Special Needs Flashcards
Long lasting health condition that limits a person’t ability to see, hear, physical activity, mental capabilities
Impairment
limitations that represent a substantial disadvantage when attempting to function in society
Disability
group of malformations, deformations, and malformation Sequences, occur together due to some identifiable underlying cause
Syndrome
4 Models of Disability:
Traditional/Moral model
Medical/Rehab model
Social model
Integrative/disability (biopsychosocial model)
How many children suffer from Developmental Disability?
1 in 6
What is the most common developmental disability?
Affects _____ million people
____% have mild impairment
Cause usually unknown
Intellectual
6.2 - 7.5
87%
True
Developmental Disability manifests prior to what age?
describes _____ disabilities
22
life-long
4 most prominent Developmental Disabilities:
Intellectual
Cerabral Palsy
Epilepsy
Autism
2 trends affecting dental care for individuals w/ ID/DD
Increased life expectancy
Deinstututionalization
Collection of conceptional, social, and practical skills learned/performed by people in their everyday lives:
Adaptive Behavior
Language/literacy; money, time, numbers, self-direction:
interpersonal skills, social responsibility, gullibility, etc
activities of daily living, personal care, occupational skills, healthcare, travel, etc
Conceptual skills
Social skills
Practical skills
3 examples of individuals who can serve as a Witness to consent:
Dental assistant
Other dental staff
Non-relative of patient
3 types of Informed Consent:
Explicit
Implied
Specific
3 people that can provide consent if pt can’t:
Guardian
Medical Power of Attorney
Public Fiduciary
Failure to collect consent can result in what 3 things?
Criminal charges
Lawsuit
Negligent behavior
ADA - American with Disabilities Act, prohibits…
services to indivisuals w/ disabilities must be offered in most ______ setting appropriate to the needs of the individual (including dental offices)
discrimination on basis of disability
integrated
Wheelchair accessibility, minimum width of hallway:
_____ feet diameter to turn wheelchair around
Best to Tx pt where?
3 feet
5 feet
in chair
Remember to take _____ off chair, use sliding board when transferring pt
______ and ______ the chair
foot rests (and sides, leg holders)
position and lock
Behavioral Hx w/ caregiver includes what 4 things?
communication abilities
rxns to sensitive stimuli
steriotypic behaviors
previous dental/med experiences
in Behavioral Hx what is important to ask?
techniques/suggestions to distract pt during Tx
*music, game, etc
Pt should have what kind of environment for care?
Least restrictive possible
*most participation possible
Medical/Social Hx, oral hygiene ability, sitting time, sedation/anesthetic contraindications, ability/willingness for RPD, esthetics
Tx plan - whole person
Past exp. dental care
med conditions
meds taking - side effects
sensory impairments?
Know your pt!
3 types of sensory impairments:
Hearing loss
Visual
Hypersensitivity (sound, touch, lighting)
SOAP:
Subjective (CC, Hx)
Objective (clinical, radiographic, vitals)
Assessment (diagnosis, risk assess)
Plan (Tx, mods, procedures)
ID type/risk associated w/ dental procedure:
AAOM risk assessment
Risk assessment based on what 4 things:
Med Hx
Exam (vitals/clinical/radiographic)
Lab/diagnostics
Consultations
3 questions to ask in Risk Assessment:
likelihood of adverse event during procedure
nature/severity of adverse event
appropriate setting for Tx
4 Purposes for Medical Consult:
Request evaluation (systemic disease)
Specific info (Tx mods)
Determine if dental Tx prudent
Request change in pts therapy
1 reason NOT to get consult:
clearance/permission
Good Med Consult must be concise, specific, request only ________
Avoid asking clearance, use a _______
Know current protocols/guidelines, inform physician of ______ and ________
contact info for dental provider/physician, and get Pt’s ________
pertinent facts
checklist
diagnosis, planned Tx
informed consent for info release
What is the most common malformation syndrome?
