Disabled children

Question 1

What is the definition of disability

Answer 1

“Physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities”

-Equality Act 2010

Question 2

What are the stats of children with a disability

Answer 2

In the UK 6% of children aged 0 - 17 years old have a disability

Question 3

What are the classifications of disabilities

Answer 3

Intellectual/behavioural
-Learning disability
-Autism Spectrum Disorder
-Down syndrome

Physical
-Cerebral Palsy

Sensory
-Vision impairment
-Hearing loss

Medically compromised
-Oncology
-Cardiac
-Haemophilia

Question 4

What may a child with autism struggle with

Answer 4

Social Communication

Social Interaction

Repetative and restrictive behaviour

Over or undersensitivity to light, sound, taste or touch

Extreme anxiety

Meltdowns or shutdowns

Question 5

If a patient has autism and may not speak or have limited language what stratagies could you use

Answer 5

Use preffered mode of communication

-makaton
-visual symbols

Question 6

If a patient has autism and always think people mean exactly what stragies could you use

Answer 6

Use concrete language, give direct requests and avoid jokes

Question 7

If a patient has autism and doesnt understand facial expressions or body language well what could your stratagies be

Answer 7

Avoid body lanaguage, hestures, or facial expressions without accompanying verbal instruction

Question 8

If a patient has autism and may not understand unwritten social rules what stratagies is there

Answer 8

Be aware of this before hand a react calmy so the child if they do something like stand too close

Question 9

If a patienht finds other people unpredictable what can you do to handle this

Answer 9

explain clearly what is happening this can be aided with pictures

Question 10

If a patient with autism loves routine what can you do to handle this

Answer 10

try and prepare them for visits to the surgery and if they are new to the practice or if carrying out something they have not had done before try and prepare for this by showing them what is going to happen at the next visit and giving them pictures with a list of what is going to happen at the next visit so they can prepare for this in advance

Question 11

What are the dental features of down syndrome

Answer 11

Maxillary hypoplasia
Class III occlusion
Macroglossia
Anterior open bite
Hypodontia/microdontia

Predisposition to periodontal disease
-due to impaired phagocyte function in neutrophils and monocytes combined with poor oral hygiene

Question 12

What is the most common physical disability

Answer 12

Cerebral palsy

Question 13

What are th 3 types of cerebral palsy and there affects

Answer 13

Spastic (80%)
-Area of brain affected, cortex
-Affect, Increased muscle tone

Ataxic CP
-affects the cerebellum and presents with difficulty with co-ordination and balance

Dyskinetic CP
-affects the basal ganglia and presents with uncontrollable movements

Question 14

What are the dental considerations for patients with cerebral palsy

Answer 14

Difficulty tolerating dental treatment

Increased rate of malocclusion
-(maj. classII) may be due to hypotonia of the facial musculature/ tongue movement and mouth breathing

Increased risk dental trauma

High prevalence of bruxism

Drooling

Poor oral hygiene
-complicated by dyskinetic movement/ difficulty holding a brush/ oral reflexes/ decreased mouth clearing

Pathological oral reflexes – biting

Calculus if peg fed

Periodontal disease
-ue to calculus deposits, impaired OH and increased incidence of Mouth breathing

Hyperplastic gingivitis

Self mutilation

Unsafe swallow

Question 15

If a patient has sensory impairments what could you use

Answer 15

Visual- Braille

Hearing- BSL interpreting service, hearing loops

ASD- Makaton, boardmaker pictures, widget symbols

Question 16

What is leukaemia

Answer 16

Blood cancer of WBC
Can affect:
-Lymphocytes
-Myeloid cells (including neutrophils)

3/4 cases are Acute Lymphoblastic Leukaemia

Can present with
-Pallor
-Increased bleeding/bruising (lack of platelets)
-Infection (lack of functioning WBC)

Question 17

What are oral manifestations of leukaemia

Answer 17

-Gingival swelling
-Ulceration
-Spontaneous gingival bleeding
-Unusual mobility of teeth
-Petechiae
-Mucosal pallor
-Herpetic infections
-Candidosis

Question 18

What cancer treatment can have oral complications

Answer 18

-Surgery to the head and neck
-Chemotherapy
-Radiotherapy to the head and neck
-Bone Marrow Transplant – involves chemotherapy +/- total body irradiation

Question 19

What dental affects can chemotherapy have

Answer 19

Short term:

Effect on Mucous membrane = Mucositis
Effect on bone marrow:
-Decreased Neutrophils = increased infection risk
-Decreased platelets = increased bleeding risk

Longer term:

-Affect developing dentition;
Enamel hypoplasia/ microdontia/ thin roots

Question 20

What dental affects does radiotherapy have

Answer 20

Short term:
Oral Mucosa=mucositis – most severe at 2-4 weeks
Salivary glands=decreased flow/increased velocity – often permanent
Hyposalivsation can lead to:
-Caries
-Taste disturbance
-IO infection – candida/ acute ascending sialodenitis
Taste buds=direct damage – loss/alteration to taste = altered diet

