Learning Disability Flashcards
what is the oral disease experience like for people with learning disability
more extracted teeth
fewer dentures provided
what impacts on the oral health of a learning disabled person
multiple medications - dry mouth and tooth decay
physical impairment making it hard to clean teeth
oral health issues overlooked in social care planning
what makes it easer to ACCESS the dental care setting
ground floor access
suitable car parking
elevators
hand rails
wide corridors
disabled toilets
what makes it easier to ACCESS the mouth
bedi shield
open wide mouth rests
toothbrush
mirror
good light
head support
what is clinical holding
where you need to physically hold to assist or support a patient to receive clinical dental care or treatment in situations where behaviour may limit ability of dental team to deliver treatment
what does assessment of learning disability depend on
level of understanding
communication
physical and emotional access
co-operation
medical status
social status
dental status
if a patient has pain but is not able to communicate this, what signs might they give
sleep interruption
changes in behaviour
rubbing of an area
pulling at an area
what do we want to know about the dental status of a learning disabled person
cooperation
preventative regime
level of support
diet and method of delivery
swallowing and thickeners if appropriate
previous delivery of dental treatment
how does someone demonstrate they have capacity
act (seeking treatment)
make decision regarding treatment
communicate the decision of treatment
understand what the treatment is
retain the memory of the treatment choice
what are the 5 principles of the AWI act
must benefit the patient
be least restrictive option
takes into account the wishes of the person
consult with relevant others
encourage person to use existing skills and develop new ones
what is the biopsychosocial model made of
biological factors
psychological factors
social factors
what are the 5 main active barriers to dental care for older people
cost
fear
accessibility
availability
characteristics of dentist
what are the barriers to dental care for disabled people
cannot tolerate treatment
lack of knowledge of ways to access oral care
communication barriers
information formats
knowledge that their carer has of oral health
what are the barriers to dental care for people who struggle with mental illness
feeling of shame/guilt
confusion and lack of recall of conversation
feel that public services are inadequate
lack of staff time
general dentists not willing to treat these patients
what is oral health literacy
the degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions
what are the barriers to communicating with your patient who may not be able to speak/hear
limited time
financial incentives promoting treatment over prevention
lack of OHL training
limited plain language patient education materials
patients with low OHL knowledge
what are the barriers to dental care for learning disabled people
lack of consent
complicating medical histories
inability to cooperate with treatment
inability to communicate dental pain
general dentists not willing to treat
shortage of specially trained or experienced dental professionals
what helps to facilitate oral health care
need for education and training
financial support
dentist chairside manner
community support
interprofessional communication
what are the non-pharmacological behavioural management techniques in practice
acclimatisation
tell, show, doe
relaxation
structured time
multiple short appointments in staged approach
when do you refer for GA
pain and swelling where no alternatives
obvious dental disease when no alternative treatment modality
when is GA used for adults
intellectual impairment
multiple disabilities
dental anxiety/phobia
medical reasons
behavioural
if a person comes in with reversible pulpitis and needs a GA, what can you do in the meantime
try to temporise
if a person comes in with irreversible pulpitis and needs a GA what can you try to do in the meantime
gain enough access for sedative dressing
if someone needs a GA for a periapical infection what can you do in the meantime
prescribe antibiotics
how can dehydration and xerostomia become and issue in patients with dysphagia
oxygen therapy
mouth breathing
side effects of medications
reduced food and fluid intake
what oral care options can we use for dysphagia
sit patient up
suction toothbrushes
hand over hand technique
regular dry mouth care
adapt toothbrush handle
what is the 2 toothbrush technique
thick handled rubber toothbrush is used as a prop between the jaws to open them up while you brush with another toothbrush
what adjuncts to communication can we use
makaton
picture boards
letter boards
wrist bands
talking mats
draw or write
technology
how do we empower patients
maximise skills and abilities
prompt
encourage
support
what behavioural strategies for toothbrushing aid can be used
bridging
chaining
hand over hand
distraction
rescuing
what is bridging
describe and show toothbrush and mimic brushing your own teeth and then they should mirror this back
what is chaining
bring persons hand to mouth while describing activity
carer starts brushing and patient finishes it
what is hand over hand
place hand over patients hand and brush their teeth together
what is distraction
place an item in their hand while you brush their teeth
what is rescuing
carer can leave and rescuer comes in to take over
how do you manage when someone bites the toothbrush
keep them biting and use another brush to clean round it
how do you manage when someone is a tongue thruster when toothbrushinig
use gauze square wrapped around finger to retract or hold back tongue
why might people resist toothbrushing
bleeding gums
pain from dental source
pain/stress from brushing
how do you develop a routine for toothbrushing
reinforce behaviour
come up with a trigger (time of day/environment)
facilitate behavioural change
what facilitates behavioural change
supportive environment
stable environments
piggyback onto already positive experience
make small and easy
unique personalised cues
practice and repeat