Trisomy 21
Mean IQ Trisomy 21:
often equivalent to _____ grade level
Congenital heart defects in _____%
Impaired immunity from decreased _______ function
Hypothyroidism in ______ %
_______ anomalies common
Atlanto-axial instability in ______%
50
6th
40-50%
neutrophil
16-20%
Airway
14%
Trisomy 21 Increased incidence of what 5 dental deficits:
Missing LI’s
Peg laterals
Excessive spacing
short rounded roots
Maxillary hypoplasia
Maxillary hypoplasia in Trisomy 21 causes _______
Class ______ malocclusion
What tooth anomaly:
increased incidence of _____ disease
Relative _______
Perio disease present when?
crowding
III
Taurodontism
perio
macroglossia
early childhood
Chronic disorder of movement/coordination, caused by injury to the immature brain during prenatal/perinatal period:
Damages ____ areas of developing brain
Is a ______ encephalopathy
Cerebral Palsy
Motor
Static
CP, Spastic ____%
Dyskinetic/Athetoid _____% (low tone, loose, uncontrolled)
Ataxic _____% (balance, depth perception)
70-80%
10-15%
less than 5%
Most common type of Dementia:
Alzheimer’s
% Dementia: Alzheimers:
Mixed Alzheimers/Vascular:
Lewy Body Variant:
Frontal Temporal
Vascular
Brain injury
40-65%
20-40%
25%
10-20%
10-20%
4%
T/F
infection, teratogens, trauma, multiple births, seizures, illness, premature birth, low birth weight, intracraneal hemorrhage, hypoxia/bradycardia, hyperbilirubinemia are risk factors for CP
True
Umbrella term for Progressive genetic diseases degenerating skeletal/voluntary muscles
*cardiac muscle/other involuntaries may or may not be involved
Muscular Dystrophy
7 most common types of neuromuscular disorders (Muscular Dystrophy)
Duchenne
Becker
Fascioscapulohumeral
Emery-Dreifuss
Limb-girdle
Myotonic dystrophy
Congenital
Describe oral characteristics of Muscular Dystrophy:
Can include what 3 oral manifestations:
Mx/Mn arch consideration:
Similar to CP b/c pts w/ gait problems are at increased risk for dental trauma:
variable, progressive (depending on disease severity)
ant open bite, MACROglossia, sialorrhea
expansion
True
What type of seizure is brief, shock-like, and usually does NOT affect consciousness
Myoclonic
Myoclonic seizure affects neck, shoulders, ____ arms, body, and ____ legs
Duration:
Consciousness:
EEG:
upper, upper
less than 1 second
not usually impaired
polyspike and slow wave discharge
T/F
Even pts compliant w/ meds have breakthrough seizures
True
Breakthrough seizures can be related to physical stress/pain
True
4 possible triggers for Breakthrough Seizures:
LA overdose/inadvertent intravascular injection
Hypoxia secondary to vasovagal syncopy
hypoglycemia/insulin OD
Cerebral vascular accident/Transient ischemic attacks
2 Anticonvulsants and their side effects:
Phenytoin - gingival hyperplasia
Carbamazepine - xerostomia/stomatitis/increased caries
Phenytoin, consider use of ____ and ______
Carbamazepine, consider using ______ to reduce caries from xerostomia
CHX, folic acid
topical fluoride
T/F
It is important to determine if the masticatory apparatus is involved in a seizure
True
4 conditions upon which seizure pt can be treated:
Seizure free (w/ or w/o meds)
Rare seizures (less than 1/yr)
not involve masticatory apparatus
no special needs
What 2 seizure types do not involve the masticatory apparatus?
absence
myoclonic
2 seizure conditions requiring special consideration for dental Tx:
involves masticatory apparatus
generalized tonic-clonic
If seizure, Place dental chair in what position?
place pt on what side?
