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Special Care Dentistry > Intellectual Impairment > Flashcards

Intellectual Impairment Flashcards

1
Q

what does intellectual ability involve problems with

A

intellectual functioning and adaptive functioning

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2
Q

what occurred in lennox castle hospital

A

people with learning disabilities were locked up and hidden from the community

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3
Q

what led to closure of long-stay institutions

A

concept of normalisation reinforced by Department of Health legislation

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4
Q

what is an impairment

A

any loss or abnormality of psychological, physiological or anatomical structure or function
occurs at level of organ or system function

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5
Q

what is disability

A

any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being

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6
Q

what is activity limitation

A

difficulty encountered by an individual in executing a task or action

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7
Q

what is participation restriction

A

problem experienced by an individual in involvement in life situations

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8
Q

what does the social model say about disability

A

it is caused by the way society is organised rather than by a persons impairment or difference

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9
Q

what does the medical model say about disability

A

people are disabled by their impairments or differences

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10
Q

what is a social model

A

social organisation that takes little or no account of people who have impairments and/or social organisation that creates segregated and second-rate provision

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11
Q

what are the barriers to a social model

A

segregated social provision
inflexible organisational procedures and practices
inaccessible information
inaccessible buildings
inaccessible transport
negative cultural representations

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12
Q

what are the causes of learning disability

A

genotype
maternal health
infection
prematurity
trauma
toxic agents
sensory social deprivation

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13
Q

name 3 syndromes associated with a learning disability

A

down syndrome
prader willi syndrome
autism spectrum syndrome

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14
Q

what is downs syndrome

A

neurodevelopmental disorder of genetic origin affecting chromosome 21

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15
Q

what is the greatest risk factor for down syndrome

A

advanced maternal age

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16
Q

what are the medical features of down syndrome

A

congenital heart defects
alzheimers dementia
epilepsy
leukaemia
hearing impairment
diabetes mellitus
coeliac disease
thyroid disease
intellectual impairment

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17
Q

how does down syndrome impact on periodontal disease

A

oral hygiene issues
oral function
impaired migration of gingival fibroblasts
saliva quality
periodontal pathogens
impaired immune system

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18
Q

what manifestations does prader willi syndrome have

A

constant desire to eat food
restricted growth - short stature
reduce muscle tone
learning difficulty
lack of sexual development
behaviour problems

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19
Q

what is ASD

A

complex developmental condition including range of possible developmental impairments in social interactions and communication

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20
Q

what feature of ASD poses as a barrier to dental treatment

A

sensory atypia

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21
Q

what is cerebral palsy

A

neurological condition that affects movement and co-ordination

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22
Q

what does cerebral paly present as

A

muscle stiffness or floppiness, muscle weakness, random and uncontrolled movements, balance and co-ordination problems

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23
Q

who is in the learning disability team

A

medical doctor
psychiatry
social work
specialist nurse
occupational therapy
nutrition/dietician
SLT

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24
Q

how should dental services be provided

A

recognises everyone as an individual
recognises that everyone has a right to participate in decisions that affect their lives
provides amount of support necessary to enable everyday living

25
Q

what are the barriers to oral healthcare with learning disabilities

A

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

26
Q

what are some individual characteristic barriers with oral healthcare

A

cognitive, physical and behavioural difficulties
dependence on family/carers
anxiety

27
Q

what are some access barriers with oral healthcare

A

not having regular dentist
cost
referral systems
transport issues

28
Q

how is pain recognition and response a barrier to oral healthcare

A

people with learning disabilities find it difficult to communicate that they are in pain

29
Q

how is transition a barrier to oral healthcare

A

transition between children and adult health services can be tricky for learning disabled people

30
Q

what works to overcome individual barriers to healthcare

A

reducing anxiety
building good relationship

31
Q

what works to overcome service barriers to healthcare

A

training and education
collaboration
service availability
population needs

32
Q

what might getting to the surgery look like for someone with an intellectual impairment

