Special Care Flashcards
What is the definition of a learning disability?
a significantly reduced ability to understand new or complex information, to learn new skills & reduced ability to cope independently
IQ less than 70
How many people in the UK have a learning disability?
1.5 million, 350,000 severe
What are the clinical features of a learning disability?
epilepsy
visual defects
hearing and speech disorders
facial deformities
body-rocking and self-mutilation
feeding difficulties
What are the causes of learning disabilites?
genetic
problems during pregnancy
problems during birth
post-natal problems
What is the most common cause of Down’s Syndrom?
Trisomy 21 (extra chromosome)
What are the physical features of Down’s Syndrome?
atlanto-axial joint instability
short stature
brachycephaly
widely spaced upward slanting eyes
weight gain
brushfield spots
What health conditions are associated with Down’s Syndrome?
cardiac problems
spinal problems
malignant disease
dementia
immune disease
hearing loss
visual defects
seizures
What are the oral features of Down’s syndrome?
large tongue
thick, dry and fissured lips
poor anterior oral seal
tongue thrust
early onset perio disease
cleft lip and palate
malocclusion
delayed eruption
missing teeth
morphological abnormalities
What are dental aspects of fragile X syndrome?
short attention span
hyperactivity
behavioural disorders similar to autism
abnormally frequent open bite and crossbite
What is Cri du chat Syndrome?
deletion short arm of chromosome 5
What are the features of Cri du chat syndrome?
high pitched cry
microcephaly
micrognathia
wide set eyes
webbing or joining together of fingers and toes
slow development of motor skills, speech and language
How is autism spectrum disorder characterised?
poor social skills
lack of interpersonal relationships
delayed speech and language
ritualistic, compulsive behaviour
what is the clinical presentation of autism?
lives in ‘own’ world
avoid eye contact
echolalia
unaware of others
practice repetitive actions
obsessional desire to follow routine
self-mutilation
sensitivity to touch, smell and sound
what are the oral findings in autistic patients?
bruxism
traumatic lesions
poor OH
poor attendance
prefer sweet foods
how should you manage autistic patients?
patience
empathetic approach
OHI and support
pre-visit pack and questionnaire
short, quiet visits with same staff
avoid aspirator, high speed, etc
pain and anxiety control
what is a sensory impairment?
when one or more of a person’s senses are no longer normal
how many people are registered blind in the UK?
358,000
what are the symptoms of visual impairment?
reduction or loss of vision
eye pain
burning sensation
gritty feeling
blurring of vision
what are the causes of visual impairment?
glaucoma
cataract
macular degeneration
diabetic retinopathy
trachoma
what causes glaucoma?
a rise in intraocular pressure
what is a cataract?
clouding of the lens in the eye
describe the effects of wet macular degeneration
severe sight loss in a matter of months
rapid loss of central vision
describe the effects of dry macular degeneration
bilateral
gradual loss of central vision
what conditions cause retinopathies?
diabetes
hypertension
what are retinopathies
a combination of retinal degeneration and inflammation
what is hemianopia?
blindness in one half of the visual field
what is the most common cause of hemianopia?
stroke
how are visual impairments treated and prevented?
early diagnosis
protect eyes from sun
medical, surgical, non-invasive
how many people in the UK are affected by a hearing impairment?
11 million
what are the causes of hearing impairment?
inherited
congenital
infections
trauma
drugs
foreign bodies
excessive noise
what are symptoms of hearing impairment in children?
inactivity
reduced development of speech and language skills
deterioration of speech
reduced social and emotional development
irratibility
autistic like behaviour
confusion
what are the signs and symptoms of hearing loss?
difficulty hearing clearly
misunderstanding
asking people to repeat themselves
listening to music or TV loudly
feeling tired or stressed
what are some ways to prevent hearing loss?
immunisation
avoidance of some drugs
reduction of occupational exposure
hearing aids
what are some ways to treat hearing loss?
early management - surgical or medical
rehabilitation
what is included in the equality act 2010?
age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation
what is the equality act 2010’s definition of disability?
physical or mental impairment
the impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities
what are the most common impairments and their %’s?
mobility 49%
stamina/breathing/fatigue 37%
dexterity 26%
mental health 25%
what is a physical disability?
any condition that permanently prevents normal body movement and/or control
what are causes of physical disabilities?
inherited or genetic disorders
conditions present at birth
serious illness affecting brain, nerves or muscles
spinal cord injury
brain injury
accidents
What should valid consent be?
Informed, freely given by a capable patient
What acronym is used to define incapable?
AMCUR
What does AMCUR stand for?
Acting
Making a decision
Communicating a decision
Understanding a decision
Retaining memory of the decision
How do you assess capacity?
Open questions
‘Chunk and check’
‘Teach back’
What is applied if a person lacks capacity to consent to dental treatment?
Adults with Incapacity Act
What does the Adults with Incapacity Act 2000 do?