Longer term:
Malocclusion
Increased risk soft tissue neoplasm
Risk of osteoradionecrosis
Affects to developing dentition
Hypodontia/ microdontia/ enamel hypoplasia/ defects of root formation

Question 21

What are the implications for dental care in childhood cancer

Answer 21

Children with cancer are managed by the dental team in the children’s hospital

Dental assessment prior to commencement of cancer therapy

All infectious dental/oral foci should be removed before the start of cancer therapy
Optimal oral hygiene important

Dental support throughout treatment

Management of dental effects of treatment including mucositis

Close liaison with oncology team if treatment required

Question 22

What congenital cardiac defects classifications are there

Answer 22

Cyanotic: Deoxygenated blood able to enter systemic circulation

Acyanotic: Normal levels of oxyhaemoglobin in the systemic circulation

Question 23

What is the most common Cyanotic and Acyanotic defects

Answer 23

Ventricular septal defect is the most common acyanotic CCD

Tetralogy of Fallot is the most common cyanotic CCD

Question 24

What are the dental complications of congenital cardiac defects

Answer 24

Medications which increase bleeding tendency: warfarin or aspirin

Higher risk of general anaesthetic, often requiring support from a cardiac anaesthetist

Careful use of adrenaline containing LA

Increased risk of enamel hypoplasia

Risk of infective endocarditis resulting from an oral bacteraemia

Question 25

When can IE occur

Answer 25

bacteria enter the blood stream causing a bacteraemia and then adhere and multiply on the damaged heart surface which results in Inflammation of the endocardium

Question 26

What patients are at increased risk to IE

Answer 26

Acquired valvular heart disease with stenosis or regurgitation

Hypertrophic cardiomyopathy

Previous IE

Structural congenital heart disease (surgical corrected or palliated strucural conditions BUT NOT isoalted atrial septal defect, fully repaired ventricular septa; defect or full repaired oatent ductus, arteriosus, closure devices considered endothelialised)

Valve repalcement

Question 27

What falls under the sub-group requiring special consideration for IE

Answer 27

Prosthetic valve

Previous IE

Congenital heart disease
-Any type of Cyanotic
-Any type repaired with prosthetic material

Question 28

What should kids in the specific sub risk group be treated with before dental treatment

Answer 28

Antibiotic prophylaxis for invasive dental procedures should be considered for children in the subgroup requiring special consideration

Question 29

What should be done with all patients at risk of IE

Answer 29

maintain optimal oral health decreasing their risk of an oral bacteramia from dental infection, poor gingival health or dental treatment

The risk of IE should be considered when planning dental treatment
-Avoid dental infection (close monitoring and early management of caries)
-More radical treatment plans to ensure the mouth is kept free from any oral sources of infection (removal of teeth with deep decay/ Hall crowns contraindicated)
-Liaison with cardiology to explore need for antibiotic prophylaxis prior to invasive procedures

Question 30

What is primary, secondary and tertiary haemostasis

Answer 30

Primary
Vasoconstriction after injury
Platelet plug formation

Secondary
Formation of fibrin through coagulation cascade

Tertiary
Fibrinolysis
Formation of plasminogen, then plasmin

Question 31

What are the most common bleeding disorders

Answer 31

Inherited:

-Von Williebrand’s disease
-Haemophilia A
-Haemophilia B

Non-inherited:
-Use of blood thinning medication – Warfarin/Aspirin
-Chemotherapy induced Thrombocytopenia

Question 32

What is Von Willibrands disease

Answer 32

-Inherited deficiency of Von Willibrand factor
-Most common inherited bleeding disorder (1%)
-Autosomal dominant

-acts in 3 ways:
Mediates platelet adhesion
Mediates platelet aggregation
Carrier of factor VIII

VWD
-Low levels vWF
-Low levels of factor VIII

-Dental treatment in Hospital dental service
-Close liason with Haematology
-Haemostatic cover

Question 33

What is haemophilia

Answer 33

-Lack of clotting factors = Increased bleeding tendency
-Haemophilia A = affects factor VIII
-Haemophilia B = affects factor IX

-Severe < 1%
-Mod 1- 5 %
-Mild > 5% activity

X linked recessive
-Males who have the affected gene are affected
-Females who have the affected gene are carriers

Question 34

What are the dental implications of bleeding disorders

Answer 34

Enhanced dental caries prevention

Dental treatment within Hospital Dental Service

Close liaison with haematology required prior to any treatment likely to induce bleeding including surgery/ interproximal restorations/ local anaesthetic.

Haemostatic cover requirements vary by:
Type of Haemophilia
Severity of Haemophilia
Treatment required

Question 35

What are the impacts of dental disease in children with disabilities

Answer 35

Increased risk of dental caries
Delayed diagnosis
Delayed management
Need for multidisciplinary planning
Pain/infection can be difficult to manage
Health risk posed by dental infection
Risks posed by dental treatment

Question 36

Whats important in communication with children with disabilities

Answer 36

Don’t assume non-verbal children do not understand anything you say

Find out from the parent how the child communicates and try to incorporate this into the exam
-BSL – use of interpreter if needed
-Makaton
-Picture Exchange Communication System

Tell the child what you are doing/ going to do

Give the child adequate time to reply