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

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

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

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

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

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

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

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

Special Needs Patients- Hasan Flashcards by Connor Schmidt

Down Syndrome

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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Down syndrome: Dental Considerations

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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Autistic Spectrum Disorder

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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Autistic Disorder

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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Asperger Disorder

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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ASD: Dental Considerations

Outpatient Tx→require patience & consistency
- might require OR
Behavioral Problem
Poor Oral Hygiene
early loss of teeth

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ADHD

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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ADHD Dental Considerations

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

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Dementia:

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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Alzheimer’s disease

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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What are the different types of Alzheimers Disease Progression:

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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Vascular Dementia

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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Lewy body Dementia

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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Fronto-Temporal Disorder

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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Dementia: Presenting Features

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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Dementia: Dental Considerations

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

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

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

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

physical or mental impairment that limits one or more major life activity

Sedation

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

Patient Management

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

Protective Stabilization

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

Treatment Planning

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

Treatment Planning: Emergency

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

Treatment planning: Periodontal Stability

Assess Periodontium
- periodontal tx performed if needed
- OHI

Treatment Planning: Caries control

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

Treatment Planning: Missing Teeth

* 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

Treatment Planning: Establish a Maintenance Plan

* Prevent dental problems * Establish re-eval interval for * routine prophylaxis * periodic exams

Self Care

* 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

Intellectual Functioning:

* 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

Mild Intellectual Disability

* IQ: 50-70 *