Special Care - Intellectual impairment

Question 1

What is intellectual impairment?

Answer 1

reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
- can either be born with it or develop it as a child

Question 2

What are the 2 types of functioning that can be affected in an LI?

Answer 2

intellectual functioning - low IQ associated problems i.e. problem solving and judgement

adaptive functioning - problems with activities of daily life

Question 3

What is the difference between impairment and disability?

Answer 3

Impairment is considered at an organ/system level

disability is considered with function;
a restriction in ability to perform an activity in the manner considered as normal for a human due to impairement

Question 4

What syndromes are associated with learning disability?

Answer 4

ASD - not all
DS
Cerebral palsy - not all 
Fragile X
Prader willi
PKU

Question 5

What causes DS? (3)

Answer 5

Trisomy of chromosome 21

mosaicism

chromosomal rearrangement of 21

Question 6

What is a risk factor for having a child with DS?

Answer 6

Advanced maternal age

Question 7

What medically features are commonly associated with DS? (9)

Answer 7

Intellectual impairment

congenital heart defects

alzheimers

epilepsy

leukaemia

hearing impairment

diabetes mellitus

coeliac and oral manifestations

thyroid disease

Question 8

What are the dental implications of DS? (5)

Answer 8

Head positioning - atlanto-occipital instability

increased risk of periodontal disease

macroglossia

class III malocclusion

AOB

Question 9

Why is DS associated with a higher incidence of periodontal disease? (5)

Answer 9

Altered immune system

poor manual dexterity and OH

don’t have full clearance when swallowing

higher prevalence of periodontal pathogens

altered saliva

Question 10

What is Prader Willi?

Answer 10

genetic disorder which affects chromosome 15

Question 11

What are the characteristics of prader willi?

Answer 11

constant desire to eat as they’re never full

intellectual impairment

lack of sexual development

behavioural problems - tantrum, stubborn

Question 12

What is cerebral palsy?

Answer 12

neurological condition that affects movement and coordination and sometimes intellectual impairment - not always

Question 13

What are the characteristics of CP?

Answer 13

Dependant on what type they have;

Muscle weakness and stiffness

uncontrolled body movement - intention tremor

balance and co-ordination problems

Question 14

What are the benefits of providing care for people with learning disabilities in a primary care setting?

Answer 14

There are primary care setting closer to the patients which makes transport easier and less expensive

Family members and carers can attend with the patient

can provide longitudinal care - prevention, treatment, falls up

can establish a relationship

Question 15

How do we prepare those with learning disabilities for the first visit?

Answer 15

send social stories home with the patient that prepares them for visiting the practice and receiving treatment

allow pre-visits - acclimatisation and trust

carry out a health passport - allows you to assess likes and dislikes (triggers)

Question 16

when is best to carry out treatment on patients with learning disabilities? (2)

Answer 16

At the start of the day - so you’re not running late and so they don’t have to wait in the waiting room for long

find out what also suits them in terms of mood and medication administration times

Question 17

What communication adjunct are useful for non-verbal patients?

Answer 17

Picture boards 
Makaton 
talking mats 
drawing and writing
PECS - autism

Question 18

What communication adjunct is not used for consent?

Answer 18

Talking mats

Question 19

How can we gain better access to the mouth for patients with learning disabilities? (4)

Answer 19

Bedi shield

open wide mouth rest

mirrors with an internal light

head support and clinical holding - last resort and requires consent

Question 20

What is the limitation of the bed shield?

Answer 20

can fracture

Question 21

When should clinical holding be used? (3)

Answer 21

In an unplanned emergency

when the patient has consented and other people in the room have too

if the patient has no capacity and is at risk to themselves and others.

must record why it was used in the notes

Question 22

What are the risk factors for oral disease in patients with learning disabilities? (4)

Answer 22

poor motor control - cannot carry out OH

mouth breathing and Dry mouth

imbrication (overlapping) of teeth

pouching and limited food clearance (leave food in the buccal sulcus)

Question 23

What OH advice can we give to carers/people with learning disabilities? (5)

Answer 23

toothpastes with no taste or foam e.g. oranurse

establish a routine - brush at the same time every morning/night

start from a different quadrant every time you brush and ensure u use a systematic technique

use an adaptive toothbrush that suits the individual

stand behind and to the side

Question 24

self injurious behaviour is associated with some LD, What are treatment strategies? (5)

Answer 24

distraction and challenge behaviour

behaviour psychology

pharmacological treatment i.e. diazepam

construct oral appliances

extract specific teeth - limited as they can use other teeth

Question 25

What are causes of drooling? (4)

Answer 25

Impaired swallowing

abnormal head position

poor mouth closure

tongue thrust

Question 26

What treatment strategies can be used for those with LD and dry mouth? (4)

Answer 26

depends on the level of disability - not all can be used

replacements - can’t be used in dysphagia

sugar free gum and fluids

fluoride rinses

high fluoride toothpastes

Question 27

What treatment strategies can be used for those with LD and feeding problems?

Answer 27

promote good OH to ensure no debris is aspirated and causes aspiration pneumonia

use a low foaming toothpaste - risk for those with dysphagia

use a suction toothbrush

Question 28

what do patients who are nil by mouth present with oral disease?

Answer 28

Since patients are NBM the family/carers don’t brush their teeth.

However, these patients still receive tasters which are usually very cariogenic (jam and honey)

Question 29

Can LA be used in patients with learning disabilities?

Answer 29

can be used but not advised in patients with more severe LD as there is poor cooperation.

also not advised if there are large volumes of treatment required

Question 30

Can conscious sedation be used in primary care settings in patients with learning disabilities? (4)

Answer 30

Yes but -
You must be able to carry out IV and airway management

the patient has to be able to understand and communicate their decision

patients medical status is below ASA 3

not on bleomycin therapy or has musculoskeletal discrepancies

Question 31

Can GA be used in patients with learning disabilities?

Answer 31

Yes - used when there is an inability to cooperate.

They may need to be kept in hospital for observation after GA if they are high risk.

Question 32

What are the advantages of using GA in patients with learning disabilities? (4)

Answer 32

Can carry out large volumes and varieties of treatment.

More controlled environment to cope with complex medical diseases

can have joint working

have the facilities for aftercare and monitoring

Question 33

What are the disadvantages of using GA in patients with learning disabilities? (5)

Answer 33

risk of death and neurological issues

require 24 hour support post GA

can’t carry out crown and bridge

have to be radical and remove all disease so that they do not require another GA in the near future

doesn’t improve coping mechanisms, behavioural problems or ability to overcome fear

Question 34

How long should there be between GA’s in patients with learning disabilities

Answer 34

8/10 years

Question 35

name physical features of Downs. (4)

Answer 35

flat and broad face

short nose

flat back of head

slanting eyes with epicanthic eyefolds