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
