18. Special Care Dentistry

Question 1

Disabilities

1. 4 barriers to care
2. ICIDH classification and definitions
3. 4 management options for visual impairments
4. 4 management options of hearing impairments

Answer 1

1. Physical, attitudinal, people-centred, professional-centred
2. Impairment - any loss/abnormality of psychological, physiological or anatomical structure or function
   Disability - restriction/lack of ability to perform an activity in a manner within the range considered normal for a human being
   Handicap - disadvantages for a given individual, resulting from an impairment or handicap, that limits/prevents normal role fulfilment for that individual
3. Use names, avoid non-verbals, inform patient of any movement, say what your will do before doing it
4. Ask about loop system, establish preferred method of communication, face person when speaking, use clear speech with normal lip patterns, be willing to repeat and rephrase

Question 2

Cerebral palsy

1. 4 types
2. 4 dental features

Answer 2

1. Spastic, athetoid, rigid, ataxic, mixed
2. Poor OH, gingival hyperplasia, enamel hyperplasia, bruxism, malocclusion, drooling, uncontrolled movements, enhanced gag reflexes

Question 3

Downs syndrome

1. 4 medical features
2. 5 dental features
3. 4 management options

Answer 3

1. CHD, increased risk of haematological malignancy, reduced IQ, epilepsy, risk of early-onset Alzheimer’s
2. Class III occlusion, AOB, macroglossia, hypodontia/microdontia, maxillary hypoplasia, predisposition to periodontal disease
3. Pre-visit, appt at quieter times, longer appts, use closed questions

Question 4

Autism

1. Definition
2. 4 features
3. 4 management options

Answer 4

1. Lifelong development spectrum disorder disability affecting areas of the brain controlling language, social interaction and creative/abstract thinking
2. Withdrawn, isolated, socially awkward and naive, difficulty relating to people, no interest in communication and interpret language literally
3. Pre-visit, social stories, appt at quieter times, longer appts, closed questions, clear commands

Question 5

Legislation

1. 2 key acts for Scotland
2. 9 protected characteristics

Answer 5

1. EA 2010, (DDA 2004), AWI 2000, MCA 2005
2. Age, sex, gender reassignment, marriage and civil partnership, religion/belief, race/ethnicity, disability, sexual orientation, pregnant/maternity,

Question 6

AWI

1. Definition of capacity
2. Definition of incapacity
3. 5 principles of the act
4. Types of PoA
5. Definition of welfare guardian
6. 5 individuals who can consent to treatment
7. Emergency situations where no consent required

Answer 6

1. Ability to receive impressions, knowledge and act/do something based upon knowledge received
2. Inability to enter into legally binding contracts
3. Benefit, minimum necessary intervention, take account of the wishes of the adult, consultation with relevant others, encourage adult to exercise residual capacity
4. Continuing (financial affairs and property) and welfare (health and personal welfare)
5. Court-appointed individual, when an individual without capacity becomes an adult. Involves continuous management of welfare and financial matters for those who have never had capacity
6. Patient with capacity, welfare PoA, welfare guardian, closest relative (no PoA/guardian), medic/dentist with Section 47 certificate, medic/dentist in emergency situation (preservation of life/prevent serious deterioration)
7. Spreading facial infection (airway risk) and severe bleeding (general authority to treat)

Question 7

Cancer

1. Definition of dentally fit
2. 8 side effects from cancer treatment
3. Definition of mucositis
4. 4 prevention/management options
5. Mucositis grading
6. Definition of xerostomia
7. 3 reasons for
8. 3 management options

Answer 7

1. Establish existing oral disease and potential risk of disease, remove foci of infection, establish good OH, develop maintenance and preventive/rehab plan
2. Xerostomia, mucositis, trismus, hoarseness, dysphagia, neck fibrosis, tiredness, hair loss, immunosuppression
3. Acute inflammation (and ulceration) of mucous membranes
4. Improve OH, adjust ill-fitting denture, smooth sharp cusps/restorations, mucosal shields, ice chips, anaesthetic MW

5. 0 - none
1 - mild - sore/erythema
2 - moderate - erythema, ulcers
3 - severe - oral ulcers (liquid diet)
4 - life-threatening - oral alimentation impossible

6. Dry mouth due to reduced/absent saliva flow/ Unstimulated flow rate <0.1ml/min.
7. Medication side effect, cancer Rx side effect, Sjogren’s, psychogenic
8. Saliva replacement (Biotene, BioXtra), saliva stimulants (water, SF gum), avoid hard/spicy/chewy foods and SLS

Question 8

Elderly

1. Definition of dementia
2. 3 things it affects
3. 4 common types and describe
4. 4 early, middle and late signs

Answer 8

1. Syndrome of chronic or progressive nature involving deterioration in cognitive function beyond what might be expected from normal ageing
2. Memory, thinking, orientation, comprehension, language, judgement
3. Alzheimer’s - beta-amyloid proteins build up and reduction in size of cortex
   Vascular - reduced blood flow to brain, causing ischaemia and necrosis
   Lewy bodies - deposits of Lewy bodies in memory and muscle movement brain areas
   Frontotemporal - ubiquitin-associated clumps, associated with TDP-43
4. Early - STML, confusion, poor judgement, indecision
   Middle - mood changes, increasingly forgetful, may fail to recognise people, aggression, anger, distress
   Late - fail to recognise familiar objects, surroundings, people, increasing physical frailty, difficulty eating and swallowing, gradual loss of speech

Question 9

Special Care Dentistry

1. 4 assisted brushing techniques
2. Definition of ART

Answer 9

1. Rescuing, hand-over-hand, bridging, distraction, chaining

2. Atraumatic restoration technique - removal of caries (hand excavator) and RMGIC restoration. No LA, no handpieces