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3. Paediatrics > Special Needs > Flashcards

Special Needs Flashcards

1
Q

What are special needs?

A

Huge range of dx and disabilities where individuals require special help or care for a condition they have

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2
Q

What are main causes of disability in children?

A

congenital and and genetic

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3
Q

Who looks after teeth of those with mild disability?

A

General dentist - enhanced fee

if pt is anxious or more moderate then public dental services

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4
Q

Who looks after teeth of those with mod/severe disability?

A

specialise led PDS

HDS

or often shared care with GDP/HDS or PDS/GDP

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5
Q

What are some dental implications for children with special needs? 5

A
  1. fewer teeth (could be due to their condition affecting anatomy, or possibly due to difficulties in oral care)
  2. more untreated dental disease/caries
  3. greater prevalence of periodontal disease
  4. increased dental fear and anxiety (often precipitated from hospital appointments)
  5. more barriers to the delivery of dental care (complex health conditions, and difficulty accessing an appropriate service)
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6
Q

What are the impacts of dental disease in children with special needs? 5

A
  1. delayed diagnosis (difficulty conveying pain or presentation of disease is different, perception of pain, or possible difficulty accessing care)
  2. 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)
  3. more multidisciplinary management (might take a lot of time to plan)
  4. greater risk of pain and sepsis (from delay in treatment)
  5. reduced quality of life
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7
Q

What qs must we consider when considering the care of a child with special needs?

A

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

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8
Q

What prevention strategies are key in special needs patients?

A

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

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9
Q

What are our aim in special need pts?

A

To provide support with normal oral function:

  • eating
  • speech development
  • promote self esteem
  • maintain good appearance
  • confidence to smile
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10
Q

What are the issues with drooling?

A

Embarrassment

parental upset

skin irritation

aspiration

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11
Q

What condition may cause drooling?

A

Cerebral palsy

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12
Q

How can we improve salivation and drooling in special needs pts?

A
  1. speech and language therapy
  2. pharmacology
  3. surgical
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13
Q

How can we use SLT to manage drooling?

A

Improve lip seal

improve swallow

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14
Q

How can we use pharmacology to manage drooling?

A

botox injection, hycosine patches

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15
Q

What are some barriers to regular attendance in special needs pts?

A
  1. clashing with or finding time among other hospital appointments
  2. challenging behaviour and anxiety
  3. access to care
  4. frequent illness, preventing completion of care plans
  5. parental attitude to dental care
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16
Q

What are some potential barrier to mouth care in special needs pts?

A
  1. manual dexterity issues (CP)
  2. involuntary movements (CP)
  3. oral aversions (nil by mouth patients)
  4. sensory issues preventing OH such as taste and texture (autism)
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17
Q

what are some solutions to access difficulties for patients with special needs?

A
  1. planning appointments close to other hospital appointments by liaising with other HCP’s involved in their care
  2. use BMT to manage anxiety in both the patient and carer
  3. make sure to plan ahead for these patients, and make provisions such as disabled parking or early appointments to fit in with their schedules
  4. be empathetic and understanding that other care may be more pressing than dental care, and cancellation may be frequent
  5. challenge and engage parents in their child’s oral care
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18
Q

what are some potential barriers to dietary changes in children with special needs?

A
  1. they may have atypical food clearance due to musculoskeletal problems
  2. they may regurgitate foods
  3. they may have to be on a special diet for their condition
  4. they sometimes have to only eat pureed foods
  5. often taking sugary medications if oral suspensions
  6. treats are used as rewards
  7. sometimes it can be very difficult for some patients to change their routine and diet (autism)
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19
Q

What is disability split into?

A

Medical, physical, sensory and mental disability

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20
Q

What are some physical disabilites?

A

Cerebal palsy

spina bifida

muscular dystrophy

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21
Q

What are some medical disabilities?

A

Cardiac defect

oncology

bleeding disorders

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22
Q

What are some sensory disabilities?

A

blind, deaf, asd

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23
Q

What are some mental disabilities?

A

Impaired learning ability

ASD

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24
Q

What does cerebral palsy affect?

A

movement and posture

can also have visual, hearing, learning or speech epilepsy

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25
Q

What causes cerebral plays?

A

Brain damage occurring before during or shortly after birth

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26
Q

What types of cerebral palsy are there?

A
  1. spastic (most common, affecting the limbs often causing jerking movements)
  2. athetoid (swings between hypo and hypertonia of muscles, leading to limpness and stiffening)
  3. ataxic (problems with balance and co-ordination)
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27
Q

What other disabilities can those with CP have?

A
  1. spastic (most common, affecting the limbs often causing jerking movements)
  2. athetoid (swings between hypo and hypertonia of muscles, leading to limpness and stiffening)
  3. ataxic (problems with balance and co-ordination)
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28
Q

What are some dental features and considerations of cerebral palsy?

A
  1. poor oral hygiene, possibly due to inability to clean themselves or of their carer to do this properly
  2. gingival hyperplasia if taking anticonvulsant mediaction
  3. enamel hypoplasia
  4. bruxism
  5. malocclusions (commonly a class 2 IR with poor lip seal)
  6. dental trauma (could fall and not be able to protect their face, possibly at higher risk)
  7. drooling and salivation is common (lowers self esteem and can cause skin irritation and dry mouth)
  8. access to care (wheelchair bound)
  9. uncontrolled movement (can make accessing the oral cavity troubling)
  10. an enhanced gag reflex
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29
Q

What can anticonvulsant meds cause?

A

Gingival hyperplasia

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30
Q

How can we help issues with brushing for CP PTS?

