Special Care Dentistry Flashcards
1-9 L1: Intro 10-33 L2: Learning Disability 34-52 L3: Sensory Impairment 53-73 L4: Physical Disability 74-92 L5: AWI (Adult With Incapacity)
Special care dentistry applies to people who are unable to access routine dental care because of various factors, what are these factors?
- Physical disability
- Intellectual disability
- Medical disability
- Emotional disability
- Sensory, mental or social impairment
- Combination of the above factors
Before we treat a patient, we must consider the following (two things), what are they?
- Is it safe? – what do we know from the medical history
- Is it legal? – do we have valid consent
The Equality Act (2010) harmonises and replaces previous legislation (such as the Race Relations Act 1976 and the Disability Discrimination Act 1995). The Equality Act (2010) covers:
- Age
- Disability
- Gender reassignment
- Race
- Religion or belief
- Sex
- Sexual orientation
- Marriage and civil partnership
- Pregnancy and maternity
What is the adults with incapacity act?
The Adults with Incapacity (Scotland) Act 2000 is an Act of the Scottish Parliament. It was passed on 29 March 2000, receiving royal assent on 9 May. It concerns the welfare of adults who are unable to make decisions for themselves because they have a mental disorder or are not able to communicate.
When did England and Wales release their own mental capacity act?
2005
There shall be no intervention in the affairs of an adult unless the person responsible for authorising or effecting the intervention is satisfied that the intervention will benefit the adult and that such benefit cannot reasonably be achieved without the intervention. This principle is taken from subsections 2 – 4 from which Act?
Adults with incapacity act – this principle states that whatever decision is made for the person who is incapable of acting, must benefit the person and not the person making the decision.
Where it is determined that an intervention as mentioned in subsection (1 The adults with incapacity act) is to be made, such intervention shall be the least restrictive option in relation to the freedom of the adult, consistent with the purpose of the intervention. What does the bold statement mean?
Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms. This is called finding the “least restrictive alternative”.
In determining if an intervention is to be made and, if so, what intervention is to be made, account shall be taken of (4 accounts) what are they?
(a) the present and past wishes and feelings of the adult so far as they can be ascertained by any means of communication, whether human or by mechanical aid (whether of an interpretative nature or otherwise) appropriate to the adult
(b) the views of the nearest relative [F1, named person] and the primary carer of the adult, in so far as it is reasonable and practicable to do so;
(c) the views of—
(i)any guardian, continuing attorney or welfare attorney of the adult who has powers relating to the proposed intervention; and
(ii)any person whom the sheriff has directed to be consulted,
in so far as it is reasonable and practicable to do so; and
(d) the views of any other person appearing to the person responsible for authorising or effecting the intervention to have an interest in the welfare of the adult or in the proposed intervention, where these views have been made known to the person responsible, in so far as it is reasonable and practicable to do so.
For the purpose of this act (adults with incapacity act), and unless the context otherwise requires – “adult” means a person who has attained the age of 16 years; “incapable” means incapable of?
- Acting; or
- Making decisions; or
- Communicating decisions; or
- Understanding decisions; or
- Retaining the memory of decisions,
An IQ less than 70 indicates what?
Learning disability
The severity of learning disability can be broken down to three categories, mild, moderate, and severe. People with mild cases of learning disability can talk and look after themselves. What are the associated features of learning disability?
- Epilepsy
- Hearing and speech disorders
- Visual defects
- Facial deformities
- Body-rocking and self-mutilation
- Feeding difficulties
What are the causes of learning disability?
- Genetic
- Problems during pregnancy
- Problems during birth
- Post-natal problems
What is the most frequent genetic cause of learning impairment?
Down syndrome
Which chromosome is responsible for down syndrome?
Extra chromosome 21. Researchers believe having an extra chromosome 21, disrupts the course of normal development.
Down syndrome is present in how many live births?
1 in 800
What increases the chances of having an extra chromosome 21?
Increases with mother’s age.
What are the physical features of down syndrome?
- Atlanto-axial joint instability
- Short stature
- Brachcephaly
- Widely spaced upward slanting eyes
- Weight gain
- Brushfield spots
Which image shows atlantoaxial instability?
B. The joint between the upper spine and base of the skull is called the atlanto-axial joint. In people with Down syndrome, the ligaments (connections between muscles) are “lax” or floppy. This can result in AAI where the bones are less stable and can damage the spinal cord.
What is Brachycephaly?
Brachycephaly, derived from the Greek ‘short head’, means the shape of the skull is shorter than average. A brachycephalic skull is flat in the rear. The crown of the head towards the back is often high, the baby’s face may be wide, and the ears can also protrude.
What are brushfield spots?
Down syndrome is associated with common characteristic features of the eyes. This includes upward slanting of the eyelids, prominent folds of skin between the eye and the nose, and small white spots present on the iris (the colored part of the eye) called Brushfield’s spots
What are the associated health conditions of down syndrome?
- Cardiac problems
- Spinal problems
- Malignant disease
- Dementia
- Immune disease
- Hearing loss
- Visual defects
- Seizures
What are the oral features of down syndrome?
- Large tongue
- Thick, dry and fissured lips
- Poor anterior oral seal
- Tongue thrust
- Early onset periodontal disease
- Cleft lip and cleft palate
- Malocclusion
- Delayed tooth eruption
- Missing teeth
- Morphological abnormalities
What is fragile x syndrome?
is a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. FXS is caused by changes in a gene called Fragile X Messenger Ribonucleoprotein 1 (FMR1). FMR1 usually makes a protein called FMRP that is needed for brain development. People who have FXS do not make this protein. Occurs in 1 in 4000 males and 1 in 8000 females, with males experiencing more severe symptoms.