Safeguards the welfare and manages the finances of people aged 16 years and over who lack capacity
What are the 5 key principles of a section 47 certificate?
- Benefit
- Least restrictive of freedom
- Wishes taken into account
- Consult relevant others
- Encourage residual capacity
What is a proxy?
Someone who has been authorised to act on behalf of an adult with incapacity
What is a power of attorney?
A person granted by the adult whilst they have capacity to choose who they wish to ack on their behalf, should the need arise
Who is a power or attorney registered with?
OPG
What types of power of attorneys is there?
Welfare
Continuing
Joint or combined
What documents should be checked for PoA’s?
All documents - need to read body of document as not all welfare PoA have the right to consent
What is the OPG?
Office of the public guardian
When would a guardian be granted?
- no longer has capacity to choose who they wish to make decisions for them
- the adult has never been able to make their own decisions
How does a person get a guardian?
Court process granted by a sheriff
What is required to get a guardian?
Medical reports
Social work report
Does a guardian have an expiry date?
Yes
Does a PoA have an expiry date?
No
What types of guardianship powers are there?
Financial/property
Welfare
Both
What statement would you look for in guardianship and PoA documents?
The power to consent or withhold consent to medical and dental treatment
What is an intervener?
Appointed for a one-off event
Who can legally consent for dental treatment?
- patients with capacity
- welfare PoA
- welfare guardians
Can medical and dental professionals consent a patient for treatment?
No - they can only authorise to under section 47 of AWI act
What must be done when getting consent from a proxy?
Have an AWI (s47) certificate issued
What should be done to consent if there is no proxy?
Follow the 5 key principles of the AWI (AMCUR)
S47 certificate to authorise tax to go ahead
Who is able to complete an AWI certificate?
Doctors
Health professionals with relevant training
What are the risk factors for dementia?
Age
Gender
Ethnicity
Genetics
Down’s syndrome
Medical factors
Lifestyle factors
Head injuries
What are the medical risk factors for dementia?
Type 2 diabetes
Hypertension
High cholesterol
Obesity
Depression
What are the lifestyle risk factors for dementia?
Physical inactivity
Smoking
Unhealthy diet
Excessive alcohol
What kind dementia do head injuries cause?
Chronic traumatic encephalopathy
What is the link between football and dementia?
3.5x more likely to suffer dementia
How can you reduce risk factors for dementia?
Physically active
Stop smoking
Healthy eating
Healthy weight
Reduce alcohol
Mentally active
Be social
What are the different types of dementia?
Alzheimer’s disease
Vascular
Mixed
Lewy-body
Frontal-temporal
How does Alzheimer’s present?
Short-term memory loss and word-finding difficulties
Mood swings and frustration as it progresses
What causes Alzheimer’s?
Amyloid plaques - tangles tau protiein - loss of connection between neurons - decrease in acetylcholine
What infections are associated with Alzheimer’s?
Oral herpes
Pneumonia
Spirochete bacteria
What is the associating between periodontal disease and Alzheimer’s?
Gingivitis more common in Alzheimer’s, higher numbers of P.gingival present in brain producing proteins
What causes vascular dementia?
Reduced blood flow to the brain
What is mixed dementia?
Combination of Alzheimer’s and vascular dementia
What is lewy-body dementia?
Small deposits of protein in nerve cells
Associated with Parkinson’s disease
How does fronto-temporal dementia present?
Short temperedness
Aggression
Mood swings
Sexually inappropriate behaviour
What questionnaire is used to assess mental abilities?
MMSE (mini mental state exam)
What drugs are licensed for Alzheimer’s?
Donepezil
Galantamine
Rivastigmine
Memantine
What happens in the early stages of dementia?
Loss of short-term memory
Confusion, poor judgement
Anxiety, agitation
Communication problems
What happens in middle stages of dementia?
Increasingly forgetful
Distress, aggression, anger, mood changes
Risk of wandering or getting lost
Inappropriate behaviour
Hallucinations
What happens in late stage dementia?
Inability to recognise familiar objects, surrounding or people
Increased physical frailty
Difficulty eating and swallowing, weight loss, incontinence
Why should you avoid GA in dementia pts?
Evidence suggests dementia can worsen following GA
How can you tell someone has dental problems who can’t communicate?
Refusal to eat
Pulling at face/mouth
Not wearing denture
Disturbed sleep
Swelling
How can you make your home dementia friendly?
Good lighting
Reduce excess noise
Safer flooring
Labels and signs on cupboard
Phones with big buttons
What are the different types of platelet disorders?
Failed platelet production
Excessive platelet destruction
Abnormal platelet function
What is thrombocytopenia?
Too little platelets
What are the causes of thrombocytopenia?
Autoimmune
Alcoholism
Bone marrow diseases
Cancer
Viruses (Hep C, HIV)
Chemotherapy
What is ITP?
Idiopathic thrombocytopenic purpura