Special needs Flashcards
definition of special dental needs
what are the different types of special needs ?
are the number of children with dental special needs increasing
yes because we are having and increase in survivors
give eg of high risk patients
previous caries
socio economic
non eng speaking
diet/fluoride
give eg of high priority
neurodisability
medically compromised
which conditions can cause enamel defects ?
what are the direct ways in which chemotherapy causes oral problems ?
directly caused by drug - methotrexate mucositis
can cause dryness
diet changes so they can drink more or eat more sugary things to keep appetite up
we can see pattern of caries
what are the problems with enamel defects ?
what are the indirect ways in which chemotherapy causes oral problems ?
list some oral problems associated with radiotherapy ?
what are some long term effects of oral oncology in patients ?
give eg of some conditions in which dental diseases may have more serious implications ?
immunocompromised
congenital heart disease
give eg of how children with conditions may be more difficult to treat
- require additional precautions= drug interactions, immunosuppressive therapy, warfarin
- behavioural issues= social issues, support services
- require GA
how do we history take?
- verbal
- correspondance = ppl involved in their care eg. GP, specialists
- other records
- get to a diagnosis
how do we determine how bad a condition is ?
severity
stability
past history
future plan
what questions would we ask a parent of child who has asthma ?
who looks after them?
any specialist involvements
what questions do we ask a parent who’s child has cardiac problems
who looks after them?
any specialist involvements
what q’s should we ask ourselves when dealing with asthmatic or cardiac patients ?
indications v contraindications
GA v LA
precautions
what is our prevention plan
diet
OHI
fluorides
fissure sealants
how often should we monitor ?
4 month recalls
- involve parents
- be flexible
- multi disciplinary
what is a disability?
Physical or mental impairment
Substantial and long-term adverse effect on ability to carry out day-to-day activities
give eg
Sensory
Fluctuating or recurring
Progressive
Auto-immune
Organ specific
Developmental
Learning disability
Mental health conditions
Produced by injury to the body
give examples of reasonable adjustments
Is there a time of day that is better?
Would your child be better with a side room?
Are there any sounds that your child is sensitive to?
list the different categories of disabilities
- emotional needs
- oral developmental problems too eg. cleft
give definition of intellectual impairment
- lower 1Q less and 70
- Significantly reduced ability to:
understand new information
learn new skills
cope independently
Causes :
Unknown
Down Syndrome
Microcephaly
Birth Anoxia
what is down syndrome?
- caused by trisomy 21 = third copy or part of a third copy of 23rd chromosome
- Prevalence = 1:1000 live births
Associated with :
Intellectual impairment
Hypotonia
Congenital heart disease in 30-40%
Increased risk of acute leukaemia
list some characteristic craniofacial features founding down syndrome
Craniofacial features:
Oval, flattened face
Flat nasal bridge
Flat occiput, short neck
Epicanthic folds, upward slant to eyes
Straight hair
Short dysplastic ears
list some oral features in Down syndrome
Large, protruding, fissured tongue
Small maxilla, Class III malocclusion
Small, conical or malformed teeth
Abnormalities in tooth number
Delayed eruption of permanent teeth
Prone to periodontal disease
define a physical impairment and give examples
A condition that affects a person’s body, resulting in a loss or reduction of the way their body functions.
E.g.
Cerebral Palsy
Muscular Dystrophy
Juvenile rheumatoid arthritis
Could also include sensory impairments such as:
Visual impairment
Hearing impairment
what is cerebral palsy?
- caused by an abnormality or disruption in brain development
- Group of disorders affecting movement, muscle tone, balance and posture.
- May be associated with intellectual impairment but not always.
Wide variety of presentations - can be due to genetic changes infections during pregnancy eg, herpes and chicken pox, disruption in blood supply to brain of fetus or reduced 02 to brain during birth or premature birth
- some maybe unable to walk, need crutches or wheelchair
what are some general features of cerebral palsy ?
Abnormal muscle tone
Spasticity
Athetosis = abnormal muscle contractions
what can be associated with cerebral palsy
Epilepsy or seizures
Eating or swallowing difficulties
Sensory impairment
Intellectual impairment
list the dental considerations of cerebral palsy
Difficulty chewing and swallowing
Increased salivary flow
Difficulty using a toothbrush
Gag reflex
Gingival overgrowth due to seizure medications
Lip, tongue and cheek biting
Difficulty with jaw muscles
list some medical impairments in which 1% of children have
Heart disease
Bleeding disorders
Diabetes
Kidney disease
list some other medical conditions
Cardiac Disease
Respiratory Disease
Bleeding disorders
Diabetes
Organ transplants
Malignancy
Some drugs (e.g. steroids, anticoagulants)
what are the 2 different types of congenital heart defects?
Cyanotic heart defect = tetrology of falla and transposition of the great arteries = reduced amount of 02 around body = buleish skin (cyanosis)
Non-cyanotic heart defect = ventricular septal defects and atrial septal defect
what can pts with heart defects be at an increase risk of?
- infective endocarditis
- may have compromised stress tolerance
- need to manage anxiety
- best to do all treatment under GA
- need to research their conditions, diagnosis, find out planned surgeries, their cardiologists, Are they at risk of infective endocarditis?
