Learning disabilities - Autism/Down syndrome Flashcards
what is Autism
-what can it affect
-lifelong developmental disability
-social imagination/language/creative & abstract thinking
How can Autism affect a person’s communication
-literal interpratation of language
-not understand reason for interaction
-diffculty understanding non-verbal comm
How can Autism affect a person’s social interaction & social imagination
-withdrawn/isolated
-difficulty relating to people
-socially awkward/naive
-difficulty maintaining friendships
-difficulty understanding other’s thoughts/feelings
-difficulty understanding future/concept of danger
-difficulty in new environmant or out of routine
Autism - how can this affect sensory information: Hyper-sensitivity
-bright/fluorescent lights
-loud noises
-smell/taste
-painful stimulus
-over-reaction to hot/cold
-extreme reaction to touch
Autism - how can this affect sensory information: Hypo-sensitivity
-accidently harming self
-not feel pain/temperature
-seeks deep pressure: under blanket
-not hear certain sounds
Prevention of oral disease in those with Autism
Dietary advice
Oral hygiene instruction
Timing
Method
Unflavoured Toothpaste (Oranurse)
Extra fluoride if high caries rate or if
providing treatment is likely to be
difficult
Twice yearly fluoride varnish
Daily fluoride mouthwash (0.05% fluoride)
2800/5000ppm Fluoride toothpaste
How to make a dental visit easier for those with autism: Environmental
Environment
Find out about your patient – particularly sensitivity
issues
Turn off radio?
Think about lighting
Quiet surgery with no interruptions
Use of distractors e.g. stress ball
Wait in the car until ready?
Home visit?
How to make a dental visit easier for those with autism: Communication
Communication
Use of written information/pictures/symbols
Use clear, simple language
Avoid idioms, irony, metaphors and words with double
meaning e.g. “take a seat”
Use direct request - “sit in this chair”
Avoid ‘chit-chat’ – “how are you today”
Structure time – “I’m going to use this mirror to look in
your mouth while I count to 10”
Adjuncts for communication
Makaton
Picture Boards
Letter Boards
Talking Mats
Draw
Write
Name conditions in which self-injurious behaviour (SIB) is common
-cerebal palsy
-autism
-tourettes
-profound neuro-disability
-exaggerated/abnormal oral reflex/habit/pain/frustration
Treatment strategies order for SIB (self injurious behaviour)
- 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
- Orthognathic (jaw) surgery to create an open bite and prevent self
injurious biting,
Erosion advice
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 at 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 afteran acidic meal
Down Syndrome - oral features
-hypodontia/microdontia: peg laterals
-delayed eruption
-maxillary hypoplasia
-anterior open bite/post crossbite
-class III occlusion
-macroglossia-protrusive fissured tongue
-pre-disposition to perio disease
-bifid uvula
-CLP common
Down Syndrome - medical features
-CHD: ASD, VSD, AV canal
-Duodenal atresia
-ATLANTOAXIAL INSTABILITY
-immunological defects: skin/GIT/resp tract
-ALL more common
-> risk of hypothyroidism & alzheimers
Treatment of children with Down syndrome
-Prevention: OH - modified tb
-treat under LA if co-op
-CHX gel/mw for perio disease
