SCD: Oral healthcare for People with Learning Disability

Question 1

What barriers to dental care exist in older people?

Answer 1

• cost & fear of cost
• fear (dental anxiety)
• accessibility
• availability
• characteristics of dentist

Question 2

What is meant by “direct” financial barriers for patients to access healthcare?

Answer 2

cost of treatment

Question 3

What is meant by “indirect” financial barriers for patients to access healthcare?

Answer 3

• travel
• carers

Question 4

What individual-level barriers might an individual with a learning disability face surrounding dental treatment?

Answer 4

• lack of ability to consent
• complicating medical history making access difficult
• inability to cooperate with treatment
• inability to communicate dental pain

Question 5

What organisational-level barriers might an individual with a learning disability face surrounding dental treatment?

Answer 5

• GDPs not willing to treat these patients
• shortage of specially trained/experienced dental professionals in treating individuals with learning disabilities

Question 6

What barriers to oral care might an individual with a mental health disorder face?

Answer 6

• access to dental care
• fear of dental care
• characteristics of mental illness
• lack of oral health screening by psychiatrists
• lack of general education & training
• stigma of mental illness
• lack of communication

Question 7

What facilitators . to oral care might an individual with a mental health disorder face?

Answer 7

• reported need for education and training
• financial support
• dentists chairside manner
• community support
• interprofessional communication

Question 8

What are the components of the biopsychosocial model?

Answer 8

• biological
• psychological
• social factors

Question 9

A pt attends your practise, they suffer from severe MS and use a wheelchair, they also have difficulty communicating, what issues does this person face in relation to his oral health?

Answer 9

• poor manual dexterity
• unable to access surgery
• unable to communicate with you
• unable to communicate pain
• carers needed to help attend practise
• difficulty getting pt into chair (may need hoist etc)

Question 10

What do polypharmacy patients struggle with?

Answer 10

Severe xerostomia

Question 11

What are disability aware changes that can be made to dental practises to make them more accessible?

Answer 11

• ground floor access
• suitable car parks
• disabled toilets
• hand rails

Question 12

Why shouldn’t you use a plastic mirror in a patient with special care considerations?

Answer 12

If pt bites mirror it will break and aspiration risk

Question 13

What is clinical holding?

Answer 13

the use of physical holds to assist or support a pt to receive clinical dental care or treatment in situations where behaviour may limit ability of dental team to deliver treatment

Question 14

Are papoose boards suitable for use in the UK?

Answer 14

NO
- pt strapped to chair
- ethical issue!!!

Question 15

What is assessment of learning disability dependent on?

Answer 15

1. level of understanding
2. communication
3. physical and emotional access
4. cooperation
5. medical status
6. social status
7. dental status

Question 16

What symptoms and signs may be indicative for people who cannot reliably report or communicate pain?

Answer 16

• tugging at face
• sleep interrupted
• changes in behaviour
• rubbing area

Question 17

If patient needs drinks etc thickened, what risk do they have that means they require this?

Answer 17

Aspiration risk

Question 18

If a patient has dysphagia, how should you sit them in the dental chair?

Answer 18

upright or semi-upright position

Question 19

What oral care methods can help patients with dysphagia?

Answer 19

• pt sitting upright
• if pt able to spit out, encourage this
• suction toothbrush

Question 20

In patients that are PEG fed, what oral health issue poses the main threat?

Answer 20

Periodontal and fungal issues
- caries less of an issue as no sugar to feed cariogenic microbiome

Question 21

What can you do to manage a tongue thrust patient when performing oral hygiene?

Answer 21

Use gauze to hold tongue out the way

Question 22

In order for an epileptic patient to undergo sedation, what is the rule?

Answer 22

The patients epilepsy must be VERY WELL CONTROLLED

Question 23

In a patient with a BMI of 40, what mode of sedation is best suited for them?

Answer 23

Inhalation