Intellectual Impairment (c)

Question 1

Intellectual disability involves problems with general mental abilities that affect functioning in which 2 areas?

Answer 1

intellectual disability involves problems with general mental abilities that affect functioning in 2 areas:

• intellectual functioning
  
  • learning, problem solving, judgement
• adaptive functioning
  
  • activities of daily life such as communication and independent living

Question 2

Who is more likely to be diagnosed with an intellectual disability - males or females?

Answer 2

males are more likely to be diagnosed with an intellectual disability than females

Question 3

What learning disability labels are appropriate to use?

Answer 3

appropriate learning disability labels:

• person with an intellectual impairment
• person with a learning difficulty
• person with a learning disability
• person with additional care needs
• person with additional support needs
• person who requires special care

Question 4

What is a problem in body function or structure known as?

Answer 4

an impairment is a problem in body function or structure

Question 5

What is activity limitation?

Answer 5

activity limitation is a difficulty encountered by an individual in executing a task or action

Question 6

What is participation restriction?

Answer 6

participation restriction is a problem experienced by an individual in involvement in life situations

Question 7

What is the social model of disability?

Answer 7

the social model of disability is the theory that disability is caused by the way that society is organised, rather than by a person’s impairment or difference

Question 8

The X model of disability is the thinking that disability is caused by the way that society is organised, rather than by a person’s disability or difference

Answer 8

X - social

Question 9

What is the medical model of disability?

Answer 9

the medical model of disability is the thinking that people, are disabled by their medical impairments or differences

Question 10

What are barriers to a social model of disability?

Answer 10

barriers to a social model of disability:

• segregated social provision
• inflexible organisational procedures and practices
• inaccessible information
• inaccessible buildings
• inaccessible transport
• negative cultural representations

Question 11

Whta are causes of learning disability?

Answer 11

causes of learning disability:

• pre-conception
  
  • hereditary - parental genotype
  • environmental - maternal health
• pre-natal
  
  • hereditary - chromosomal, genetic
  • environmental - infection, maternal health, nutrition, toxic agents
• peri-natal
  
  • environmental - prematurity, injury
• post-natal
  
  • hereditary - untreated genetic disorders (PKU)
  • environmental - infection, trauma, toxic agents, nutrition, sensory social deprivation

Question 12

What are examples of syndromes associated with learning disability?

Answer 12

syndromes associated with learning disability:

• autistic spectrum disorders
• Down’s Syndrome
• cerebral palsy
• fragile X syndrome
• prader willi
• PKU

Question 13

Down’s Syndrome is a neurodevelopmental disorder of genetic origin affecting chromosome X

Answer 13

X - 21

Question 14

What is the single greatest risk factor for Down’s Syndrome?

Answer 14

the single greatest risk factor for Down’s Syndrome is advanced maternal age

Question 15

Women over the age of X are more likely to have a child with Down’s Syndrome and this risk continues with advancing age

Answer 15

X - 35

Question 16

Prader Willi is a condition affecting which chromosome?

Answer 16

Prader Willi is a syndrome affecting chromosome 15

Question 17

What is there a constant desire to do in people with Prader Willi?

Answer 17

with Prader Willi, there is a constant desire to eat food

Question 18

With Prader Willi, there is X growth

Answer 18

X - restricted

Question 19

With Prader Willi, what can be said about muscle tone?

Answer 19

with Prader Willi, there is reduced muscle tone (hypotonia)

Question 20

With Prader Willi, there is a lack of X development

Answer 20

X - sexual

Question 21

With Prader Willi, what are common behavioural problems?

Answer 21

with Prader Willi, there are behavioural problems such as temper tantrums or stubborness

Question 22

What medical condition is being described?:

• neurological condition affecting movement and coordination
• muscle stiffness or floppiness (hypotonia)
• muscle weakness
• random and uncontrolled body movements
• balance and coordination problems

Answer 22

cerebral palsy:

• neurological condition affecting movement and coordination
• muscle stiffness of floppiness (hypotonia)
• muscle weakness
• random and uncontorlled body problems
• balance and coordination problems

Question 23

Learning disability is more common in families of X socioeconomic status

Answer 23

X - lower

Question 24

What are the benefits of people with intellectual impairment accessing primary care services?

Answer 24

benefits of people with intellectual impairment accessing primary care services:

• proximity usually good for transport
• relationships may already have been established
• family members may already attend the practice
• longitudinal care - prevention and floow up
• equal opportunity to services

Question 25

What are steps to take to geting people with an intellectual impairment to your surgery?

Answer 25

getting a person with an intellectual impairment into the surgery:

• preparation
• social stories (autism)
• hospital/health passport
• pre-visit to scout the place out is a good idea
• multiple visits with slow progress
• liaise with community disability nurse/team for help

Question 26

When a patient with intellectual impairment is attending for an appointment, you should limit their time spent in the X

Answer 26

X - waiting room

Question 27

What are adjuncts to communication?

