiety, augmenting pain control, minimising movement and increasing safety
30
In order to carry out conscious sedation, an experienced practitioner, equipment and facilities are required. Why is this? (6)
- More flexible than GA
- Available in primary care/PDS
- Need for IV access
- Need to maintain airway - keep breathing
- Level of understanding necessary
- Medical status
31
When is GA indicated?
- When there is a clear inability to co-operate with the provision of dental care - using other patient management techniques including sedation (or contraindications to the use of sedation)
32
What does GA require? (6)
- Systematic assessment - full history and consent
- Ideally seen by the dentist who will perform the 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
33
What are the pros of GA? (4)
- Comprehensive care
- Potentially more controllable environement if medical diseases
- Opportunity for joint working
- Aftercare and monitoring - inpatient
34
What are the cons of GA? (7)
- Risk - death, brain damage
- Need support for at least 24 hours post op
- Organisation of procedure
- Complex restorative dental treatment not possible
- Teeth of dubious prognosis removed - reduce risk of future GA
- Difficult working environment
- No improvement in coping mechanisms - GA pattern/dependent
35
Safeguarding involves a spectrum of measures with the purposes of what? (2)
- Preventing harm and promoting welfare
| - Protecting individuals from harm
36
What is the role of the dental practitioner in adult protection? (3)
- Recognise - being able to identify an adult at risk
- Respond - Manage the acute situation and inform other services as required
- Record - document and report in detail the information obtained, and the actions taken
37
If concerns over adult protection arise or a disclosure is made ot the practitioner what is the initial management? (4)
- Remain calm and reassure the individual
- Seek further information - obtaining who, what, when, where and why
- Record the information given
- Inform person of your next actions
