Paeds - Learning Disability Flashcards by Roxanne B

what are the dental implications for children with special needs? (5)

Fewer teeth: delayed presentation/registration to a dental practice

More untreated dental caries: due to poor access to the practice or medication

Increased periodontal disease: especially in those with down syndrome

Dental fear and anxiety

Barriers to care i.e. transport and mobility

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what preventative measures are put in place for children with SN? (3)

Arrange more regular dental visits

Practice safe eating and drinking habits: this can be difficult to change in autistic patients

Treat with high caries risk management

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how do we support normal function in children with SN? (4)

Allow the patient to eat as they wish

Allow the patient to develop their speech, liaise with speech and language team

Promote self esteem by maintaining good physical appearance of teeth,

Reduce drooling by;
Improving lip seal
Improving swallowing
Use scopolamine/hyoscine patches 
Botox injections 
Surgery

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What are the barriers to regular dental attendance in children with SN? (5)

The child might have a busy schedule with appointments

The child has challenging behaviour or anxiety

Difficulty with access/transport to the practice

The child could have frequent illness

The parents attitude could be challenging

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when giving a child with diabetes treatment involving LA, what do we ask them to bring?

Ask them to bring their testing kit and test bloods before treatment.

Ask them to bring a liquid form of a sugary snack (prevents having to eat and accidentally chew their lip/tongue etc)

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what is the cause of cerebal palsy?

Brain damage directly before or after birth.

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what are the dental implications of CP? (11)

Poor OH from lack of manual dexterity
Head forward posture: CP patients have to be treated in this position to prevent aspiration of the drool
Drooling/saliva
Malocclusion: Class II from no lip seal

Gingival hyperplasia 
Enamel hypoplasia 
Bruxism 
Trauma 
Poor access 
Uncontrollable movements 
Enhanced gag reflex

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What are parental barriers to carrying out oral hygiene in children with SN? (5)

Poor manual dexterity themselves

Exhaustion

Childs mouth has poor access

Lack of time

Anxiety

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what is the most common type of congenital heart defect?

Ventricular septal defect

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why do congenital heart defects occur? (6)

Congenital rubella
Maternal drug misuse
Downs syndrome
Marfans syndrome
Noonan syndrome: change to autosomal dominant gene(s)
Elhers danlos syndrome: effects connective tissues

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what are the dental implications of CHD? (4)

Susceptible to infective endocarditis
Can be on certain medications that increase bleeding tendency
GA high risk liaise with cardiologist
Caution when using LA with adrenaline

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what is the most common type of cancer in children? (2)

Acute leukaemias (1/3)

Brain tumours (1/4)

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what is our role in children with cancer? (2)

Palliative care

Some children during stages of treatment have no neutrophils - so we must ensure that their mouths are as caries free and healthy as possible before and during this time.

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what are oral signs of cancer/cancer treatment? (7)

Mucosal/gingival haemorrhage 
Gingival enlargement 
Throat infections 
Mouth infections 
Immunosuppression 
Thrombocytopenia 
Oral mucositis

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what are the effects of chemo/radiotherapy in a developing childs mouth?

Can affect the permeant successors that are still developing - crown hypoplasia and microdontia
or not developed at all

Can reduce the length of the roots - makes ortho treatment later in life unlikely

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what are the most commonly inherited bleeding disorders?

VW disease
Haemophilia A
Haemophilia B

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what are the most commonly acquired bleeding disorders in children? (2)

Warfarin therapy - congenital heart defects

Thrombocytopenia - chemotherapy

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patients require haematological cover and 5 hour observation after what treatments?

LA block
Scale and polish
Extraction

define learning disability.

An individual with arrested/incomplete development of the mind
An individual with significant impairment of intellectual, adaptive and social functioning

define autism.

