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
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
3
Q
What are physical barriers to care
A
- access
- travelling distance for specialist
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
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
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
7
Q
What prevents access to dental setting
A
- ground floor access
- car parking
- elevator
- hand rail
- wide corridors
- disabled toilet
8
Q
What can assist your px into their chair
A
banana board
wheelchair tipper
hoist
9
Q
What proprs can assist in access to the mouth
A
- bedi shield
- open wide mouth rests
- toothbrush
- mirror
- good light
- head support
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
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
12
Q
What are indicative signs of pain if px cant communicate
A
- sleep interruption
- changes in behaviour
- rubbing of area
- pulling at area
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
14
Q
What should you ask in the social history
A
- smoking
- alcohol
- living arrangement
- transport
- support
- consent and capacity
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
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
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
18
Q
What conditions experience drooling
A
- developmental disability
- cerebral palsy
- progressive neurological condition
- parkinsons
- motor neuron disease
19
Q
How can drooling be presented
A
- head positioning and posture
- speech and language therapy
- behavioural techniques
- medication
20
Q
What is dysphagia
A
difficulty swallowing
21
Q
What can cause dysphagia
A
- hospitalisation
- stroke px
- increased exposure to AB
- dehydration/xerostomia
22
Q
What can lead to a dry mouth
A
- oxygen therapy
- mouth breathing
- side effect of meds
- reduced food and fluid intake
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
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
25
Do PEG fed people still need oral care
yes
often get given small 'tasters'
can cause biofilm production
26
What toothpaste should be used for px with dysphagia
assess ability to swallow
may advise non-foaming toothpaste
if sensory issue exists non-flavoured may be best
27
What toothpastes dont have SLS
oranurse
sensodyne
28
What is open wide
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
What are examples of communication adjuncts
* makaton
* picture board
* wrist band
* talking mat
* draw or write
* technology
30
How should we position px with dysphagia or gag reflexes when brushing
* provide support
* comfortable head position, supported
* head forward and down
31
What are examples of toothbrushing behavioural strategies
* bridging
* chaining
* hand over hand
* distraction
* rescue
32
What is bridging
* 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
What is chaining
* involves gently bringing the persons hand to their mouth while describing the activity
* carer starts the activity and the individual finishes it
34
What is hand over hand
last resort
place hand over their hand
brush teeth together
35
If hand over hand isnt working, how can you use distraction to brush their teeth
* distract individual by placing a familiar item in their hand while you brush
* music can be helpful
36
What is rescuing
| behavioural strategy for toothbrushing
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
If the patient likes to bite on the toothbrush, how can you manage this
* get px to continue biting on one brush
* use another brush to clean
38
What is a tongue thruster
| toothbrushing
* person moves tongue a lot
* or press lips together tightly
* pushes toothbrush out the way
39
How do you manage a tongue thruster
* use a gauze square wrapped around your forefinger
* gently retract or hold back the tongue or lip
* this will need patience and perserverance
40
How should we look after the mouth of thsoe who are tube fed
* keep mucosa moist and lubricates
* use non foaming toothpaste to clean teeth
* consider upright position
* aspiration
41
If patient is resistant to brushing, what kind of toothbrush can we think of
* smallhead
* soft brush
* silk brush
* remember start at back and move forward
* use dry brush
* use flavourless toothpast
42
What are examples of sensory aids
* power suit
* stories or books
* warm water
* desensitisation
43
How should carers provide denture hygiene
* 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
How can we make oral care a positive habit
* provide a cue/trigger e.g time of day or environment
* repetition
* provide rewards
* practice and repeat
45
When a px is placed in residential care, what should be completed
oral health assessment
within 48h
46
What does the oral health assessment consist of
* risk assess
* identify risks to oral health and subsequent needs
* e.g natural teeth, dentures etc
47
After the oral health assessment, what is developed
* oral care plan
* records level of oral care required
* individual plan
* highlight required support and techniques
48
What is the daily oral care record
* 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
What is DisDAT
* disability distress assessment tool
* allows distress cues to be identified
50
What should we think about when planning dental care for this cohort of px
* cooperation and anxiety
* safety and risk assessment
* social status
51
What should we assess when assessing coop and anxiety
can they accept care
what modality of tx should be used
what are the alternatives
52
What should we look at when considering a patients medical risk
nature of disease
severity
control
prognosis
53
What should we look at when considering a patients medical risk
nature of disease
severity
control
prognosis
54
What are the risks of sedation
* over sedation
* resp depression
* abnormal reactions
55
What are the types of sedation
* oral
* intranasal
* inhalation
* IV
56
When is IS useful
* anxious px
* medical risk modified by stress
* good cooperation
* sedation assessment can be done same day
* margin of risk is minimal
57
When is IV sedation useful
* 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
What are the risks of GA
* 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
When is GA the best way to provide care
* significant volume of tx
* patient is uncooperative
* significant medical complexity
requires more severe tx plan
60
When should you refer a px with learning disability for GA
* 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
What are post GA dental emergencies
* bleeding
* diagnosis
* gain local access
* post op infection
62
How do you manage reversible pulpitis in uncooperative px
* try to buy time
* can you gain enough access for tx or temporisation
63
How do you manage an uncooperative px with irreversible pulpitis
* cant give AB, no effect in pulpal inflammation
* can you gain enough access to place a sedative dressing
64
How do you manage an uncooperative px with PA infeciton
* antibiotics
* plan for future sedation or GA
65
What are the benefits of px being seen in primary care
* proximity
* established relationships
* family can come
* longitudinal care
