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BDS4 SCD > Oral healthcare for people with learning disabilities > Flashcards

Oral healthcare for people with learning disabilities Flashcards

1
Q

What are user/carer barriers to care

A
  • physical/mental/cognitiive ability to carrying out effective OH
  • ability to self care
  • diet & medications
  • communication
  • fear and anxiety
  • greater need for behaviour management
  • require support to attend appointments
  • knowledge of carers
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2
Q

What are professional service barriers

A
  • low confidence in management of people with learning disability by new graduates
  • inadequacies in professional training
  • lack of experience from dentists
  • financial constraints due to nhs contracts
  • carers belief that dentist would prefer non troublesome px
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3
Q

What are physical barriers to care

A
  • access
  • travelling distance for specialist
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4
Q

What are cultural barriers to care

A
  • minority groups barriers exacerbated by ethnicity and language
  • different attitudes to oral health
  • gender sensitivities
  • communication of need
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5
Q

What is the experience of oral disease in those with mild learning disability

A
  • managed within GDP setting
    Compared to adults with more profound disability
  • more likely to have filled teeth
  • fewer XLA
  • more untreated active decay
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6
Q

What parts of physical access can make it difficult

A
  • location of site - distance and safety of transport
  • moving and handling
  • medical support available
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7
Q

What prevents access to dental setting

A
  • ground floor access
  • car parking
  • elevator
  • hand rail
  • wide corridors
  • disabled toilet
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8
Q

What can assist your px into their chair

A

banana board
wheelchair tipper
hoist

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9
Q

What proprs can assist in access to the mouth

A
  • bedi shield
  • open wide mouth rests
  • toothbrush
  • mirror
  • good light
  • head support
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10
Q

What is clinical holding

A
  • use of physical holds to assist, support a patient to recieve clinical dental care or treatment in situations where the behaviour may limit the ability of the dental team to deliver tx effectively
  • where px behaviour may present a safety risk to themselves, members of dental team or other accompanying persons
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11
Q

What should we assess when assessing a px with learning disability

A
  • level of understanding and intellectual function
  • communication
  • physical and emotional access
  • cooperation
  • medical status
  • social status
  • dental status
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12
Q

What are indicative signs of pain if px cant communicate

A
  • sleep interruption
  • changes in behaviour
  • rubbing of area
  • pulling at area
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13
Q

What conditions are associated with intellectual impairment

A
  • down syndrome
  • fragile X
  • williams syndrome
  • autistic spectrum disorder - not all px have LD
  • cerebral palsy - not all px have LD
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14
Q

What should you ask in the social history

A
  • smoking
  • alcohol
  • living arrangement
  • transport
  • support
  • consent and capacity
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15
Q

What should you get in the dental history

A
  • ability to cooperate
  • prevention regime
  • level of support required
  • diet and method of delivery
  • swallowing and thickeners if appropriate
  • previous delivery of dental tx
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16
Q

How does a patient demonstrate capacity

A
  • ability to act
  • make a decision
  • communicate decision
  • understand the decision
  • retain memory of the decision
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17
Q

What are the principles of the adult with incapacity act

A
  • benefit
  • least restrictive option
  • take into account wishes of the person
  • consult with relevant others
  • encourage person to use existing capacity
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18
Q

What conditions experience drooling

A
  • developmental disability
  • cerebral palsy
  • progressive neurological condition
  • parkinsons
  • motor neuron disease
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19
Q

How can drooling be presented

A
  • head positioning and posture
  • speech and language therapy
  • behavioural techniques
  • medication
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20
Q

What is dysphagia

A

difficulty swallowing

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21
Q

What can cause dysphagia

A
  • hospitalisation
  • stroke px
  • increased exposure to AB
  • dehydration/xerostomia
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22
Q

What can lead to a dry mouth

A
  • oxygen therapy
  • mouth breathing
  • side effect of meds
  • reduced food and fluid intake
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23
Q

How should we manage px with disphagia

A
  • check for pouching (food getting stuck in sulci)
  • moderate consistency of fuid and liquid
  • reduce aspiration risk
  • px should sit upright
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24
Q

How should we manage dysphagia patients in dentistry

A
  • sit upright or semiupright for toothbrushing
  • encourage spitting after mouthcare
  • use suction toothbrush if available
  • hand over hadn technique
  • dry mouth care
  • use a mouthguard, finger prop or second toothbrush to gain access if requried
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25
Q

Do PEG fed people still need oral care

A

yes
often get given small ‘tasters’
can cause biofilm production

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26
Q

What toothpaste should be used for px with dysphagia

A

assess ability to swallow
may advise non-foaming toothpaste
if sensory issue exists non-flavoured may be best

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27
Q

What toothpastes dont have SLS

A

oranurse
sensodyne

28
Q

What is open wide

A

Open Wide is an oral health improvement programme for adults aged 16-64 who require support with daily oral care as a result of a physical, cognitive or medical condition.

