SPECIAL NEEDS (7/10/13) Flashcards
Special needs 2:
define Disability?
A disabled person is someone with a physical or mental impairment which has a significant and long-term adverse effect on his/her ability to carry out normal day to day activities. So, Reasonable adjustments may need to be made to enable people with disability to be able to access health care.
Special needs 2:
dental services should be provided in a way that:
- Recognises everyone as an individual
- Recognises that everyone has a right to participate in decisions that affect their lives
- Support them to enable everyday living including adequate healthcare
Special needs 2:
define Children with special dental needs?
A child has a condition that:
- Puts his general health at risk if he/she suffers dental disease and needs dental treatment
- Makes his access to dental care difficult
- So, makes providing a dental treatment difficult
So, makes the dental disease more likely to occur and progress
Special needs 2:
types of disability?
Intellectual impairment
Physical impairment
Medical impairment
Sensory impairment
Emotional
Oral development problems
Special needs 2:
Intellectual impairment:
mention Prevalence, Classification according to IQ scoring, Causes:
- Prevalence = 2-3%
- Classification according to IQ scoring (normal IQ = 80-120):
1) Mild to moderate (IQ 50–70)
2) Severe to profound (IQ <50 )
- Causes:
Many cases lack of well-defined aetiology (poorly understood) but there are some causes are well-known:
1) Down’s syndrome (Most common genetic cause of intellectual impairment)
2) Fragile X syndrome
3) Cerebral Palsy (They may have intellectual impairment but often IQ is normal)
4) Birth Anoxia (low O2)
5) Autism (Autistic Spectrum Disorder “ASD”) including Asperger’s syndrome (not always):
→ Although Autism (Autistic Spectrum Disorder “ASD”) can be a cause of intellectual impairment but Asperger’s syndrome which is a High Functioning Autism could have IQ>70 which means there is no intellectual impairment but they will suffer from Behavioural and communicative disorders, so still being special needs
6) Meningitis
7) Rubella
8) Microcephaly
Special needs 2:
what is Down’s syndrome, implications and features
Down’s syndrome (Most common genetic cause of intellectual impairment):
→ Trisomy 21 defect (chromosome 21 has 3 copies instead on 2) occurs in 1:1000 live births, leading to:
a) Intellectual impairment (very variable)
b) Hypotonia (muscle movement difficulty)
c) Cranio-facial anomalies:
- Oval and Flattened face, Flat occiput, Short neck
- Straight hair, Epicanthic folds with upward slant to eyes, Flat nasal bridge and Short dysplastic ears
d) Abnormal hand creases
e) Abnormal tooth morphology, Abnormalities in tooth number, Delayed eruption, Small, conical or malformed teeth, Small maxilla, Class 3 malocclusion, Large, protruding, fissured tongue
f) Less likely to develop dental caries but more prone to periodontal disease
g) Congenital cardiovascular disease in 30-40%
h) Increased risk of acute leukaemia
Special needs 2:
Physical impairment types?
► Physical impairment:
1) Cerebral Palsy (most common)
► Musculo-skeletal disorders:
1) Muscular Dystrophy
2) Juvenile rheumatoid arthritis (Stills Disease)
► Visual impairment
►Hearing impairment
Special needs 2:
what is Cerebral Palsy?
A motor manifestation of cerebral damage due to birth anoxia (low O2), leading to Abnormal muscle tone and reflexes (Spasticity and Athetoid “Uncontrollable movement”).
Special needs 2:
mention what medical impairment do children might have?
1) Heart disease (Childhood Cardiac Diseases):
a) Congenital Heart Defects
b) Cyanotic heart disease
c) Endocarditis
d) Poly-cythaemia
e) Thrombo-cytopenia
f) Abnormal clotting and anti-coagulants
2) Bleeding disorders
3) Respiratory Disease
4) Kidney disease
5) Diabetes
6) Organ transplants
7) Malignancy
8) Using Drugs (Steroids, Anti-coagulants)
Special needs 2:
Sensory Impairment types:
1) Blindness
2) Visual impairment
3) Deafness
4) Deaf-Blindness
5) Speech and Language delay
6) Sign Language User
7) Hearing impairment
8) Background noise
9) Multi-sensory impairment
10) Communication aids
Special needs 2:
what are the causes of emotional needs?
1) Abuse
2) Neglect
3) Non-Accidental Injury
Special needs 2:
Oral developmental problems:
types and a brief about each one?
1) Cleft lip and/or palate:
→ Diagnosed either in uterus or at birth
2) Ectodermal dysplasia:
→ Large group of inherited disorders where there is a Primary defect of 2 or more structures derived from ectoderm (outer layer of embryo), leading to defects in Hair, Skin, Nails, Sweat glands and Teeth
Special needs 2:
what is Hypo-hydrotic Ectodermal Dysplasia?
Commonly X-linked inherited mutation occurs in 1:100,000 children where they have:
a) No sweat glands so easily become hyper-pyrexic (having High temperature)
b) Absent teeth (Both Primary and Permanent)
Abnormal teeth morphology (Conical, Small, Peg-shaped)
Special needs 2:
who is the high priority group?
Disabled children are more likely to get a disease (eg: caries)
disabled children with Dental disease may have more serious implications
Disabled children with disease are more difficult to treat
Special needs 2:
how a medical condition/disability affects the treatment plan?
Sometimes it can be helpful to formulate an initial plan ignoring the disability so you don’t get distracted by the disability. Then, discuss with the patient, parent or carer and modify the plan based on their needs. Then, take their CONSENT (check who has Parental Responsibility and/or mental capacity)
All children with a medical condition should be considered to be high priority for dental prevention
Special needs 2:
children with special needs require Full prevention programme (the 4 pillars of prevention), mention them?
- OHI:
- Modification of Toothbrushing technique with e-TB with the correct handling way (Plaque control)
- Unflavoured non-foaming Fluoride toothpaste (Ora-nurse) can be tolerated
- Chlorhexidine MW
- Regular Professional cleaning
-
Patients are unable to brush their teeth, instruction should be given to their carer. Pts are able to brush should be encouraged to do so.
- Systemic / Topical Fluorides
- Fissure Sealants
- Dietary advice
Special needs 2:
what are the Challenges in delivering oral care?
- Dental health being of Low priority
- Difficulties in accessing dental care
- Difficult Communication and understanding:
- Lack of providing the necessary care
- Practical difficulties in delivery of dental care
- Fear and Anxiety
Special needs 2:
who are the Providers of dental care?
General Dental Practitioners
Community Dental Service (CDS)
Hospital Dental Service
Special needs 3:
What are the 4 pillars of Full Preventative programme?
OHI
Diet
Flourides
Fissure Sealants
Special needs 3:
What are the 2 divisions of Congenital heart disease in children?
Acyanotic
Cyanotic
Special needs 3:
Describe Acyanotic Congenital Heart Disease
Left to Right shunt
Blood does not bypass the lungs
Deoxygenated blood not found in systemic
Oxygenated – as it goes through lungs
Special Needs 3:
Describe Cyanotic Congenital Heart Disease
Right to left shunt
Blood bypasses lungs
Deoxygenated blood found in systemic circulation
Cyanosis
Special Needs 3:
What are the 4 key features of Tetralogy of Fallot?
Ventral septal defect (VSD)
Right Ventricular Hypertrophy
Pulmonary stenosis
Overriding aorta
Special Needs 3:
Name top 2 oral bacteria that are a significant cause of Infective Endocarditis?
Viridans streptococci
Staphylococci
