Special needs Flashcards
what is Down syndrome ?
- Most frequent genetic cause of a learning disability.
- Error in cell division resulting in an additional third chromosome 21 (trisomy 21)
- Trisomy 21 – 92%
- Mosaic (mixture of some cells with 3 and some a pair) Trisomy 21 – 2-4%
- Translocation (where one chromosome breaks off and watches to another) Trisomy 21 – 3-4% (carries increased likelihood of DS in future pregnancies)
what are the characteristics of someone with downs syndrome?
Short Stature
Bradycephaly
Widely spaced eyes
50% have a congenital heart defect
Ten-fold increased risk than the general population of
developing a seizure disorder
Increased risk of early onset Dementia or Alzheimer’s
Disease
Atlantoaxial instability – meaning the neck must be handled (should reconsidered when on dental chair)
correctly as there is a risk of spinal cord depression
90% have hearing deficits
Children with DS are 15 more likely to develop Leukaemia
Multiple immune defects putting them at increased risk of
developing periodontal disease.
- delay in wound healing
what is fragile x syndrome ?
- affects 1 in 1500
- second most common genetic defect associated with learning disabilities
- tip of the X chromosome is fragile and susceptible to breakage
- sex linked dominant trinuleotide repeat disorder on fmr1 gene
- other eg are Huntingtons disease and freidrichs ataxia
what are the characteristics of someone who has fragile X syndrome ?
- learning disability
- long face
- prominent ears and forehead
- hypotonia
- high arched palate/ malocclusions
- large testes
- seizures in 10% hyperactivity and attention span disorders eg. ADHD or autism in 1:3
- behavioural disorders
what is Williams disorder ?
- A rare genetic disorder affecting 1 in 18,000 people in the UK.
- Deletion of elastin gene on Chromosome 7
- Non-hereditary genetic abnormality
- Commonly associated with a LD
what are the characteristics of Williams syndrome?
Facial characteristics: wide mouth, pronounced bottom lip, flattened nasal bridge, high rounded cheeks, irregularly spaced dentition, starburst eyes.
Commonly have a congenital heart defect (narrowing of the aorta)
Delayed growth and failure to meet development targets in life.
Excessive talking and hyperactivity with uninhibited behaviour and over friendliness with strangers including a compulsion to talk to adults (often inappropriately).
Exaggerated reactions to happiness/sadness/fear.
Can develop depression/mental health issues in later life
- dentally = small mouth and teeth
- can have inappropriate convos with adults
what is triple x syndrome ?
- Trisomy X or XXX Syndrome where females have an extra chromosome X.
- Is relatively common affecting 1 in 1000 live births in the UK
- Many don’t have symptoms or will have mild symptoms and will go on to lead a normal life.
what are some symptoms of triple x syndrome?
Delayed speech development and motor skills, failure
to meet developmental targets
Learning Disabilities of varying degrees.
Behavioural problems such consistent with ADHD or
Autism
Mental Health issues are common such as depression
and anxiety
Epicanthal folds with upward slanting palpebral
fissures (as in DS).
Classic features: Hypertelorism, Tall, Early menopause,
weak muscle tone, dental abnormalities.
Increased risk of developing sleep apnoea, asthma,
scoliosis, lupus and Sjogren’s.
what is prader will syndrome ?
Genetic Condition related to partial chromosome 15 deletion (paternal).
Prevalence in the UK is estimated to be between 1:10-30,000
what are does of the symptoms of prader willi syndrome?
Most will have mild to moderate learning disabilities.
Hyperphagia (over-eating/insatiable appetite) resulting in diabetes and obesity.
Mental Health issues such as temper outbursts, stubbornness, compulsive behaviours, controlling and manipulative behaviour, have difficulty changing their routine.
Delayed development and poor growth as a result;
short stature, small hands and feet.
Poor muscle tone, feeding difficulties as a child
Narrow forehead and almond shaped eyes with a
triangular mouth
- because theyre obese may have to refer to bariatric dental service
- if they have diabetes may be more prone to perio, post extarction healing
what are some dental aspects to consider that re relevant to DS?
dental summary for DS
what are the 5 principles of the MCA
- assume capacity (unless they lack)
- make reasonable adjustments (make things easier for them to understand eg. removing jargon)
- unwise decisions (just because they make unwise decisions doesn’t mean they lack capacity)
- best interests decision ( the decision must be in the pts best interest)
- least restrictive ( managing the pts care in the least restrictive way possible eg. instead of using GA where they are fully unconscious give LA where they are fully conscious however if the pt lacks capacity and has severe learning disabilities and GA is the only way you can safely provide care
what test do we do to assess capacity ?
2 stage test
1) do they have an impairment or disturbance in the functioning of the mind or brain
2) is this affecting their ability to
a) Communicate
b) Understand
c) Retain
d) Evaluate
Answering Yes to any of the above (a-d) indicates a lack of capacity
what is learning disability ?
