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BDS4 Special Care > Prevention at Individual and Population Level in Patients with Disabilities > Flashcards

Prevention at Individual and Population Level in Patients with Disabilities Flashcards

1
Q

What is the purpose of having an MDT looking after the healthcare with a patient with a disability?

A

Encourages/facilitates the safe delivery of care

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2
Q

What can be done to help patients with oral care and prevention if they have disability but are capable of independent living?

A

Maximise existing skills

Establish routines

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3
Q

What can be done to help patients with oral care and prevention if they have disability and are dependent?

A

Engage carers

Provide appropriate education

Facilitate support

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4
Q

Which conditions may cause people to experience drooling?

A

Developmental disabilities

Cerebral palsy

Progressive neurological conditions
-> parkinsons
-> MND

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5
Q

What can be done to prevent drooling in patients?

A
  • Head Positioning and Posture
  • Speech and Language Therapy
  • Behavioural techniques
  • Medication and Surgery
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6
Q

What can cause dehydration, xerostomia and dysphagia in patients who are hospitalised?

A

oOxygen therapy
oMouth breathing
oSide-effects of medications
oReduced food and fluid intake

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7
Q

Which habits in patients who suffer from dysphagia can contribute to oral disease?

A
  • Pouching
  • Modification of consistency of foods and liquid- suggest swallowing issue
  • Nutritional changes
  • Sip Feeding- increased caries risk
  • Risk of Aspiration
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8
Q

What is pouching, what can it cause, how can it be checked?

A

 Keeping foods and medicines (iron tablets, alendronic acids can result in communications) in buccal sulcus

 Can result in cervical and root caries

 Check this to see if anything is being held- clear with gloved finger

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9
Q

What techniques can be helpful to aid oral care in those with dysphagia?

A

Get patient in upright position

Encourage patient to spit out toothpaste if they can

Use of suction toothbrush

Use of hand over hand technique

Adaptions to toothbrush handle

Using 2 toothbrushes- one to brush teeth, one to hold muscosa out of the way/mop mucous off tissues

Mouth guard/finger props

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10
Q

Why are foam sticks not recommended for OH in patients who have dysphagia?

A

Ineffective at removing plaque

Risk of aspiration and choking as the foam can become detached or be bitten off (especially if it is left soaking in liquid)

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11
Q

Why do patients who are PEG fed or nil by mouth still need oral hygiene?

A

 Still need oral health care as they still get biofilm development or may still take food orally
 Tissues must be kept moist

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12
Q

What are the issues with tasters? How can this be prevented?

A

Tend to be sweet (contain sugar) to help with dry mouth
 Discuss with carers as this can cause caries
 Knoppert tasters- non-cariogenic option

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13
Q

Which toothpastes may helpful for OH in patients with learning and disabilities?

A

Ora-nurse- unflavoured

SLS free/non-foaming- if swallowing issue
-> Sensodyne, oranurse, ultradex, biotene

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14
Q

How is the 2 toothbrush technique carried out?

A
  • Thick handled rubber toothbrush
  • Used between the occlusion as a prop
  • Mop and Go-
    Using gauze to wipe mucosa and teeth where mucus
    has deposited
  • 2 Person approach:
    -> 1 to support brushing -> 1 to support induviudal
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15
Q

What is open wide?

A

Programme for disabled people of middle age to improve oral hygiene

 Broad- not specific to people with stroke, ASD etc

 Aims to facilitate patients to look after their own mouths are far as possible

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16
Q

What are the different aspects of open wide programme?

A

Unit 1 – Core Oral Health Knowledge
-> educating patients about prevention, risk factors

Unit 2 – Practical Oral Care
-> OH, denture care, strategies to overcome barriers

Unit 3 – Oral Health Documentation
-> OHA, Oral care plan, daily oral care plan

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17
Q

What are action cards? Who are they used for?

A

Communication resource (similar to social stories) which explains task such as OH in steps

-> useful for people with ASD

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18
Q

Which adjuncts to communication can be helpful to aid consultation with patients with learning and physical disability?

A

Makaton

Picture boards

Letter boards

Wrist bands

Talking mats

Draw/write

Technology

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19
Q

How should a dentist communicate with patients who have learning and physical disability?

A

Smile

Be caring, calm, friendly

Speak clearly at appropriate pace

Use short sentences with certain words

Remain positive- do not show frustration

Make use of gentle touch if appropriate

20
Q

What can be done to empower patients who have learning and physical disability when communicating?

A

Prompt

Encourage

Support

21
Q

How should OH advice be given to patients with learning and physical disabilities?

A

Discuss at eye level with patient

Put pea sized amount on small headed toothbrush

Systematic approach
-> Outside surfaces
-> inside surfaces
-> chewing surfaces
-> mucosa

Encourage patient to spit toothpaste out (don’t rinse)

22
Q

What can be done to make OH easier/more enjoyable for patient’s with learning and physical disability?