29
Q

What are examples of communication adjuncts

A
  • makaton
  • picture board
  • wrist band
  • talking mat
  • draw or write
  • technology
30
Q

How should we position px with dysphagia or gag reflexes when brushing

A
  • provide support
  • comfortable head position, supported
  • head forward and down
31
Q

What are examples of toothbrushing behavioural strategies

A
  • bridging
  • chaining
  • hand over hand
  • distraction
  • rescue
32
Q

What is bridging

A
  • helps engage person with the task through their senses
  • helps them understand the task
  • describe and show them the brush, mimic brushing your own teeth
  • give anotehr brush to individual
  • they should mimic your behaviour and brush their own teeth
33
Q

What is chaining

A
  • involves gently bringing the persons hand to their mouth while describing the activity
  • carer starts the activity and the individual finishes it
34
Q

What is hand over hand

A

last resort
place hand over their hand
brush teeth together

35
Q

If hand over hand isnt working, how can you use distraction to brush their teeth

A
  • distract individual by placing a familiar item in their hand while you brush
  • music can be helpful
36
Q

What is rescuing

behavioural strategy for toothbrushing

A

if attempts are not going well, get carer to leave and have rescuer come and take over
someone esle with fresh approach may encourage cooperation

37
Q

If the patient likes to bite on the toothbrush, how can you manage this

A
  • get px to continue biting on one brush
  • use another brush to clean
38
Q

What is a tongue thruster

toothbrushing

A
  • person moves tongue a lot
  • or press lips together tightly
  • pushes toothbrush out the way
39
Q

How do you manage a tongue thruster

A
  • use a gauze square wrapped around your forefinger
  • gently retract or hold back the tongue or lip
  • this will need patience and perserverance
40
Q

How should we look after the mouth of thsoe who are tube fed

A
  • keep mucosa moist and lubricates
  • use non foaming toothpaste to clean teeth
  • consider upright position
  • aspiration
41
Q

If patient is resistant to brushing, what kind of toothbrush can we think of

A
  • smallhead
  • soft brush
  • silk brush
  • remember start at back and move forward
  • use dry brush
  • use flavourless toothpast
42
Q

What are examples of sensory aids

A
  • power suit
  • stories or books
  • warm water
  • desensitisation
43
Q

How should carers provide denture hygiene

A
  • remove at night
  • rinse dentures after every meal
  • clean dentures morning and night using toothbrush and denture cream or soap and water
  • clean over filled basin
  • soak denture in disinfecting solution once a day
  • soak dentures overnight in plain water
44
Q

How can we make oral care a positive habit

A
  • provide a cue/trigger e.g time of day or environment
  • repetition
  • provide rewards
  • practice and repeat
45
Q

When a px is placed in residential care, what should be completed

A

oral health assessment
within 48h

46
Q

What does the oral health assessment consist of

A
  • risk assess
  • identify risks to oral health and subsequent needs
  • e.g natural teeth, dentures etc
47
Q

After the oral health assessment, what is developed

A
  • oral care plan
  • records level of oral care required
  • individual plan
  • highlight required support and techniques
48
Q

What is the daily oral care record

A
  • completed by carer
  • checked weekly by senior staff
  • aids identification of a problem to enable supportive response
  • reviewed after 4 wks
  • stored in central folder for easy access
  • valuable for dental team
49
Q

What is DisDAT

A
  • disability distress assessment tool
  • allows distress cues to be identified
50
Q

What should we think about when planning dental care for this cohort of px

A
  • cooperation and anxiety
  • safety and risk assessment
  • social status
51
Q

What should we assess when assessing coop and anxiety

A

can they accept care
what modality of tx should be used
what are the alternatives

52
Q

What should we look at when considering a patients medical risk

A

nature of disease
severity
control
prognosis

53
Q

What should we look at when considering a patients medical risk

A

nature of disease
severity
control
prognosis

54
Q

What are the risks of sedation

A
  • over sedation
  • resp depression
  • abnormal reactions
55
Q

What are the types of sedation

A
  • oral
  • intranasal
  • inhalation
  • IV
56
Q

When is IS useful

A
  • anxious px
  • medical risk modified by stress
  • good cooperation
  • sedation assessment can be done same day
  • margin of risk is minimal
57
Q

When is IV sedation useful

A
  • to gain cooperation for assessment
  • cooperation for cannulation
  • still requires some cooperation
  • paradoxical reaction
  • requires 24h post op 1:1 care
  • may require multiple appointments
  • broader range of tx options compared to GA
58
Q

What are the risks of GA

A
  • death
  • risk increases with age, complexity of surgery and baseline health
  • brain damage
  • nausea and vomiting
  • lethargy
  • social status –> is it safe to send px home with little care
59
Q

When is GA the best way to provide care

A
  • significant volume of tx
  • patient is uncooperative
  • significant medical complexity

requires more severe tx plan

60
Q

When should you refer a px with learning disability for GA

A
  • pain and swelling, no alternatives exist, must be managed acutely
  • obvious dental disease when no alternative tx modality is possible to facilitate dental care
  • a number of years since examination in the presence of poor OH and suspicion of disease
61
Q

What are post GA dental emergencies

A
  • bleeding
  • diagnosis
  • gain local access
  • post op infection
62
Q

How do you manage reversible pulpitis in uncooperative px

A
  • try to buy time
  • can you gain enough access for tx or temporisation
63
Q

How do you manage an uncooperative px with irreversible pulpitis

A
  • cant give AB, no effect in pulpal inflammation
  • can you gain enough access to place a sedative dressing
64
Q

How do you manage an uncooperative px with PA infeciton

A
  • antibiotics
  • plan for future sedation or GA
65
Q

What are the benefits of px being seen in primary care

A
  • proximity
  • established relationships
  • family can come
  • longitudinal care

BDS4 SCD (5 decks)

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