special care dentistry Flashcards
Cerebral Palsy
You are working as a General Dental Practitioner. The dental practice in which you work cannot be accessed from street level as it is situated in a building one level above ground.
A 24-year-old male with cerebral palsy, who uses a wheelchair, arrives with his carer and wishes to gain access to your dental surgery premises.
- Adjustments can be made to a building to improve access for someone using a wheelchair.
Name TWO adjustments that will allow a person in a wheelchair access to your above ground level dental practice.
(1 mark)
have a wheelchair lift or ramp
elevator access
- Legislation in the U.K. has sought to ensure that all new dental practice premises are built to allow people with an impairment or disability equal access.
(2 marks)
Equality Act 2010
- This gentleman could be described as being a person with a disability.
The definition of disability varies between the medical model and the social model. Briefly describe the difference between the two models in their definition of disability.
(2 marks)
the medical model defines disability as something that needs to be fixed or cured through medical interventions
social model highlights that disability is not caused by impairments but is also a product of inaccessible environments, discrimination, and societal attitudes.
the emphasis is on removing barriers and promoting inclusion and equality to enable individuals with disabilities to participate fully in society, regardless of their impairments.
- The patient is unable to communicate with you verbally. Due to his cerebral palsy he is unable to communicate using sign language or pen and paper.
List TWO other augmentative and alternative communication methods which could be utilised for this gentleman.
(2 marks)
picture communicating symbols/ makaton
BLS interpreter
communication boards or books
talking mat
communication apps
gestures
- Having gained consent from this patient, you are now required to examine him. You are unable to do this safely with him in his current position in his wheelchair. He is unable to weight bear.
Name TWO options that are available to allow for the improved positioning of this gentleman to allow for safe dental examination. (1 mark)
two person transfer into dental chair
portable patient lift
transfer board
hoist
- Having positioned the patient correctly, you are now required to access the patient’s mouth.
i) Which particular aspect related to his cerebral palsy may affect the dentist’s access to the mouth?
(1 mark)
spasticity / involuntary muscle movements
ii) What non-pharmacological adjuncts are available to overcome this and aid the dentist’s access to the mouth?
Name TWO aids.
mouth props / bite blocks
dental mirrors with retractors
Mark, a 50 year old male, attends your general dental practice. He has a diagnosis of Down’s Syndrome and was born with a congenital heart defect.
- List FOUR physical characteristics which are associated with Down’s Syndrome
(2 marks)
flatter facial profile
enlarged tongue
epicentral folds
upper slanting eyes
low muscle tone (hypotonia)
single transverse palmar crease
- To confirm a diagnosis of Down’s Syndrome a genetic test is undertaken. What genetic change is responsible for Down’s Syndrome?(1 mark)
extra copy of chromosome 21 - trisomy 21
- Mark requires the extraction of his remaining six teeth. Following assessment you decide he lacks the capacity to consent to this treatment.
List TWO medical aspects of Down’s Syndrome which may have resulted in his lack of capacity. (1 mark)
intellectual disability - ability to understand and process information
communication difficulties - may experience challenges in verbal communication, expressive language and understanding instructions
- Mark’s mother is legally registered as his Welfare Guardian.
Considering the Adults with Incapacity (Scotland) Act 2000, List TWO differences between a Welfare Guardian and a Welfare Power of Attorney? (2 marks)
Welfare Guardian is appointed by court whereas as welfare power of attorney is appointed by the person themselves when they still have capacity
Welfare Power of Attorney specifies which powers are granted where as welfare guardian is more broad spectrum of decision making
- Mark requires the removal of his remaining six teeth as a result of periodontal disease.List TWO features associated with Down’s Syndrome that are likely to have contributed to his periodontal disease? (2 marks)
poor OH due to dexterity
increased susceptibility to infections
delayed eruption
- Mark has previously experienced Infective Endocarditis. In line with SDCEP guidance he will require antibiotic prophylaxis for the removal of his 6 remaining teeth. He has no known allergies.
i) What antibiotic and what dose of antibiotic should be prescribed for Mark? (1 mark)
amoxicillin
3g oral powder sachet
60 minutes before the procedure
ii) When should you provide and observe Mark taking the antibiotics prescribed?
(1 mark)
prior to the appointment so they can be taken an hour before
someone from dental team or welfare guardian should observe for compliance
Mr Clarke is a 67-year-old who presents to your general dental practice complaining of black staining on his teeth. He is otherwise asymptomatic.
Mr Clarke received treatment for mouth cancer 15 years ago. This included surgery with adjuvant radiotherapy. He is currently disease free.
He is prescribed no medications.
1. List FOUR risk factors for mouth cancer
(2 marks)
smoking
excessive alcohol
HPV
sun exposure
poor OH
diet
previous cancer history
age, gender, genetics
- Mr Clarke received adjuvant radiotherapy to treat his mouth cancer. What TWO additional pieces of information do you require to know about the radiotherapy treatment he received? (2 Marks)
radiation dosage and duration
radiation field and target areas
- What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis (1 Mark)
exceeds 60 Gy