A

Counting and singing

Give meaning to toothbrush- Different coloured toothpaste for each segment
-> Patient associates certain parts of mouth

Timing- do at best time for patient, do at same time in same place to create routine

Make sure the lighting is adequate

Dignified environment

23
Q

What head position should disabled patients with gag reflex and dysphagia be encouraged to be in when carrying out OH?

A

Forwards and downwards

24
Q

What is the bridging technique? How can it be applied to tooth brushing for people with disabilities?

A

This helps to engage a person with the task through their senses and helps them to understand the task

Describe and show them the toothbrush, then mimic brushing your own teeth

Give another toothbrush to the individual. They may mirror your behaviour and brush their own teeth.

25
Q

What is the chaining technique? How can it be applied to tooth brushing for people with disabilities?

A

This involves gently bringing the person’s hand to their mouth while describing the activity

-> The carer starts the activity and the individual finishes it

26
Q

What is the hand over hand technique in brushing?

A

When the carer helps the patient by placing there hand over the patients and they gently brush together

27
Q

What is the distraction technique? How can it be applied to tooth brushing for people with disabilities?

A

Distract the individual by placing a familiar item in their hand while you brush their teeth

Other distraction such as music may be helpful

28
Q

What is the rescuing technique? How can it be applied to tooth brushing for people with disabilities?

A

If attempts are not going well, the carer can leave and a ‘rescuer’ comes in to take over
-> Bringing in someone else with a fresh approach may encourage the individual to cooperate

29
Q

What can be done with patients who bite the toothbrush when the carer is trying to carry out OH with them?

A

Allow the person to continue biting the brush, use another toothbrush to provide oral care

30
Q

What can be done with patients who thrust their tongue when the carer is trying to carry out OH?

A

Use a gauze square wrapped around your forefinger to gently retract or hold back the tongue or lip

31
Q

How is OH carried out in tube fed individuals?

A

Aim to keep mucosa moist and lubricated- toothbrushing helps with this

Use non foaming toothpaste and upright position
-> prevents aspiration

32
Q

What different brushes may be better tolerated by patients with learning and physical disability?

A

Small head

Soft/Silk brushes

33
Q

Why is brushing and good oral hygiene important in terms of diet in people with physical and learning disability?

A

Better dentition leads to uptake of better quality more nutrient dense food

34
Q

What can cause resistance to OH in patients with physical and learning disabilities?

A

Pain from dental source

Pain/stress from process

Stress from environment or person carrying out brushing with them

35
Q

Which sensory aids can help with OH in patients with learning and physical disabilities?

A
  • Power Suit- provides pressure sensation
  • Use of sensory aid prior to brushing to de-stress and afterwards
  • Desensitisation
  • Counting
  • Find a brush which is something they are interested in
  • Warm water
  • Stories or Books
36
Q

What is the denture hygiene advice given to patients with learning and physical disabilities/carers?

A
  • Dentures must be removed from the mouth at night
    -> Reduces the risk of oral mucosal disease
  • Rinse dentures after every meal
  • Clean dentures morning and night using a toothbrush and denture cream, or plain soap and water
  • Do this over a filled basin or a soft surface to reduce the risk of breaking the dentures if you drop them
  • Soak dentures in disinfecting solution for at least 20 minutes once a day
  • Soak dentures overnight in plain water
37
Q

What is positive and negative reinforcement when developing a routine?

A

Positive reinforcement- Refers to an increase in the rate of behaviour as a result of the presentation of a preferred event or stimulus

Negative reinforcement- refers to 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.

38
Q

What are the steps in the habit loop?

A

Cue/trigger

Routine- repetition

Reward

39
Q

Which cues can be helpful for patients with learning and physical disabilities when completing oral care?

A

Time of day

Environment- associate bathroom with oral care

Person

Preceding behaviour

Objects

40
Q

Which factors can be helpful when trying to facilitate behavioural change?

A

Supportive/stable environment

Piggyback- add new behaviour onto an already positive experience

Make it easy for patient

Use of unique personalised cues

Practice and repetition

41
Q

When should an oral health assessment be carried out if patient has moved into residential care?

A

Within 48 hours

42
Q

What is noted down in an oral health assessment?

A

 Natural teeth
 Dentures
 Current oral problem list
 Dental registration and attendance
 Medicines and Smoking status

-> refer to dentist if required

43
Q

What should be be included in the oral care plan?

A

Record of oral care required

Individual plan to meet the needs of each person- tailored

Highlight required support and techniques

44
Q

Who completes and checks the daily oral care records?

A

Completed by carer each day

Checked by senior member of staff each week

-> after 4 weeks the assessment is reviewed again

45
Q

What is the DisDAT?

A

Disability Distress Assessment Tool
-> enables distress cues to be identified

46
Q

As per DisDAT what are the different features that may signify a disabled patient is distressed?

A

Facial appearance

Jaw movement

Eye appearance

Skin appearance

Vocal sounds/speech

Body posture

Habits/mannerisms

BDS4 Special Care (9 decks)

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