Special Needs Flashcards
What are special needs?
Huge range of dx and disabilities where individuals require special help or care for a condition they have
What are main causes of disability in children?
congenital and and genetic
Who looks after teeth of those with mild disability?
General dentist - enhanced fee
if pt is anxious or more moderate then public dental services
Who looks after teeth of those with mod/severe disability?
specialise led PDS
HDS
or often shared care with GDP/HDS or PDS/GDP
What are some dental implications for children with special needs? 5
- fewer teeth (could be due to their condition affecting anatomy, or possibly due to difficulties in oral care)
- more untreated dental disease/caries
- greater prevalence of periodontal disease
- increased dental fear and anxiety (often precipitated from hospital appointments)
- more barriers to the delivery of dental care (complex health conditions, and difficulty accessing an appropriate service)
What are the impacts of dental disease in children with special needs? 5
- delayed diagnosis (difficulty conveying pain or presentation of disease is different, perception of pain, or possible difficulty accessing care)
- delayed management (other conditions may be more pressing and care sometimes involves a lot of planning, can also take a long time to build up to treatment)
- more multidisciplinary management (might take a lot of time to plan)
- greater risk of pain and sepsis (from delay in treatment)
- reduced quality of life
What qs must we consider when considering the care of a child with special needs?
What is getting in the way of this Childs wellbeing? - is it them? the parent?
what can I do to help them?
what can my profession to do help this pt?
what additional support can we offer to pt?
we can pick up phone and liase
What prevention strategies are key in special needs patients?
Ensure regular visits
good mouth care
safe eating and drinking habits
consider tx these pts as high risk caries pts
provide realistic helpful advice - aware that it is difficult
What are our aim in special need pts?
To provide support with normal oral function:
- eating
- speech development
- promote self esteem
- maintain good appearance
- confidence to smile
What are the issues with drooling?
Embarrassment
parental upset
skin irritation
aspiration
What condition may cause drooling?
Cerebral palsy
How can we improve salivation and drooling in special needs pts?
- speech and language therapy
- pharmacology
- surgical
How can we use SLT to manage drooling?
Improve lip seal
improve swallow
How can we use pharmacology to manage drooling?
botox injection, hycosine patches
What are some barriers to regular attendance in special needs pts?
- clashing with or finding time among other hospital appointments
- challenging behaviour and anxiety
- access to care
- frequent illness, preventing completion of care plans
- parental attitude to dental care
What are some potential barrier to mouth care in special needs pts?
- manual dexterity issues (CP)
- involuntary movements (CP)
- oral aversions (nil by mouth patients)
- sensory issues preventing OH such as taste and texture (autism)
what are some solutions to access difficulties for patients with special needs?
- planning appointments close to other hospital appointments by liaising with other HCP’s involved in their care
- use BMT to manage anxiety in both the patient and carer
- make sure to plan ahead for these patients, and make provisions such as disabled parking or early appointments to fit in with their schedules
- be empathetic and understanding that other care may be more pressing than dental care, and cancellation may be frequent
- challenge and engage parents in their child’s oral care
what are some potential barriers to dietary changes in children with special needs?
- they may have atypical food clearance due to musculoskeletal problems
- they may regurgitate foods
- they may have to be on a special diet for their condition
- they sometimes have to only eat pureed foods
- often taking sugary medications if oral suspensions
- treats are used as rewards
- sometimes it can be very difficult for some patients to change their routine and diet (autism)
What is disability split into?
Medical, physical, sensory and mental disability
What are some physical disabilites?
Cerebal palsy
spina bifida
muscular dystrophy
What are some medical disabilities?
Cardiac defect
oncology
bleeding disorders
What are some sensory disabilities?
blind, deaf, asd
What are some mental disabilities?
Impaired learning ability
ASD
What does cerebral palsy affect?
movement and posture
can also have visual, hearing, learning or speech epilepsy
What causes cerebral plays?
Brain damage occurring before during or shortly after birth
What types of cerebral palsy are there?
- spastic (most common, affecting the limbs often causing jerking movements)
- athetoid (swings between hypo and hypertonia of muscles, leading to limpness and stiffening)
- ataxic (problems with balance and co-ordination)
What other disabilities can those with CP have?
- spastic (most common, affecting the limbs often causing jerking movements)
- athetoid (swings between hypo and hypertonia of muscles, leading to limpness and stiffening)
- ataxic (problems with balance and co-ordination)
What are some dental features and considerations of cerebral palsy?
- poor oral hygiene, possibly due to inability to clean themselves or of their carer to do this properly
- gingival hyperplasia if taking anticonvulsant mediaction
- enamel hypoplasia
- bruxism
- malocclusions (commonly a class 2 IR with poor lip seal)
- dental trauma (could fall and not be able to protect their face, possibly at higher risk)
- drooling and salivation is common (lowers self esteem and can cause skin irritation and dry mouth)
- access to care (wheelchair bound)
- uncontrolled movement (can make accessing the oral cavity troubling)
- an enhanced gag reflex
What can anticonvulsant meds cause?
Gingival hyperplasia
How can we help issues with brushing for CP PTS?
Modified brushes - can take impressions of hands with IM
Why do CP pts drool?
