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week 87 > Special Needs Patients- Hasan > Flashcards

Special Needs Patients- Hasan Flashcards

1
Q

Down Syndrome

A
  • Most common intellectual impairment syndrome
  • Chromosome disorder
    • Extra Chromosome 21
      • full or partial
  • Altered Craniofacies:
    • Flat Facial Profile
    • Open Mouth Posture
    • Protruding & Furrowed Tongue
  • Congenital Cardiac Anomalies
    • AV Septal Defect-45%
    • Ventricular Septal Defect
    • Atrial Septal Defect
    • patent ductus arteriosus
    • Tetralogy of fallot(4%)
  • Increased risk of Heart Diseases
    • Mitral Valve Prolapse
    • Tricuspid valve prolapse
    • Aortic regurgitation
  • Impaired Immune System:
    • Increased Susceptibility to infection
    • Autoimmune disorders & malignancy
    • Chemotactic Defects
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2
Q

Down syndrome: Dental Considerations

A
  • Most Managed in out patient settting
  • 50% have congenital Heart disease or GI Malformations
    • follow ADA for antibiotic prophylaxis
  • Class 3 Malocclusion
  • High Palate Vault
  • Angular Cheilitis
  • Lip Fissuring
  • Candida infection
  • Retain Primary Teeth in 3rd decade
  • Increased Risk of Perio→ loss of teeth
  • Diminutive/Hypoplastic teeth
  • Increased wear due to grinding
  • Acid Erosion due to GERD
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3
Q

Autistic Spectrum Disorder

A
  • Pervasive Development Disorder
  • Impair 3 Major domains:
    • Socialization
    • Communication
    • Behavior
  • Restricted, Repetitive patterns of behavior, interests, activities
  • Require symptoms in early developmental period
    • 1-2 yo
  • Includes:
    • Autistic Disorder
    • Asperger Syndrome
    • PDD
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4
Q

Autistic Disorder

A
  • Most severe form of ASD
    • non verbal cognitive impairment
    • severe motor stereotypes
    • Disruptive behavior
  • Diagnosed by 3 y.o.
  • Unknown cause
    • environmental factors
    • prenatal infections
      • CMV
      • Rubella
    • Metabolic Disorders
  • Associated conditions:
    • Intellectual impairment
    • Epilepsy
    • Fragile X Syndrome
    • Tuberous Sclerosis
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5
Q

Asperger Disorder

A
  • Aka High Functioning Autism
  • Form of ASD
  • Dx when symptoms of autism are present
    • w/no significant delay in language & cognitive development
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6
Q

ASD: Dental Considerations

A
  • Outpatient Tx→require patience & consistency
    • might require OR
  • Behavioral Problem
  • Poor Oral Hygiene
  • early loss of teeth
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7
Q

ADHD

A
  • Developmental Condition:
    • inattention
    • distractibility (optional)
  • unknown etiology
  • Symptoms:
    • Onset before age 7
    • persist through adolescence & Adult
  • Prevalence:
    • Children: 5M:F
    • Adult: M;F close to even
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8
Q

ADHD Dental Considerations

A
  • Most Managed in Ambulatory Setting
  • Behavioral issues→ Mild Sedation
  • Oral Hygiene the same as general population
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9
Q

Dementia:

A
  • Loss of Cognitive Function that interferes w/daily life & activities
    • thinking
    • remembering
    • reasoning
    • Behavioral ability
  • Causes:
    • Alzheimer’s disease
    • Vascular Dementia
    • Lewy body Dementia
    • Fronto-Temporal disorders *
    • Mixed Dementia
    • Other: Head injury, HIV, Thyroid problems, Vitamin B deficiency
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10
Q

Alzheimer’s disease

A
  • Most common cause of dementia in people 65+
  • Slowly Progresses over 8-10 years
  • Brain
    • contain Plaques & Tangles
      • Plaques: beta-amyloid
      • Tangles: tau protein
    • exhibits:
      • Shrinkage of:
        • Cerebral Cortex
        • Hippocampus
      • Enlarged Ventricles
    • Areas of brain don’t work properly
      • memory
      • language
      • judgement
      • spatial abilities
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11
Q

What are the different types of Alzheimers Disease Progression:

A
  • Mild Cognitive Impairment
    • Duration: 7 years
    • Begins in Medial Temporal Lobe
    • Symptoms:
      • Short Term Memory Loss
  • Mild Alzheimers
    • Duration: 2 years
    • spreads to lateral temporal & parietal lobes
    • Symptoms:
      • Reading problems
      • Poor Object Recognition
      • Poor sense of direction
  • Moderate Alzheimers
    • Duration: 2 years
    • spreads to frontal lobe
    • Symptoms:
      • poor judgement
      • impulsivity
      • short attention
  • Severe Alzheimers
    • Duration: 3 years
    • spreads to occipital lobe
    • Symptoms:
      • visual problems
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12
Q

Vascular Dementia

A
  • 2nd most common Type of dementia
  • caused by brain damage due to:
    • reduced or blocked blood flow to Brain
  • Symptoms:
    • Sudden onset
    • occur in ppl with HTN, Strokes, Heart attacks
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13
Q