- combination of an IQ below 70 and a difficulty with performing everyday activities such as:
▪ Household Tasks
▪ Managing Money
▪ Socialising
▪ Self-care
▪ Developing new skills
A learning disability is lifelong meaning it will affect that person for their whole life.
what is a learning difficulty ?
Learning difficulty does not affect intellect and is not necessarily lifelong, it also does not hinder performance of
everyday activities. Examples include:
▪ Dyslexia
▪ Dyspraxia
▪ ADHD
▪ Dyscalculia
what is a mild IQ?
IQ between 69-50 - many adults can maintain good social relationships and contribute to society
what is a moderate IQ?
IQ between 35-49 (in adults mental age is from 6-9 years old) – marked developmental delays in childhood but most are able to develop some degree of independence with self-care and maintain adequate communication/academic skills but may need varying degrees of support in order to live and work in the community.
what is a severe IQ?
IQ range from 20-34 (in adults mental age is from 3-6 years old) – they will need continuous support with all aspects of life including varying degrees of limitation in communication and self-care
what is a profound IQ?
IQ range of <20 (in adults mental age is <3 years old) – they will have a severe limitation in self-care, communication,
mobility and continence.
what are the causes of learning disabilities ?
- disruption of brain development either during pregnancy, labour/ childbirth or in early childhood
eg:
- Maternal illness in pregnancy
* Hypoxic injuries during child-birth
* Genetic disorders/conditions e.g. Trisomy 21
* Illness or injury in early childhood
LD stats ?
list some common conditions associated with a learning disability
- Downs Syndrome
- Williams Syndrome
- Autism
- Fragile X Syndrome
- Global Developmental Delay
- Cerebral Palsy
- Challenging Behaviour
what is autism spectrum disorder?
- persistent difficulties with social communication and social interaction” AND
- “restricted and repetitive patterns of behaviours, activities or interests” (this
includes sensory behaviour) AND - present since early childhood, to the extent that these “limit and impair everyday
functioning”.
Autism is a Spectrum Disorder, meaning the severity can vary from person to person.
Also important to note is that not everyone with Autism will necessarily have a learning disability.
what is the autism traid?
- Non-Verbal and Verbal Communication – literal interpretations of language with difficulty communicating with others and communicating their own thoughts.
- Social understanding and Social behaviour – difficulty with empathy,
dealing with and understanding social situations and inappropriate social
responses. - Imagination and thinking/behaving flexibly – difficulty in coping with a
change to routine, may pursue singular interests obsessively, excellent
memory with regards to their own interests, prefer solitary play as they
struggle with imagination.
Additionally, may be sensitive to sounds, smells, tastes and textures.
stats of autism in uk?
what is ADHD?
- a persistent pattern of inattention or hyperactivity and impulsiveness that has a direct impact on daily living.
- In the UK, ADHD is recognised as a long-term health condition and therefore falls under the Equality Act (2010). This means reasonable adjustments should be made so that they are not placed at a disadvantage to receive dental care in comparison to a non-disabled person.
characteristics of ppl with ADHD ?
▪ Careless mistakes and fails to give full attention when performing tasks.
▪ Seems to not be listening when spoken to directly.
▪ Trouble organizing tasks and activities.
▪ Easily distracted and forgetful.
▪ Often loses thing that are needed for activities (e.g. in school, pens, pencils,
books etc).
▪ Often fidgets, taps, squirms, inability to sit still.
▪ Talks excessively, interrupts or struggles to wait for their turn.
▪ May display challenging behaviours.
what are some of the dental considerations when dealing with someone with ADHD?
- May display inappropriate behaviours, disruptive behaviours or need
pharmacological adjuncts to enable dental treatment.
▪ Try to arrange appointments within their daily schedule and minimize disruption to routine.
▪ Avoid keeping them waiting, keep appointments short and use simple short sentences.
▪ LA is usually safe but avoid adrenaline if they are taking tricyclic antidepressants
or monoamine oxidase inhibitors as there is a risk of tachycardia or prolonged hypertension.
▪ Inhalation sedation is generally safe, however intravenous sedation may cause further disinhibition of behaviours and not be successful
which pts fall under special care dentistry?
what is SCD?
why is SCD important ?
- most need adjustments to be Abel to accept dental care
- eg. longer appts, being hoisted on dental chair, having things explained in different lang/ format, needing additional support in decision making etc
- GDP sometimes may not be enough for safe management
what is community dental service ?
- usually based in multiple clinics within a defined region
- has additional equipment eg. hoists, wheel chair tippers, bariatrics, banana boards, other mobility aids
- combination of paeds and SCD
- provide care under NHS and CBT, acupuncture, sedation and GA