A

preparation
social stories
health passport
pre-visit
multiple visits with slow progress
liaise with community disability nurse

33
Q

how would you time the appointment for an intellectually impaired person

A

dont run late
give lots of time
ask what time is best for the patient
limit time spent in waiting room

34
Q

what are some signs and symptoms that someone might be in pain

A

aggression towards themselves or others
changes to how person holds or moves their body
altered facial expression
changes to mobility or balance
change in behaviour
changes to appetite
confusion
restlessness or sleep pattern changes

35
Q

how would you verbally communicate with someone

A

speak naturally and clearly
ask yes or no questions
dont lead patient responses
allow time to communicate
dont interrupt or finish sentences

36
Q

what are some adjuncts to communication

A

makaton
picture boards
letter boards
talking mats
draw
write

37
Q

what helps to create the right atmosphere

A

non-threatening environment
friendly
acclimatise
consider augmentive techniques - music
singing

38
Q

what should you expect on the first visit

A

trust and relationship building

39
Q

what helps for a good examination

A

access to mouth
bedi shield
open wide mouth rests
toothbrush
mirror
good light
head support

40
Q

when should a clinical holding take place

A

considered if failure of other techniques
patient consents
no capacity and is deemed benefit
unplanned emergencies

41
Q

what is important to find out with social history

A

living arrangements
support
transport
likes/dislikes

42
Q

what kind of oral disease experience do intellectually impaired people have

A

more filled teeth, fewer extractions, more untreated active decay
depends on their ability to comprehend

43
Q

what are risk factors for people with learning disabilities in relation to oral disease

A

frequent sugar intake
GORD
lower income and education
difficulty in access
non-oral feeders
reduced dexterity
poor motor control
medications

44
Q

what oral diseases do learning disabled people get

A

high levels of periodontal disease
gingival inflammation
high numbers of missing teeth
increased toothlessness rate
higher plaque levels
greater unmet oral health needs
poorer access to dental services

45
Q

what should treatment planning be

A

individual
co-operation
holistic
oral health risk factors
complexity of treatment provided may be influenced by severity of learning disability
realistic

46
Q

how do we give toothbrushing advice

A

explain first
good time of day
wear gloves
stand behind person
keep systematic

47
Q

what conditions can be linked to self-injurious behaviour

A

cerebral palsy
autism
tourettes

48
Q

what treatment strategies can we use

A

symptomatic relief
reassurance for patients and parents
pharmacological treatment
behavioural psychology
construction of oral appliances
extraction of specific teeth
orthognathic surgery to create open bite and prevent biting

49
Q

why do people have a problem with drooling

A

abnormalities swallowing and moving it to the back of the throat
poor mouth closure
jaw instability
tongue thrusting

50
Q

what can we do for drooling patients

A

nonpharmacological and non-surgical methods
posture improving methods

51
Q

what can give NCTSL

A

grinding
reflux
medications
drinks

52
Q

what can we give for erosion

A

fluoride mouthwashes
toothpaste
brushing delayed for an hour after consuming acidic foods and drinks
fluoride varnish
sugar free gum after acidic meal

53
Q

what can be used for dry mouth

A

saliva replacements
sugar free chewing gum
fluoride rinses

54
Q

what is recommended for people who have feeding problems

A

good OH
intensive regime
low foaming toothpaste
suction toothbrush

55
Q

what do we need to watch out for when people are nil by mouth

A

thickeners and tasters

56
Q

what are some risks associated with GA

A

brain damage, nausea, vomiting, lethargy, shivering, bladder problems, dizziness, sore throat, waking up during operation

57
Q

when is GA the best way to provide care

A

significant volume of treatment
patient uncooperative
significant medical complexity

58
Q

when do you refer for GA

A

pain and swelling where no alternatives exist
obvious dental disease when no alternative treatment is possible
number of years since reasonable examination in presence of poor oral hygiene

59
Q

what is the role of the dental practitioner in adult protection

A

recognise
respond
record

Special Care Dentistry (15 decks)

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