Answer 27

adjuncts to communication:

• Makaton
• picture boards
• letter boards
• talking mats
• drawing
• writing

Question 28

What is the right environment when treating patients with intellectual impairment?

Answer 28

creating the right environment with patients with intellectual impairment:

• non-threatening environment
• friendly
• acclimitise them to the environment with multiple visits
• consider augmentive techniques such as relaxation and music
• the environment can be fun - singing, laughing

Question 29

What things should be kept in mind during the patient’s first visit?

Answer 29

the patient’s first visit:

• find out what you can prior to the first visit
• keep it simple
• don’t expect too much
• build trust and relationships
• sometimes managing to see inside the mouth is an achievement

Question 30

What adjuncts can be used in the examination?

Answer 30

examination adjuncts:

• bedi shield
• open wide mouth rests
• head support

Question 31

When can clinical holding take place?

Answer 31

clinical holding should only take place if:

• the patient consents
• there is no capacity and it is deemed of benefit - the patient may present a safety risk to them self or others
• unplanned emergencies, where a patient presents a significant risk

Question 32

What should you obtain from the patient’s social history?

Answer 32

social history:

• living arrangements
• support
• transport
• likes and dislikes

Question 33

What may the complexity of treatment provided be influenced by in patients with intellectula impairment?

Answer 33

the complexity of treatment provided may be influenced by the severity of the learning disability

Question 34

What are risk factors for oral disease in patients with intellectual impairment?

Answer 34

risk factors:

• poor motor control
• imbrication of teeth
• lack of cleansing
• pouching and limited food clearance
• mouth breathing → reduced saliva
• medications
• rewarding - less common

Question 35

What toothbrushing advice can be given for patients with intellectual impairment?

Answer 35

toothbrushing advice - patients with intellectual impairment:

• pick a good time of day/night, when the patient is relaxed
• wear gloves
• stand behind the patient, slightly to one side of them
• may vary according to what is comfortable for the patient and carer
• adapted toothbrush may be useful
• keep brushing systematic
• encourage the person to do as much as possible

Question 36

What is self-injurious behaviour?

Answer 36

self-injurious behaviour is self biting of hands, arms, lips and tongue

Question 37

What are treatment strategies for self injurious behaviour?

Answer 37

treatment strategies for self injurious behaviour:

• symptomatic relief
• reassurance for patients, parents and carers with monitoring of the situation
• distraction when this behaviour is observed
• pharmacological treatment (haloperidol, diazepam, carbamazepine)
• behavioural psychology such as positive reinforcement
• construction of oral appliances
• extraction of specific anterior teeth (although this may transfer the self-injurious behaviour to another area of the mouth rather than resolve the behaviour)
• orthognathic (jaw) surgery to create an open bite and prevent self injurious biting

Question 38

Construction of X in bruxism/NCTSL may be helpful

Answer 38

X - splints

Question 39

What is appropriate erosion advice to give these patients?

Answer 39

erosio advice:

• fluoride mouthwash unless there are swallowing difficulties
• toothpaste which is low in abrasion, low acidity, high fluoride and anti-hypersensitivity
• brushing should be delayed for at least one hour after consuming acidic foods or drinks
• 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 these as part of meal times
• chew sugar-free gum, suck a sugar-free lozenge or eat cheese after an acidic meal

Question 40

What adjuncts can be helpful and advised in patients with dry mouths?

Answer 40

dry mouth:

• saliva replacements
• sugar-free chewing gum/fluids
• fluoride rinses or high fluoride containing toothpastes

Question 41

A low X toothpaste is recommended in patients with feeding problems

Answer 41

X - foaming

Question 42

What are the aims of conscious sedation?

Answer 42

aims of conscious sedation:

• reducing fear and anxiety
• augmenting pain control
• minimising movement
• incraesing safety

Question 43

What is more flexible, GA or conscious sedation?

Answer 43

conscious sedation is more flexible than GA

Question 44

What kind of access is needed in conscious sedation?

Answer 44

IV access is needed in conscious sedation

Question 45

What are the indications for GA?

Answer 45

indications for GA:

• clear inability to co-operate with the provision of dental care using other patient management techniques including sedation
• contraindications to the use of sedation

Question 46

What are positives for general anaesthesia?

Answer 46

positives for general anaesthesia:

• comprehensive care
• potentially more controllable environment if there are medical diseases
• opportunity for joint working
• aftercare and monitoring - inpatient

Question 47

What are negatives to general anaesthesia?

Answer 47

negatives to general anaesthesia:

• risk of death or brian damage
• need support for at leats 24 hours post-op
• organisation of procedure
• complex restorative dental treatment is not possible
• teeth of dubious prognosis are removed to reduce the risk of future GAs being scheduled
• difficult working environment
• no improvement in coping mechanisms

Question 48

The role of the dental practitioner in adult protection is three-fold - what are the 3 Rs to represent this?

Answer 48

the role of the dental practitioner in adult protection is three-fold:

• recognise - being able to identify an adult at risk
• respond - manage the acute situation and informt other services as required
• record - document and report in detail the information obtained and the actions taken