if seizure lasts more than ____ minutes, call 911
can administer _____ L/min Oxygen if pt cyanotic
if lasts longer than ___ min, Status Epilepticus
supine (low to floor)
left
3
6-8
5 min
3 types of single gene disorders:
auto dom
auto rec
x-linked
OI (osteogenesis imperfecta) inheritance:
mutation is genes that code for what?
clinical class system developed in 1970 by David ______
Autosomal Dominant
type I collagen
Sillence
OI defect at ______ on chromosome 17
______ on chromosome 7
Col1A1
Col1A2
4 factors determining effect of teratogen:
timing
length
species
genetic predisposition
What type of inheritance is responsible for the largest percentage of birth defects?
Multifactorial
3 multifactorial diseases:
Asthma
Coronary artery
Alzheimers
4 categories of craniofacial disorders:
craniosynostosis syndromes
clefting syndromes
branchial arch disorders
dental, gingival, perio (syndromes)
T/F
There are no specific genetic, medical lab tests available for autism and Diagnosis is based on behavior
True
In ASD there is enormous variation on _____ patterns and _____ of symptoms
behavioral
severity
ASD etiology:
unknown
*genetic, neurotransmitter defect, infection, metabolic errors, immunologic, environmental - all theories
5 Indications for further eval (ASD):
no babbling, cooing by 12 months
no pointing, waving, grasping by 12 months
no single words by 16 months
no 2 words by 24 months
loss of language/social skills
6 characteristics ASD:
insistence on sameness
repetitive (stereotypical) movements
unresponsive to verbal cues, no eye contact
difficulty expressing needs
social situation difficulty
attachment to objects
6 impairments of ASD:
sensorimotor
echolalia
no symbolic thinking
self-injury
intellectual disability
seizure
ASD, ____% have intellectual disability
____% have seizures:
70%
30%
4 behavior management strategies for ASD:
Hx
peculiarities/stereotypic
communication
noise, touch, light sensitivities
ASD, after Hx, before Tx:
desensitization (familiarize w/ dental environment, staff
3 Behavior management strategies:
Tell-show-do
immediate positive/neg reinforcement
Modeling (sibling)
ABA
Medical immobilization, sedation, general anesthesia
applied behavioral analysis
*behavioral management ASD
3 reasons for medical immobilization:
uncooperative due to lack of maturity
unable to cooperate due to mental/physical disability
safety of pt/practitioner
Some ASD pts like restraints, others don’t, be sure to obtain…
consent from guardian
How many americans have a disability?
50 million
Premedicate in what 4 conditions?
Prosthetic heart valve
bacterial endocarditis hx
heart transplant w/ valvulopathy
congenital heart defects
Dementia is the deterioration of mental faculty due to what?
organic disease/disorder of brain
Dementia is defined by what?
severity to interfere w/ daily functioning
Dementia is characterized by multiple cognitive defects, memory impairment, and at least one of the following 5 disturbances:
aphasia (idea)
amnesia
agnosia (objects)
apraxia (coordination)
executive functioning (goal directed behavior)
Prevalence Alzheimers increases w/ age, but most often above…
Avg lifespan of people w/ Alzheimers:
65
8-10 yrs
investigates/resolves complaints of residents in nursing facilities, board and care facilities, etc
long-term care ombudsman program
Every year ____ million older americans are victims of elder abuse
every case reported, probably ____ not reported
abused elders tend to die earlier
2.1
5
True
Elder abuse, dentist should report to…
Academy of general dentistry, dentists 1st line of defense, must take action
Adult Protective Services
True
Trauma, injuries, bruising, confinement, isolation, passivity, depression, anxiety, large financial withdrawals, unpaid bills
think elder abuse
Warning signs of Elder Abuse may include what 3 things?
Bleeding gums
poor dentition
oral hygiene
Reporting abuse, dentist required to take photographs, include _______
if you’re guilty of not reporting, it is a….
radiologic exams
class 1 misdemeanor