A Neurodevelopment spectrum disorder which affects social interaction, communication and have limited and restrictive patterns of behaviour.

what medical conditions can autism be associated with? (8)

ADHD
Downs 
Dyslexia
Dyspraxia
Learning disability 
Epilepsy 
GI issues
Sleeping disorder

how can we communicate with children with autism? (3)

Makaton
PECS
Widget symbols (picture)

how can we prepare to treat an autistic child? (6)

Find out what the patient likes and dislikes - health passport

Give the patient a social story explaining a visit to the dentist (use PECS)

Give the patient a plastic mirror/ other instruments to familiarise themselves with

bring them in for a visit before treatment to see the surgery/meet the team

have the patients in first thing in the morning/eliminate time in the waiting room

Have a de-cluttered surgery

what medical conditions do those with down syndrome commonly also suffer with? (6)

Autism/intellectual impairment 
congenital heart defects 
Leukaemia 
Epilepsy 
Alzheimers/dementia
hearing impairment

what are the dental features of those with downs syndrome? (6)

``` Maxillary hypoplasia Class III malocclusion Macroglossia (big tongue) Anterior open bite Hypodontia/microdontia Periodontal disease ```

what toothpaste is recommended to use in those with down syndrome?

Oranurse No flavour or foam Contains fluoride (1450ppm)

when should we avoid doing conscious sedation in those with special needs? (3)

Those undergoing Bleomycin therapy (high O2) Those with musculoskeletal disorder ASA 3 or above

what communication TECHNIQUES do we have to use in children with autism? (3)

Always say their name before giving them an instruction Leave time before saying next piece of information Keep things simple, don’t overload them with conversation

list the techniques used to treat autistic patients. (8)

Predictability!! Consistent staff, location, time and day for all treatment More regular & short appointments Declutter the surgery Radio off or on playing music that they like Use PECS Speech - literal, Short and clear commands Tell show do (using clear and short commands as well) Use water (autistic kids love water – predictable)

what signs show that an autistic child is becoming uncomfortable?

Watch for flapping hands and repetitive actions = child becoming uncomfortable

what toothbrushing tips can we give to parents with SN children?

Oranurse – no taste or foam but does contain fluoride. 2 toothbrushes (one on each side) chewing on one side and brushing on the other If you start on one quadrant one day start on a different quadrant the next day: always rotate to ensure each area is getting cleaned as efficiently as possible. If the parent is too exhausted by night tell them to do it earlier in the night

what are the 3 ways congenital heart defects can be categorised?

1. Cyanotic 2. Acyanotic 3. Where the defects are – valves, vessels, septal defects

what should we consider when treating a child with CHD's? (4)

Medications risk of infective endocarditis outgrowth their repairs: want to know if they’ve got any upcoming surgeries. Dental anxiety from lots of medical intervention

who is at risk of infective endocarditis?

* Previously had it * Valve replacement * Heart valve disease * Congenital heart defects * Hypertrophic cardiomyopathy

what are the symptoms of infective endocarditis? (5)

High fever and Night sweat Malaise Heart murmur Unintentional weight loss Joint pains

why does leukaemia prevent the body from fighting infection?

the white blood cells are released prematurely so cannot function as normal

name the types of leukaemia. (4)

1. Acute lymphoblastic – common in children 2. Chronic lymphoblastic -common in children 3. Chronic myeloid leukaemia 4. Acute myeloid leukaemia

what is the main way leukaemia is treated?

chemotherapy

what are the 3 stages of chemotherapy.

1. Remission/induction- aim to eradicate all of the leukaemia cells (happens quickly after diagnosis) How do we check if this is successful – take a sample from bone marrow 2. Consolidation and CNS treatment – maintain the remission use a lumbar puncture 3. Maintenance – Daily/weekly tablets for u to 2 years (girls) and boys 3 years to ensure the disease doesn’t reoccur. Child is immunosuppressed for this period and they will be in and out of hospital.

what are the oral side effects of chemo therapy? (6)

– Xerostomia – from damage to the salivary glands – Mucositis – atrophy of the mucosa (ulceration) – Gingivitis from defective haemostasis _ Gingival enlargement & haemorrhage – Prone to infection (fungal, bacterial and viral) – Vinchristine used in chemo can cause trismus and jaw pain.

how can we manage mucositis in children? (8)

* Reinforce OH * Recommend a soft, small headed tooth brush * Alcohol free mouthwash * Use ice chips to cool and soothe the mouth * Lidocaine mouthwash – numbing mouthwash * Diflam spray/mouthwash * Cafisol – super saturated calcium phosphate rinse has mineralisation potential, lubricates and soothes. * Low level light laser – can give instant relief and improves the mucositis

what is the next mode of treatment for leukaemia if chemotherpy stops working?

bone marrow transplant

can inhalation sedation be used in a child undergoing chemotherapy?

can we carry out biological caries management i.e. hall technique in children with CHD and cancer?