Due to head forward posture - don’t swallow own saliva
and also have a malocclusion - class 2 due to poor lip seal
ANTERIOR HEAD TILT - most comfortable for them
What is the solution to pt having other appts preventing attendance?
collaborate and plan well
What is the solution to pt having challenging behaviour and anxiety preventing attendance?
empathise, understand, reassure, support, acclimatise, plan ahead
What is the solution to parking/access issues preventing attendance?
Plan ahead, work out suitable parking
What is the solution to pt having freq illness preventing attendance?
Empathise and support
What is the solution to PARENTAL ATTITUDES preventing attendance?
Influence positive chance, promote good knowledge, help make them confident in oral hygiene of their child
How can we help manage atypical food clearance?
collaborate, empathise, no judging, support and understand
How can we help manage food holding and regurgitation?
consider additional mouth care such as enhanced prevention
How can we help manage pureed foods?
consider 2800ppmF toothpaste
How can we help manage fortified foods?
set achievable goals in liaison with parent/carer/patient
How can we help manage use of sugary medicines?
work with other HCP to discuss alternative medications (e.g.sugar free)
What are some potential causes of congenital heart defects?
Mostly unknownbut could be linked to maternal drug use. cmv, rubella
What syndromes are associated with CHD?
Downs syndrome, marfans syndrome, elders danlos
What are the dental aspects of CHD?
At a greater risk of infective endocarditis
increased bleeding tendency if on warfarin or aspirin
higher risk under ga
care when using LA
What are some oral symptoms of cancer? (usually due to tx)
Mucosal gingival haemorrhage
gingival enlargement
mouth and throat infections
immunosuppression
thrombocytopenia
oral mucositis
developing dentition can be affected by chemo and radiotherapy
What are the most common bleeding disorders?
Von williebrands
haemophilia A
Haemophilia B
What is autism?
broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication.
What aids can we use for visual impairment?
Braille
What aids can we use for hearing impairments?
BSL interpreting service
hearing loops
What aids can we use for and?
macaron
widget symbols
picture boards
What is the definition of a learning disability?
State of arrested or incomplete development of the mind
significant impairment of intellectual, adaptive and social functioning
What is autism?
it is a lifelong neurodevelopment disorder that affects:
- social interaction
- social communication
- limited and restricted patterns in behaviour
What are the 3 main things those with ASD struggle with?
social interaction - don’t understand they way we do, must be direct, address them
communication - may be non verbal
behaviour - doesn’t like change, restricted eating patterns
What conditions are related to ASD?
ADHD
Downs syndrome
dyslexia
dyspraxia
learning disability
epilepsy
git issues
sleep disorder
What can people with autism take literally?
Verbal communication
What can we use for communication with non verbal autistic patients?
Makaton
pecs
widget
What are some likes of autistic pts in the surgery?
computer
water taps
dental unit controls
What are some dislikes of ASD pts in the surgery?
touch
dental light
noises
smells
textures
tastes
How do we prepare ourselves for an autistic pt?
Get a profile of likes and dislikes from parent or school so we can prepare appropriately
send out social story explaining dental journey - ie dental chair, waiting room, chair
send out plastic mirror - parent can show it to child
be ready and on time - if we can’t then pt can wait in car and we can phone when ready
de-clutter surgery
What is down syndrome?
Down syndrome is a genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21
What are the dental features of Down syndrome?
Maxillary hypoplasia
Class 3 occlusion due to maxillary hypoplasia
large tongue - macroglossia
anterior open bite
hypodontia/microdontial
predisposition to perio disease
What id macroglossia?
Large tongue
What medical conditions do those with Down syndrome have a higher risk of?
Cardiac defects
leukaemia
epilepsy
alzheimers
How can we get a good exam of pts with disabilities?
knee to knee
on parents lab - cuddled by parent
in wheelcahir
standing up
lying on floor
sitting on floor
brushing teeth no paste
parent holding their hands
What aids are available for brushing?
Finger props
open wide disposable mouth rests
two sided brushes
using two brushes - child bites down on one whilst we brush other side
What are some good toothpastes for pts with disabilities?
Oranurse
What is oranurse?
non foaming
flavour free
fluoride containing toothpaste
What other toothpaste can we prescribe to pts?
Duraphat 2800ppmF due to higher caries risk for those 10+ - supervised no swallowing
What must we show parents how to do?
OHI and demos for parent and carer on how to get into all areas of mouth
What is a good tip for parent carers when brushing?
if starting morning at bottom right then at night start top left so we can ensure all areas get a good clean at least once a day
What is the criteria for inhalation sedation in special needs pts?
Same as non special needs pts but avoided in those undergoing high oxygen therapy and those with musculoskeletal diroders
What can iv sedation with midazolam do?
Can benefit some anxious special needs young people and is protective in those with anxiety
In ASA III what would we consider?
Specialist anaesthetist
What are the aims of GA?
Autraumatic induction
complete comprehensive dental tx
eliminate pain and infection
establish a basis for continued preventative care
short uncomplicated recovery
What are the indications for GA?
no cooperation
extensive tx need
What are the considerations for GA?
Joint cases - if child needs other tx under ga we can lease with other medical teams to set this up - sen courtesy email
medical reassessment
ASA III and IV needs specialist anaesthetist
Who signs consent for under 16?
parents
When might teens be able to sign consent form?
If deemed gillie competent then they can sign form however they may refuse on the day so we need to consider this
What if child is 16+ and refuses tx?
Adult with incapacity certificate is available to consider
