learning disability

Question 1

What is the biopsychosocial model?

Answer 1

The fact that illness and health are the result of an interaction between biological, psychological and social factors

Question 2

Give 4 examples of user barriers in those with learning disabilities

Answer 2

Physical, mental and cognitive ability to carry out effective OH
Communication
Fear and anxiety
Require support for appointments

Question 3

Give 2 examples of professional service barriers for those with learning disabilities?

Answer 3

Dentist lack of experience
Financial constraints

Question 4

Name 3 physical barriers for those with learning disabilities

Answer 4

Cost
Travelling distance for specialist services
Access

Question 5

Name 3 cultural barriers for those with learning disabilities?

Answer 5

Minority groups subject to the same barriers but exacerbated due to ethnicity
Language
Gender sensitivities

Question 6

What is the typical clinical presentation of someone with a mild learning disability?

Answer 6

More likely to have filled teeth
Fewer extractions
More untreated active decay
Fewer dentures provided

Question 7

Name 6 things that can impact access to the dental setting

Answer 7

Ground floor access
Suitable car parking
Elevators
Hand rails
Wide corridors
Disabled toilets

Question 8

Name 6 aids that can assist access to the mouth

Answer 8

Bedi shield
Open wide mouth rests
Toothbrush
Mirror - plastic, not glass in case it shatters
Good light
Head support - ask consent to do this

Question 9

What is clinical holding?

Answer 9

The use of physical holds to assist or support a patient to receive dental care or treatment where their behaviour may limit effective treatment or pose a safety risk

Question 10

What can a learning disability depend on

Answer 10

Level of understanding
Communication
Physical and emotional access
Cooperation
Medical status
Social status
Dental status

Question 11

Name 4 signs of pain commonly used by people with learning disabilities

Answer 11

Sleep interuption
Changes in behaviour rubbing of an area
Pulling at an area
Rubbing at an area

Question 12

Name 4 other syndromes commonly associated with intellectual impairments

Answer 12

Down syndrome
Williams syndrome
Cerebral palsy
Fragile X

Question 13

What are the 5 principles of the adults with incapacity (Scotland) act 2000?

Answer 13

Benefit
Least restrictive option
Take account of the wishes of the person
Consultation with relevant others
Encourage the person to use existing skills and develop new skills

Question 14

Name 5 augmentative communication aids

Answer 14

Social stories
Talking mats
Makaton
Technology
Draw or write

Question 15

Name 3 causes of drooling

Answer 15

Cerebral palsy
Parkinson’s disease
Motor neurone disease

Question 16

What are the implications of dysphagia?

Answer 16

Can affect stroke patients ability to maintain OH effectively
Can lead to dehydration and xerostomia
Risk of aspiration

Question 17

What are the different grades of textured diets?

Answer 17

B is a thin purée
C is a thick purée
D is pre-mashed
E is fork mashable

Question 18

How should oral care be undertaken in patients with dysphagia?

Answer 18

If possible sit patient in upright or semi upright position for toothbrushing
Regular dry mouth care
Mouth guard or finger prop may be useful
Consider adaptations to toothbrush handle

Question 19

Give an example of an unflavoured toothpaste

Answer 19

Oranurse

Question 20

Describe the two toothbrush technique

Answer 20

Thick handled rubber toothbrush used between the occlusion as a prop
2 person approach - 1 to support brushing and 1 to support the individual

Question 21

What is open wide?

Answer 21

A training resource and manual for the delivery of oral care to people with additional care needs
Consists of 3 units:
1. Core oral health knowledge
2. Practical oral care
3. Oral health documentation

Question 22

Name 5 behavioural strategies

Answer 22

Bridging
Chaining
Hand over hand
Distraction
Rescuing

Question 23

Name 4 sensory aids

Answer 23

Power suit
Counting
Warm water
Stories or books

Question 24

What denture hygiene advice should always be given?

Answer 24

Must be removed from mouth
Rinse after every meal
Clean morning and night using a toothbrush and plain soap and water
Clean over a basin to avoid breakage
Soak in disinfecting solution for at least 20 minutes once a day
Soak overnight in plain water

Question 25

What is positive reinforcement?

Answer 25

An increase in the rate of behaviour as a result of the presentation of a preferred event or stimulus

Question 26

What is negative reinforcement?

Answer 26

An increase in the rate of a behaviour as a result of the withdrawal or prevention of occurrence of a non-preferred stimulus or event

Question 27

Give 5 examples of behavioural management techniques

Answer 27

Acclimatisation
Tell, show, do
Relaxation
Structured time
Multiple short appointments in staged approach

Question 28

When is GA the best treatment option?

Answer 28

If significant volume of treatment
If patient is uncooperative
If significant medical complexity

Question 29

When should you refer someone with a learning disability for GA?

Answer 29

Pain and swelling where no alternatives exist but must be managed acutely
If obvious dental disease where no alternative modality is possible to facilitate care
If a number of years since a reasonable examination in the presence of poor oral hygiene and suspicions of disease

Question 30

How should different dental emergencies be treated in people with learning disabilities?

Answer 30

Reversible pulpitis - can gain enough access for ART or temporisation
Irreversible pulpitis - can gain enough access for sedative dressing, antibiotics not effective for pulpal inflammation
Periapical infection - antibiotics and plan for the future - sedation or GA

Question 31

What is shared care and who is most likely to use it?

Answer 31

Those with moderate and severe impairments and disabilities - may require more care by specialist services