Intro to SCD Flashcards
Special Care Dentistry
The speciality of Special Care Dentistry is concerned with the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. The specialty focuses on adolescents and adults only and includes the important period of transition as the adolescent moves into adulthood.
Formally recognised by GDC 2008
Not special needs
SCD groups
Learning difficulties
Physical disability
Mental health problems
- In unit, Effect OH
Homeless, refuges, asylum
Medical compromised
- Transplant, cancer, end of life care
Older people
Behavioural management techniques needed
age for SCD
adult speciality 16+
impairment
Any loss or abnormality of psychological, physiological, or anatomical structure or function.
Impairment is considered to occur at the level of organ or system function
Do not have
disability
Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
Disability is concerned with functional performance or activity, affecting the whole person.
Disability is activity restricted by impairment.
Different
- Due to impairment
Born with impairment – no arm
Live with disability – effect on life, unable to open door
handicap
A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.
Lose arm due to road traffic accident
- Previously able to open door but now not able
WHO stance on Disability
Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions.
Impairment is a problem in body function or structure
Activity limitation is a difficulty encountered by an individual in executing a task or action
Participation restriction is a problem experienced by an individual in involvement in life situations.
paradox of disability
Prove unable to participate in society – need evidence
- But want them to be able
Level of support directionally proportional to level of disability
- Determined by person in office who doesn’t experience of disability
complexity of disability
Complex
- Body level, system level
Not just health
- Inequalities – health, financial
Lower socioeconomic has increased level of disability
Need to remove environmental and social barriers to help target disability
how many consultant SCD Scotland
4
how to become consultant in SCD
Tri-collegiate Exit exam
however New undergraduate curriculum in Special Care Dentistry (raise knowledge)
SCD recognised
2008
professional SCD societies
The International Association for Disability and Oral Health (IADH)
The Academy of Dentistry for Persons with Disabilities (ADPD) Special Care in Dentistry
British Society for Disability and Oral Health (BSDH) Journal of Disability and Oral Health
prevalence of disability
Difficulty in gathering numbers of cases
- WHO: 10% worldwide population (very)
Developed countries report lower rates?
UK: 18% over age 16 years
UK: 5% serious disability
Prevalence increases with age
Locomotor disability most prevalent
Hidden disabilities
scottish disability stats
Nearly one in five people of working age (1 million, or 19%) in Scotland are disabled
- 18% men
= 19% women
45% over 75 years old
4% 16-24 age group
>800,000 people
> 800,000 people
disability and employment
Only about half of disabled people of working age are in work (50%), compared with 80% of non disabled people of working age
Almost half (45%) of the disabled population of working age in Britain are economically inactive i.e. outside of the labour force.
There are currently 1.2 million disabled people in the UK who are available for and want to work.
Employment rates vary greatly according to the type of impairment a person has.
Disabled people with mental health problems have the lowest employment rates of all impairment categories at only 21%. The employment rate for people with learning disabilities is 26%.
Disabled people are more than twice as likely as non-disabled people to have no qualifications (26% as opposed to 10%)
problems with disability stats
For example:
- 7% population estimated to have a visual impairment
- Only 0.6% population actually registered
Different definitions worldwide
‘Hidden’ disabilities
Surveys v Questionnaires
who deals in SCD
“The registrant will recognise and take account of the needs of different patient groups including children, adults, older people, and those with special care requirements throughout the patient care process.”
issues with disability and OH
Basic Tasks like brushing teeth unable to perform if
- Epidermolysis Bullosa
- Substance abuse
- Learning disability
- Dementia/ frailty
- End of life care
- Cancer therapy
barriers to care
Physical
Attitudinal
People Centred
Professional Centred
characteristics of service use for special care
Fewer visits, longer intervals between
Limited access to buildings
Difficulty communicating pain
Financial
Emergency care rather than planned
History of extractions
Treatment with GA
SCD and clinical medical science
Not enough to have knowledge of disease
Must know how that disease pertains to dental health & treatment
- What treatment is most appropriate?
- Who is most appropriate person to deliver care?
- Where is the best place to provide treatment?
why dentists need to know SCD
The Human Rights Act 2000
(DDA 2005)
The Equality Act 2010
The Adults with Incapacity Act (Scotland)
The Mental Capacity Act (England & Wales)
NHS terms of service
GDC
SCD needs
Excellent Communication Skills
Empathy
Experience
Pragmatic
Patience
Decisive
Interest in Medicine & Medical Problems
Excellence in the most challenging conditions
physical disability e.g
Spina Bifida
- access, allergies
Cerebral palsy
Arthritis
Spinal injury pt
intellectual impairment e.g
Down Syndrome
- multiple presentations
Fragile X syndrome
Autism spectrum disorder
mental disability e.g.
schizophrenia
dementia
alzheimers
sensory disability e.g.
visually impaired
hearing impaired
emotional disability e.g.
Anxiety States
Depression
Bipolar Affective Disorder
Personality Disorders
Eating Disorders
social disability e.g.
Illegal Drug use
Alcohol abuse
Homelessness
Obesity
Poverty
effect of SCD on oral cavity
Late presentation and severe levels of disease
Caries Periodontal disease Tooth wear Xerostomia – polypharmacy Infections – fungal, bacterial, viral – compromise health, beyond just teeth (soft tissues etc) Mucosal disease Malignancy – oral cancer Infected osteoradionecrosis – head and neck cancer, tumour removed, radiotherapy, which dissolved blood vessel in bone, bone infected – may need to lose jaw
struggle with where to begin
biphosphonates
Metastatic cancer and myeloma
- Prevent osteolytic lesions
- Reduce bone pain
- Regulate serum calcium
Osteoporosis
- Reversal and prevention Issue date: Reversal and prevention
- with calcium/vit D supplementation
- Paget’s disease
Know about Medicine important and interaction
long period of biphosphonate or steroid use
osteonecrosis of joint – areas of bone do not heal after extraction
Prevention
- Make dental decisions before commencing drug
infected osteoradionecrosis
head and neck cancer, tumour removed, radiotherapy, which dissolved blood vessel in bone, bone infected – may need to lose jaw
who provides SCD
General Dental Practitioners Public Dental Service Hospital Dentists Specialists in SCD Shared Care
Full range of NHS Dental Treatment +/- other as appropriate
Must be appropriate & tailored to each patient
considerations for SCD Tx
Patient Medical History
Patient Previous Dental History
Patient Social History
Clinical Holding
Treatment will fail if not maintained
Holistic approach essential
Multi-Disciplinary Team Care
where is SCD carried out
Dental Practice
Community Dental Surgery / Public Dental Service
Hospital - MAINLY
Own homes/care homes/hospice not safe to extract – clutter
Oral health importance
enables a person to eat, speak and socialise without active disease, discomfort and embarrassment.
Quality oral healthcare contributes to holistic health.
Oral Health Strategy Group, Department of Health, 1994
It should be a RIGHT and NOT a privilege.
