learning disability Flashcards
What is the biopsychosocial model?
The fact that illness and health are the result of an interaction between biological, psychological and social factors
Give 4 examples of user barriers in those with learning disabilities
Physical, mental and cognitive ability to carry out effective OH
Communication
Fear and anxiety
Require support for appointments
Give 2 examples of professional service barriers for those with learning disabilities?
Dentist lack of experience
Financial constraints
Name 3 physical barriers for those with learning disabilities
Cost
Travelling distance for specialist services
Access
Name 3 cultural barriers for those with learning disabilities?
Minority groups subject to the same barriers but exacerbated due to ethnicity
Language
Gender sensitivities
What is the typical clinical presentation of someone with a mild learning disability?
More likely to have filled teeth
Fewer extractions
More untreated active decay
Fewer dentures provided
Name 6 things that can impact access to the dental setting
Ground floor access
Suitable car parking
Elevators
Hand rails
Wide corridors
Disabled toilets
Name 6 aids that can assist access to the mouth
Bedi shield
Open wide mouth rests
Toothbrush
Mirror - plastic, not glass in case it shatters
Good light
Head support - ask consent to do this
What is clinical holding?
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
What can a learning disability depend on
Level of understanding
Communication
Physical and emotional access
Cooperation
Medical status
Social status
Dental status
Name 4 signs of pain commonly used by people with learning disabilities
Sleep interuption
Changes in behaviour rubbing of an area
Pulling at an area
Rubbing at an area
Name 4 other syndromes commonly associated with intellectual impairments
Down syndrome
Williams syndrome
Cerebral palsy
Fragile X
What are the 5 principles of the adults with incapacity (Scotland) act 2000?
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
Name 5 augmentative communication aids
Social stories
Talking mats
Makaton
Technology
Draw or write
Name 3 causes of drooling
Cerebral palsy
Parkinson’s disease
Motor neurone disease
What are the implications of dysphagia?
Can affect stroke patients ability to maintain OH effectively
Can lead to dehydration and xerostomia
Risk of aspiration
What are the different grades of textured diets?
B is a thin purée
C is a thick purée
D is pre-mashed
E is fork mashable
How should oral care be undertaken in patients with dysphagia?
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
Give an example of an unflavoured toothpaste
Oranurse
Describe the two toothbrush technique
Thick handled rubber toothbrush used between the occlusion as a prop
2 person approach - 1 to support brushing and 1 to support the individual
What is open wide?
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
Name 5 behavioural strategies
Bridging
Chaining
Hand over hand
Distraction
Rescuing
Name 4 sensory aids
Power suit
Counting
Warm water
Stories or books
What denture hygiene advice should always be given?
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
What is positive reinforcement?
An increase in the rate of behaviour as a result of the presentation of a preferred event or stimulus
What is negative reinforcement?
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
Give 5 examples of behavioural management techniques
Acclimatisation
Tell, show, do
Relaxation
Structured time
Multiple short appointments in staged approach
When is GA the best treatment option?
If significant volume of treatment
If patient is uncooperative
If significant medical complexity
When should you refer someone with a learning disability for GA?
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
How should different dental emergencies be treated in people with learning disabilities?
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
What is shared care and who is most likely to use it?
Those with moderate and severe impairments and disabilities - may require more care by specialist services
