Intellectual Impairment and Dentistry

Question 1

what are the barriers to oral healthcare for patients with learning disability?

Answer 1

• access
• transition
• individual characteristics
• attitudes, skills and knowledge of staff
• pain recognition

Question 2

what individual characteristics can be a barrier to receiving oral healthcare?

Answer 2

• cognitive, physical and behavioural difficulties that impact on someone’s ability to undertake daily oral care & cope with dental visit
• dependence upon family carers or supporters
• anxiety is a major factor influencing access to dental services

Question 3

what access barriers can prevent patients with a learning disability from receiving oral healthcare?

Answer 3

• not having a regular dentist
• difficulties in getting an NHS dentist
• cost of dental treatment
• finding a GDP willing to provide treatment
• complex referral systems
• difficulties with transport

Question 4

what pain recognition and response barriers can prevent patients with learning difficulties from accessing oral healthcare?

Answer 4

• may find it difficult to communicate that they are in pain

Question 5

what attitudes, skills and knowledge of dental staff barriers can prevent patients with learning difficulties from accessing oral healthcare?

Answer 5

• can be challenging to provide dental treatment to people who struggle to understand what is being done and may be uncooperative
• dentists may be unconfident about interactions
• dentists may have lack of knowledge
• poor attitudes from healthcare staff

Question 6

what transition barriers can prevent patients with learning difficulties from accessing oral healthcare?

Answer 6

• transition between children and adult health services can be a difficult process for people with learning disabilities

Question 7

what are signs and symptoms that a person may be in pain include?

Answer 7

• aggression directed towards themselves or others
• changes to how the person holds or moves their body
• altered facial expression
• changes to mobility or balance
• change in behaviour = tearfulness/irritability/withdrawal
• changes to appetite or vocalisation
• confusion
• restlessness or changes in sleep patterns

Question 8

how should verbal communication with people with a learning disability be structured ?

Answer 8

• speak naturally and clearly
• ask to repeat information if you dont understand
• ask questions that can be answered ‘yes’ or ‘no’
• don’t lead patients responses
• allow enough time to communicate with patient slowly

Question 9

what are examples of adjuncts to aid communication?

Answer 9

• makaton
• picture boards
• letter boards
• talking mats
• draw
• write

Question 10

how can you create the right atmosphere for patients with learning disabilities?

Answer 10

• non threatening environment
• friendly
• acclimatise (multiple visits)
• consider augmentive techniques (relaxation, music etc)

Question 11

what should you except from the first visit with a patient with a learning disability?

Answer 11

• what can you find out before the visit
• keep it simple
• don’t expect too much
• building trust and relationships

Question 12

what aids can help with examination of patients with a learning difficulty?

Answer 12

• bedi shield
• open wide mouth rests

Question 13

when is clinical holding permitted?

Answer 13

• due to failure of other techniques
• patient must consent
• unplanned emergencies when patient poses a significant risk
• always record in notes and justify

Question 14

what are risk factors for poor oral health in patients with a learning disability?

Answer 14

• frequent sugar intake
• medications cause dry mouth
• GORD
• difficulty in accessing dental services
• being non oral feeders
• reduced dexterity
• sensory sensitivity