Are they at increased risk of GA?
list the different types of blood disorders and wet are the considerations
Polycythaemia (erythrocytosis)
Thrombocytopenia
Sickle-cell anaemia
Von Willebrands
Haemophilia
Consider:
Anticoagulation / clotting
General anaesthetic = ppl with SCA have complications with GA
how can we adapt our communication with pts with sensory impairment
Makaton
BSL
Lip reading
Hearing loops
Reducing background noise
Interpreters
Written or verbal information
what is a neurodevelopment disability
Difficult to define.
Lifelong conditions believed to be caused by differences in brain development.
E.g.
Autism
ADHD
dyslexia
dyscalculia
dyspraxia
what is autism ?
Persistent deficits in social communication and interaction, and restricted, repetitive behaviours, interests or activities. (DSM-V)
Prevalence = 1 in 100
Males to Females 4:1
Can be associated with a learning disability- not always
what is it like to be autistic ?
Sensory sensitivities
Restricted and Repetitive Interests
Social communication difficulties
how to manage autistic pts ?
- speak in shorter sentences and give them time to process info
what are the oral implications of autism ?
Difficulty complying with toothbrushing advice (may not like the taste, don’t like sound of brushing) = can use 3 sided toothbrush or use tooth paste with no flavour like oronurse
Difficulty complying with diet advice = if they’re safe food isn’t available they won’t eat
Difficulty attending the dentist = overwhelming sensory input
Difficulty accepting dental care
Increased levels of untreated dental caries and gingivitis
May experience dental trauma- stimming / challenging behaviour
how can we detect emotional needs in pts
SEMH = social emotional mental health needs
Abuse/ Neglect /NAI
Anxiety and school refusal
may show anger/ frustration/ being withdrawn
list eg of oral developmental problems
Ectodermal Dysplasia
Cleft lip +/- palate
what is ectodermal dysplasia
- more than 180 types
Primary defect of two or more structures derived from ectoderm:
Skin
Hair
Nails
Sweat glands
Teeth
Group of inherited disorders
what is hypohydrotic ectodermal dysplasia ?
1 in 100,000
Commonly X-linked
Affects: Sweat glands and teeth
Absent sweat glands = easily hyperpyrexic
describe the oral features of hypohydrotic ectodermal dysplasia
Absent teeth (primary and secondary)
Abnormal tooth morphology
- Conical
- Small
- Peg-shaped
what is cleft lip and palate ?
Failure of the medial nasal and maxillary prominences to fuse
1 in 700 births in UK
Detected on 20 week ultrasound
Can be unilateral or bilateral
what are the complications of cleft lip ?
Complications:
Feeding difficulties
Speech problems
what q’s do we ask with pts who have cleft lip palate
- need to know who treated the pt?
- Nature and severity of defect
- What treatment needs to be done?
- teeth can erupt in the cleft and they need to be extracted
- dental anomalies of shape and number of teeth can be seen
What dental problems do children with special needs face?
- same challenges as someone who doesn’t have special needs
At risk of:
- perio
- crowding
- caries
- vdevelopmental anomalies
- dental anxiety
common dental problems in ppl with special needs
- untreated caries for undiagnosed due to hard to accept dental examination or tx
- plaque control = poor manual dexterity so poor perio
- experience in loads of medical procedures so can be wary of tx and so increase dental anxiety
- medication with sugar
- diabetic pts may need to have regular sugary snacks to maintain blood glucose = balance is needed between prevention and managing a hypoglycaemic event
what is our prevention plan
advice given to pt and parent
1) brush last thing before bed and one other time in the day
2) spiting don’t rinse
3) high risk = 1350-1500 ppfm up to age 10 or 2800ppmf 10-16 yrs
4) oronurse instead of flavoured toothpaste
5) children with ulceration can have toothpaste that doesn’t contain SLS
6) children age 7+ can use fluoride mouth rinse another time after or before brushing
7) eat well diet guide and less snacking
8) FS applied as soon as permeant teeth erupt
how can we tx plan with special need pts
1) Consent - consider their capacity
2) plan without the disability first
3) modifications to plan
what are the general challenges with special need pts
- some children may need time to process infant instructions
- some may need diagrams = widget health good for communication
- physical access wheel chairs / disables parking = wheelchair tipper maybe used
- some struggle when routine is changed
- transfer to dental chair maybe difficult
- document how u will treat the pt
- if child cannot lie supine - difficult
- some pts may have anxiety or exhibit unwanted movements and may be unsafe providing dental treatment whilst theyre awake
who can treat special needs children?
General Dental Practitioners (GDP) Level 1
Community Dental Service (CDS) Level 2 or 3
Hospital Dental Service (HDS) Level 2 or 3
what is level 1?
General dentist.
Treatment that can be completed by someone who has undertaken foundation training.
what is level 2?
Treatment/patient complexity requiring a clinician with enhanced skills, may be a specialist.
what is level 3a?
Treatment/patient complexity to be treated or managed by a specialist in Paediatric Dentistry (on GDC specialist list)
what is level 3b?
Treatment/patient complexity to be treated or managed by Consultant in Paediatric Dentistry
what is community dental service?
Paediatric Dentistry
Special Care Dentistry (Adults)
Prison Dentistry
Urgent Dental Care
what is hospital dental service?
- level 2, 3a and 3b
Consultants in:
Paediatric Dentistry
Special Care Dentistry
Hospital-based consultant service:
Specialist advice and treatment
Postgraduate training
