special care dentistry

Question 1

What are learning difficulty stats?

Answer 1

1.5 million in UK
Lack of adjustments can be barrier- can contribute to a no of avoidable deaths
Life expectancy 18 yrs shorter for women, 14 yrs shorter for men
37% are obese

PHE- your legal duty to provide reasonable adjustments

Question 2

What are examples of reasonable adjustments?

Answer 2

1. Wheelchair access
2. Hoist
3. Wheelchair tipper
4. Stand aid/Turner
5. Access to dental chair from each side
6. Knee break chair
7. Bariatric facilities
8. Slide boards
9. Accessible adult changing facilities
10. Familiar, uncluttered surgeries
11. Transport assistance
12. Domiciliary care for house bound pts

Question 3

What does the mental capacity act 2005 say?

Answer 3

1. A presumption of capacity
2. Individual supported to make own decision
3. Unwise decisions
4. Best interests
5. Less restrictive option

For 16+
2 stage capacity test-
- does person have impairment of mind/brain?
- does impairment make person unable to make specific decision when needed?

Question 4

How can you help a person make their own decision?

Answer 4

1. Give all the relevant info
2. Do they know alternatives
3. Can it be explained/presented easier
4. Use non verbal
5. Get someone else to help
6. Use a particular time/place
7. Delay the decision

Question 5

When does a person lack capacity?

Answer 5

They can’t-
1. Understand the info
2. Retain the info
3. Use/weigh up the info to make the decision
4. Communicate the decision

Question 6

How do you decide what’s in the persons best interest?

Answer 6

1. Encourage participation
2. Identify all relevant circumstances 
3. Find out persons views
4. Avoid discrimination
5. Assess if they might regain capacity
6. Consult others (friends/family/attorney/deputy)

Question 7

What is an advanced decision?

Answer 7

18+
Legally binding decision to refuse med tx for a time in future when they might like capacity/consent

Question 8

What is a lasting power of attorney?

Answer 8

Person appoints someone to make decisions about health +/- finance

Question 9

What is the court of protection?

Answer 9

Oversees MCA and deals w all issues for people who lack capacity to make decisions
Resolves serious disputes about best interest

Question 10

What is an independent MC advocate?

Answer 10

Person appointed to support pt who lacks capacity w best interest decisions where there are no close family/friends

Question 11

How can you manage a pt w learning difficulties?

Answer 11

1. Acclimatisation- get to know pts triggers, comforters
2. Timing of appts
3. Use of aids- eg. Bite stick, flavours, finger guards
4. Clinical holding
5. Sedation/GA

Question 12

How might a learning difficulty affect oral hygiene?

Answer 12

1. Dexterity
2. Access
3. Cooperation
4. Flavour aversion
5. Swallow impairment
6. Training of carers
7. Gag reflex

Question 13

How should you aid oral hygiene?

Answer 13

1. Oral care plan
2. Toothbrush mods
3. Collins curve/super brush
4. Mouth rest
5. Suction tooth brush
6. Non foaming non flavoured tooth paste
7. Fluoride/saliva supplements

Question 14

What are communication models?

Answer 14

LINEAR- uni directional transfer of message, no feedback

INTERACTIVE- two way exchange, feedback, context, noise

TRANSACTIONAL- simultaneous communication w 2+ people

Question 15

Why might there be limited communication opportunities?

Answer 15

1. Limited range of interactions
2. Oral/muscular impairment
3. Speech delay
4. Illness
5. Limited language use
6. Difficultly establishing rapport
7. Reliance on others

Question 16

What are communication aids?

Answer 16

1. Accessible consent and info sheets
2. Picture banks (CHANGE)
3. Talking mats
4. Picture exchange communication systems
5. Widgit sheets
6. Makaton

Question 17

Who might have a carer?

Answer 17

Person w-
learning disability
sensory impairment
mental health condition
progressive neurological condition
physical disability
short term memory problem

Question 18

What are carer stats?

Answer 18

7 million in UK
58% women
3/5 people will be carer at some point

166363 carers are kids
Carers 16-18- 2x as likely to not be in education
13000 care >50hrs/week

65% older carers have health problems themselves

80% carers say that it has had a negative impact on their health

High lvls of arthritis, high BP, back problems, diabetes, anxiety, depression

Question 19

What is the importance of carers?

Answer 19

Advocacy
Support communication
Familiarity and trust
Know the pt
Safety

Question 20

What are issues around caring for someone?

Answer 20

1. Time and other pressures
2. Lack of skills/knowledge
3. Feeling isolated
4. Cooperation
5. Challenging behaviour
6. Carers own needs
7. Conflict of interest
8. Other priorities
9. Communication difficulties
10. Not knowing what’s best
11. Practical difficulties
12. Carer burnout
13. Compassion fatigue

Safe guarding aspects

Question 21

How can carers support pts OH?

Answer 21

1. Support tooth brushing/mouth care
2. Prompt, remind, facilitate
3. Spot problems, early signs
4. Diet choices

Question 22

What are barriers to carers providing OH?

Answer 22

PRACTICAL
-perceived lack of time
-inadequate training
-lack of equipment
-resistant behaviour
-high staff turnover

SOCIAL
-lack of confidence
-worries about pt dignity/privacy
-feel embarrassed/repulsion

Question 23

How can carers help during dental visits?

Answer 23

1. Organise appt
2. Prepare pt for visit
3. Transport
4. Transfer to chair
5. Reassure and support
6. Communicate issue
7. Tooth brush demo/advice
8. Help communicate w pt

Question 24

What are top tips?

Answer 24

1. Greet carer and pt
2. Listen to carer
3. Speak to both
4. Don’t presume carers competence
5. Don’t rush
6. Build relationship w both
7. Look out for changes in behaviour w different carers
8. Give carer advice on best support