Lewy body Dementia

A
  • 10% of ppl w/dementia
  • More common w/age
  • Lewy body
    • abnormal clumps of protein in brain
    • Found in: Alzheimers & Parkinsons, Lew body dementia
  • Unique Features:
    • Lucidity
      • fluctuations b/w confusion & clear thinking
    • visual hallucinations
    • Parkinsonism
      • tremor & rigidity
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14
Q

Fronto-Temporal Disorder

A
  • Type of dementia
  • occurs at a younger age than Alzheimers
    • 50-70 y.o.
  • Degeneration/Breakdown of nerve cells in frontal and temporal lobes
  • Symptoms:
    • inappropriate behavior
    • language problems
    • difficulty thinking & concentration
    • movement problems
    • loss of inhibition
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15
Q

Dementia: Presenting Features

A
  • Loss of short term memory initially
  • Personality changes
    • (frontal lobe)
  • Purposeful wondering
    • secondary to memory loss
  • Confusion
  • Deterioration of personal hygiene
  • Loss of language skills
  • Immobility
  • Incontinence
  • Generalized wasting of body
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16
Q

Dementia: Dental Considerations

A
  • Consent
  • History
    • patients forget the reason or visit or which tooth
  • Challenge to localize pain
  • Progressive Cognitive decline
    • Self care & ability to cooperate in dental chair
  • Tx in Later stages→ Exodontia
17
Q

What are the oral hygiene products for patients with special needs?

A
  • Toothbrushes & Floss Holders w/extended or wide handles
  • Water Flossers
  • 3-sided toothbrushes
  • Pre-pasted toothbrushes
  • Mouth Props
  • Suction Toothbrushes
18
Q

Americans with Disabilities Act Defines a person with a disability as?

A
  • physical or mental impairment that limits one or more major life activity
19
Q

Sedation

A
  • Decision made based on:
    • pts cooperation
    • health history
    • extent of tx
  • Monitor vitals during procedure
  • Inhaled Sedation
    • use Nitrous Oxide & O2
    • decrease anxiety in fearful or anxious patinets
  • Oral Sedation
    • minimal to moderate sedation
  • IV sedation:
    • drug-induced depression of consciousness→moderate sedation
    • recommend:
      • Dental anesthesiologist or physician administer while you do dental work
  • General anesthesia
    • uncooperative pts w/extensive work needed
20
Q

Patient Management

A
  • Pediatric Behavioral Management techniques used on special needs patients
    • especially intellectual disabilities
  • Tell-Show-Do
  • Distraction techniques
21
Q

Protective Stabilization

A
  • Restricton of patients freedom of movement with or without the patients permission
    • decrease the risk of injury to patient or provider
  • Controversial:
    • psychological harm
    • violate patients rights if performed unethically or w/o consent
  • Only consider if NEEDED
    • not out of convenience
  • Minimum stabilization should be used
  • Ex:
    • holding patients hands down
    • holding head in place during procedure
22
Q

Treatment Planning

A
  • Be aware of:
    • dental-related sequelae associated w/any medical conditions
    • pts ability to cooperate
    • pts self care regimen
23
Q

Treatment Planning: Emergency

A
  • First priority
    • swelling, abscesses, tooth pain
  • Extract hopeless teeth
  • Eliminating dental infections
    • to prevent spread to other parts of body
  • Prescribe antibiotics or pain meds when appropriate
24
Q

Treatment planning: Periodontal Stability

A
  • Assess Periodontium
    • periodontal tx performed if needed
    • OHI
25
Q

Treatment Planning: Caries control

A
  • Restore teeth with carious lesions
  • consider:
    • ability of pt to keep mouth open
    • isolate teeth
      • rubber dam→isolation and protection
    • restoration material used
26
Q

Treatment Planning: Missing Teeth

A
  • offer all appropriate options
    • ex: bridges, implants, removable dentures
  • Before starting removable prosthetic tx:
    • make sure the patient can tolerate impressions
    • has the manual dexterity to insert and remove the prosthetic
    • removable appliance isn’t a choking hazard
27
Q

Treatment Planning: Establish a Maintenance Plan

A
  • Prevent dental problems
  • Establish re-eval interval for
    • routine prophylaxis
    • periodic exams
28
Q

Self Care

A
  • Dont underestimate the ability of patient or caregiver to do selfceare
  • Poor Oral Hygiene lead to:
    • failed dental tx
    • compromise oral and systemic health
  • Identify reasons for poor oral care
  • Make sure patient understands the necesitty of home hygiene
  • provide self care instructions so the patient or caregiver understands
29
Q

Intellectual Functioning:

A
  • 2-4 years behind in cognitive development
    • reasoning
    • problems solving
    • working memory
  • Short Attention span
  • Easily Distracted
  • Delayed Speech Development
    • may affect reading
  • School
    • Academic Difficulties last across school years
    • learn slower than other students
    • Low achievement in most or all academic areas
      • reading, math, writing
    • Not confident in school and easily frustrated
    • Difficulty with:
      • learning concepts
      • working memory tasks
        • math facts, spelling words
      • academic strategies
        • note taking, memorize definitions
      • generalization of info:
        • to other material
        • in one setting to another
          • school→community
      • advanced academic skills related to content
      • comprehending and summarizing what has been read
        • Remember info one day, forget it the next day
    • weak vocabulary
    • operates at concreted instead of abstract level of thinking
30
Q

Mild Intellectual Disability

A
  • IQ: 50-70
    *

week 87 (7 decks)

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