What are the dental aspects of fragile x syndrome, dental management difficult due to?
- Short attention span
- Hyperactivity
- Behavioural disorders similar to autism
- Abnormally frequent open bite and crossbite
What is Cri du chat syndrome (CdCS or 5p-)?
is a rare genetic disorder in which a variable portion of the short arm of chromosome 5 is missing or deleted (monosomic). Symptoms vary greatly from case to case depending upon the exact size and location of the deleted genetic material. Affecting 1 in 30000 births.
What are the features of Cri du chat syndrome?
- High pitched cry
- Microcephaly - a condition where a baby’s head is much smaller than expected.
- Micrognathia – a condition where the lower jaw is undersized
- Wide set eyes
- Webbing or joining together of fingers and toes
- Slow development of motor skills, speech and language
A lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them, this statement is taken from which society?
National Autistic Society
Autism develops at a very early stage in life, when is it seen?
Usually begins in first 30 months of life. And is four times more in boys than girls.
What are the characteristics of autism?
- Poor social skills
- Lack of interpersonal relationships
- Delayed speech and language
- Ritualistic, compulsive behaviour
- Can have average or above average intelligence
- Learning disabilities
- ADHD or depression
- Epilepsy
- Other conditions – visual, hearing impairment
What are the clinical presentation of autism?
- Live in their ‘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
Some suspected risk factors for ASD include:
- having an immediate family member who’s autistic
- certain genetic mutations
- fragile X syndrome and other genetic disorders
- being born to older parents
- low birth weight
- metabolic imbalances
- exposure to heavy metals and environmental toxins
- a maternal history of viral infections
- fetal exposure to the medications valproic acid or thalidomide (Thalomid)
what are the oral findings in autistic patients?
- Bruxism – teeth grinding
- Traumatic lesions
- Poor oral hygiene
- Poor attendance
- Prefer sweet foods
What are dental management of autistic patients
- Patience
- Empathetic approach
- Oral hygiene education and support
- Previous training at school or home with visual aids
- Pre-visit packs and questionnaire
- Patient is not kept waiting
- Short, quiet visit with same staff
- Avoid aspirator, high-speed etc
- Have a parent or carer present
- Pain and anxiety control: LA, Sedation, GA
What is sensory impairment?
When one or more of a person’s senses is no longer normal: a person does not have to have full loss of a sense to be sensory impairment.
- Sight
- Hearing
- Smell
- Touch
- Taste
Blind and partially sighted come under visually impaired, how many people are registered blind or partially blind in the UK?
358,000
Symptoms of visual impairment are?
- Reduction or loss of vision
- Eye pain
- Burning sensation – optic neuritis occurs when swelling damages, the optic nerve
- Gritty feeling – also known as dry eye syndrome
- Blurring of vision
What is the normal intraocular pressure?
15-20mmHg
What is cataract?
Cataracts are when the lens, a small transparent disc inside your eye, develops cloudy patches. Over time these patches usually become bigger causing blurry, misty vision and eventually blindness. When we’re young, our lenses are usually like clear glass, allowing us to see through them.
Most cataracts develop when aging or injury changes the tissue that makes up the eye’s lens. Proteins and fibres in the lens begin to break down, causing vision to become hazy or cloudy. Some inherited genetic disorders that cause other health problems can increase your risk of cataracts.
What is macular degeneration?
Age-related macular degeneration (AMD) is an eye disease that can blur your central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye)
It’s generally caused by abnormal blood vessels that leak fluid or blood into the macula (MAK-u-luh). The macula is in the part of the retina responsible for central vision.
AMD is a very common cause of vision loss in older adults. Dry AMD makes up the majority of cases, progressing slowly and causing permanent vision damage. Wet AMD is rarer and more severe but also more treatable than dry AMD.
Which macular degeneration causes severe sight loss in a matter of months, due to the growth of new vessels under retina which then break and leak into the macula?
Wet macular degeneration.
Which macular degeneration is usually a bilateral condition, which develops overtime giving a gradual loss of central vision?
Dry macular degeneration.
What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes/hypertension or a combination of both, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight
As diabetic retinopathy progresses, new blood vessels may grow and threaten your vision. Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels.
What is hemianopia?
A hemianopia is where there is a loss of one half of your visual field. Hemianopia is caused by damage to the brain, for example, by a stroke, trauma or tumour. The extent of field loss can vary and depends on the area of your brain that has been affected.
What is trachoma?
Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. It is a public health problem in 44 countries and is responsible for the blindness or visual impairment of about 1.9 million people. Blindness from trachoma is irreversible
Trachoma is caused by certain subtypes of Chlamydia trachomatis, a bacterium that can also cause the sexually transmitted infection chlamydia. Trachoma spreads through contact with discharge from the eyes or nose of an infected person. Hands, clothing, towels and insects can all be routes for transmission.
Causes of hearing impairment include the following, which of these is the most common cause of hearing impairment?
- Inherited
- Congenital
- Infections
- Trauma
- Drugs
- Foreign bodies
- Excessive noises
Excessive noise (prolonged loud noise/industrial deafness)
What are the three types of hearing aids available?
- Behind the ear hearing aids
- In the ear hearing aids
- In the canal hearing aids
What is spina bifida?
Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD). Spina bifida can happen anywhere along the spine if the neural tube does not close all the way.
If there is no proxy and the patient is not deemed to have capacity for the particular decision then what do you do?
- Have an AWI (s47) certificate
- The s47 certificate authorises the treatment to go ahead.