A

Modified brushes - can take impressions of hands with IM

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31
Q

Why do CP pts drool?

A

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

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32
Q

What is the solution to pt having other appts preventing attendance?

A

collaborate and plan well

33
Q

What is the solution to pt having challenging behaviour and anxiety preventing attendance?

A

empathise, understand, reassure, support, acclimatise, plan ahead

34
Q

What is the solution to parking/access issues preventing attendance?

A

Plan ahead, work out suitable parking

35
Q

What is the solution to pt having freq illness preventing attendance?

A

Empathise and support

36
Q

What is the solution to PARENTAL ATTITUDES preventing attendance?

A

Influence positive chance, promote good knowledge, help make them confident in oral hygiene of their child

37
Q

How can we help manage atypical food clearance?

A

collaborate, empathise, no judging, support and understand

38
Q

How can we help manage food holding and regurgitation?

A

consider additional mouth care such as enhanced prevention

39
Q

How can we help manage pureed foods?

A

consider 2800ppmF toothpaste

40
Q

How can we help manage fortified foods?

A

set achievable goals in liaison with parent/carer/patient

41
Q

How can we help manage use of sugary medicines?

A

work with other HCP to discuss alternative medications (e.g.sugar free)

42
Q

What are some potential causes of congenital heart defects?

A

Mostly unknownbut could be linked to maternal drug use. cmv, rubella

43
Q

What syndromes are associated with CHD?

A

Downs syndrome, marfans syndrome, elders danlos

44
Q

What are the dental aspects of CHD?

A

At a greater risk of infective endocarditis

increased bleeding tendency if on warfarin or aspirin

higher risk under ga

care when using LA

45
Q

What are some oral symptoms of cancer? (usually due to tx)

A

Mucosal gingival haemorrhage

gingival enlargement

mouth and throat infections

immunosuppression

thrombocytopenia

oral mucositis

developing dentition can be affected by chemo and radiotherapy

46
Q

What are the most common bleeding disorders?

A

Von williebrands

haemophilia A

Haemophilia B

47
Q

What is autism?

A

broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication.

48
Q

What aids can we use for visual impairment?

A

Braille

49
Q

What aids can we use for hearing impairments?

A

BSL interpreting service

hearing loops

50
Q

What aids can we use for and?

A

macaron

widget symbols

picture boards

51
Q

What is the definition of a learning disability?

A

State of arrested or incomplete development of the mind

significant impairment of intellectual, adaptive and social functioning

52
Q

What is autism?

A

it is a lifelong neurodevelopment disorder that affects:

  • social interaction
  • social communication
  • limited and restricted patterns in behaviour
53
Q

What are the 3 main things those with ASD struggle with?

A

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

54
Q

What conditions are related to ASD?

A

ADHD

Downs syndrome

dyslexia

dyspraxia

learning disability

epilepsy

git issues

sleep disorder

55
Q

What can people with autism take literally?

A

Verbal communication

56
Q

What can we use for communication with non verbal autistic patients?

A

Makaton

pecs

widget

57
Q

What are some likes of autistic pts in the surgery?

A

computer

water taps

dental unit controls

58
Q

What are some dislikes of ASD pts in the surgery?

A

touch

dental light

noises

smells

textures

tastes

59
Q

How do we prepare ourselves for an autistic pt?

A

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

60
Q

What is down syndrome?

A

Down syndrome is a genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21

61
Q

What are the dental features of Down syndrome?

A

Maxillary hypoplasia

Class 3 occlusion due to maxillary hypoplasia

large tongue - macroglossia

anterior open bite

hypodontia/microdontial

predisposition to perio disease

62
Q

What id macroglossia?

A

Large tongue

63
Q

What medical conditions do those with Down syndrome have a higher risk of?

A

Cardiac defects

leukaemia

epilepsy

alzheimers

64
Q

How can we get a good exam of pts with disabilities?

A

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

65
Q

What aids are available for brushing?

A

Finger props

open wide disposable mouth rests

two sided brushes

using two brushes - child bites down on one whilst we brush other side

66
Q

What are some good toothpastes for pts with disabilities?

A

Oranurse

67
Q

What is oranurse?

A

non foaming

flavour free

fluoride containing toothpaste

68
Q

What other toothpaste can we prescribe to pts?

A

Duraphat 2800ppmF due to higher caries risk for those 10+ - supervised no swallowing

69
Q

What must we show parents how to do?

A

OHI and demos for parent and carer on how to get into all areas of mouth

70
Q

What is a good tip for parent carers when brushing?

A

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

71
Q

What is the criteria for inhalation sedation in special needs pts?

A

Same as non special needs pts but avoided in those undergoing high oxygen therapy and those with musculoskeletal diroders

72
Q

What can iv sedation with midazolam do?

A

Can benefit some anxious special needs young people and is protective in those with anxiety

73
Q

In ASA III what would we consider?

A

Specialist anaesthetist

74
Q

What are the aims of GA?

A

Autraumatic induction

complete comprehensive dental tx

eliminate pain and infection

establish a basis for continued preventative care

short uncomplicated recovery

75
Q

What are the indications for GA?

A

no cooperation

extensive tx need

76
Q

What are the considerations for GA?

A

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

77
Q

Who signs consent for under 16?

A

parents

78
Q

When might teens be able to sign consent form?

A

If deemed gillie competent then they can sign form however they may refuse on the day so we need to consider this

79
Q

What if child is 16+ and refuses tx?

A

Adult with incapacity certificate is available to consider

3. Paediatrics (10 decks)

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