Paeds - Learning Disability Flashcards
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
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
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
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
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)
what is the cause of cerebal palsy?
Brain damage directly before or after birth.
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
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
what is the most common type of congenital heart defect?
Ventricular septal defect
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
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
what is the most common type of cancer in children? (2)
Acute leukaemias (1/3)
Brain tumours (1/4)
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.
what are oral signs of cancer/cancer treatment? (7)
Mucosal/gingival haemorrhage Gingival enlargement Throat infections Mouth infections Immunosuppression Thrombocytopenia Oral mucositis
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
what are the most commonly inherited bleeding disorders?
VW disease
Haemophilia A
Haemophilia B
what are the most commonly acquired bleeding disorders in children? (2)
Warfarin therapy - congenital heart defects
Thrombocytopenia - chemotherapy
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?
- Cyanotic
- Acyanotic
- 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)
- Acute lymphoblastic – common in children
- Chronic lymphoblastic -common in children
- Chronic myeloid leukaemia
- Acute myeloid leukaemia
what is the main way leukaemia is treated?
chemotherapy
what are the 3 stages of chemotherapy.
- 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 - Consolidation and CNS treatment – maintain the remission use a lumbar puncture
- 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?
no
can we carry out biological caries management i.e. hall technique in children with CHD and cancer?
no
