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BDS3 Special Care Dentistry > Intro to SCD > Flashcards

Intro to SCD Flashcards

1
Q

Special Care Dentistry

A

The speciality of Special Care Dentistry is concerned with the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. The specialty focuses on adolescents and adults only and includes the important period of transition as the adolescent moves into adulthood.

Formally recognised by GDC 2008

Not special needs

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2
Q

SCD groups

A

Learning difficulties

Physical disability

Mental health problems
- In unit, Effect OH

Homeless, refuges, asylum

Medical compromised
- Transplant, cancer, end of life care

Older people

Behavioural management techniques needed

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3
Q

age for SCD

A

adult speciality 16+

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4
Q

impairment

A

Any loss or abnormality of psychological, physiological, or anatomical structure or function.

Impairment is considered to occur at the level of organ or system function

Do not have

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5
Q

disability

A

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.

Disability is concerned with functional performance or activity, affecting the whole person.

Disability is activity restricted by impairment.

Different
- Due to impairment
Born with impairment – no arm
Live with disability – effect on life, unable to open door

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6
Q

handicap

A

A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.

Lose arm due to road traffic accident
- Previously able to open door but now not able

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7
Q

WHO stance on Disability

A

Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions.

Impairment is a problem in body function or structure

Activity limitation is a difficulty encountered by an individual in executing a task or action

Participation restriction is a problem experienced by an individual in involvement in life situations.

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8
Q

paradox of disability

A

Prove unable to participate in society – need evidence
- But want them to be able

Level of support directionally proportional to level of disability
- Determined by person in office who doesn’t experience of disability

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9
Q

complexity of disability

A

Complex
- Body level, system level

Not just health
- Inequalities – health, financial

Lower socioeconomic has increased level of disability

Need to remove environmental and social barriers to help target disability

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10
Q

how many consultant SCD Scotland

A

4

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11
Q

how to become consultant in SCD

A

Tri-collegiate Exit exam

however New undergraduate curriculum in Special Care Dentistry (raise knowledge)

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12
Q

SCD recognised

A

2008

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13
Q

professional SCD societies

A

The International Association for Disability and Oral Health (IADH)

The Academy of Dentistry for Persons with Disabilities (ADPD) Special Care in Dentistry

British Society for Disability and Oral Health (BSDH) Journal of Disability and Oral Health

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14
Q

prevalence of disability

A

Difficulty in gathering numbers of cases
- WHO: 10% worldwide population (very)

Developed countries report lower rates?

UK: 18% over age 16 years
UK: 5% serious disability

Prevalence increases with age

Locomotor disability most prevalent

Hidden disabilities

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15
Q

scottish disability stats

A

Nearly one in five people of working age (1 million, or 19%) in Scotland are disabled
- 18% men
= 19% women

45% over 75 years old
4% 16-24 age group
>800,000 people

> 800,000 people

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16
Q

disability and employment

A

Only about half of disabled people of working age are in work (50%), compared with 80% of non disabled people of working age

Almost half (45%) of the disabled population of working age in Britain are economically inactive i.e. outside of the labour force.

There are currently 1.2 million disabled people in the UK who are available for and want to work.
Employment rates vary greatly according to the type of impairment a person has.
Disabled people with mental health problems have the lowest employment rates of all impairment categories at only 21%. The employment rate for people with learning disabilities is 26%.
Disabled people are more than twice as likely as non-disabled people to have no qualifications (26% as opposed to 10%)

17
Q

problems with disability stats

A

For example:

  1. 7% population estimated to have a visual impairment
    - Only 0.6% population actually registered

Different definitions worldwide

‘Hidden’ disabilities

Surveys v Questionnaires

18
Q

who deals in SCD

A

“The registrant will recognise and take account of the needs of different patient groups including children, adults, older people, and those with special care requirements throughout the patient care process.”

19
Q

issues with disability and OH

A

Basic Tasks like brushing teeth unable to perform if

  • Epidermolysis Bullosa
  • Substance abuse
  • Learning disability
  • Dementia/ frailty
  • End of life care
  • Cancer therapy
20
Q

barriers to care

A

Physical

Attitudinal

People Centred

Professional Centred

21
Q

characteristics of service use for special care

A

Fewer visits, longer intervals between

Limited access to buildings

Difficulty communicating pain

Financial

Emergency care rather than planned

History of extractions

Treatment with GA

22
Q

SCD and clinical medical science

A

Not enough to have knowledge of disease

Must know how that disease pertains to dental health & treatment

  • What treatment is most appropriate?
  • Who is most appropriate person to deliver care?
  • Where is the best place to provide treatment?
23
Q

why dentists need to know SCD

A

The Human Rights Act 2000

(DDA 2005)

The Equality Act 2010

The Adults with Incapacity Act (Scotland)

The Mental Capacity Act (England & Wales)

NHS terms of service

GDC

24
Q

SCD needs

A

Excellent Communication Skills

Empathy

Experience

Pragmatic

Patience

Decisive

Interest in Medicine & Medical Problems

Excellence in the most challenging conditions

25
Q

physical disability e.g

A

Spina Bifida
- access, allergies

Cerebral palsy

Arthritis

Spinal injury pt

26
Q

intellectual impairment e.g

A

Down Syndrome
- multiple presentations

Fragile X syndrome

Autism spectrum disorder

27
Q

mental disability e.g.

A

schizophrenia

dementia

alzheimers

28
Q

sensory disability e.g.

A

visually impaired

hearing impaired

29
Q

emotional disability e.g.

A

Anxiety States

Depression

Bipolar Affective Disorder

Personality Disorders

Eating Disorders

30
Q

social disability e.g.

A

Illegal Drug use

Alcohol abuse

Homelessness

Obesity

Poverty

31
Q

effect of SCD on oral cavity

A

Late presentation and severe levels of disease

Caries
Periodontal disease
Tooth wear
Xerostomia – polypharmacy
Infections – fungal, bacterial, viral – compromise health, beyond just teeth (soft tissues etc)
Mucosal disease
Malignancy – oral cancer
Infected osteoradionecrosis – head and neck cancer, tumour removed, radiotherapy, which dissolved blood vessel in bone, bone infected – may need to lose jaw

struggle with where to begin

32
Q

biphosphonates

A

Metastatic cancer and myeloma

  • Prevent osteolytic lesions
  • Reduce bone pain
  • Regulate serum calcium

Osteoporosis

  • Reversal and prevention Issue date: Reversal and prevention
  • with calcium/vit D supplementation
  • Paget’s disease

Know about Medicine important and interaction

33
Q

long period of biphosphonate or steroid use

A

osteonecrosis of joint – areas of bone do not heal after extraction

Prevention
- Make dental decisions before commencing drug

34
Q

infected osteoradionecrosis

A

head and neck cancer, tumour removed, radiotherapy, which dissolved blood vessel in bone, bone infected – may need to lose jaw

35
Q

who provides SCD

A 
General Dental Practitioners
Public Dental Service
Hospital Dentists
Specialists in SCD
Shared Care

Full range of NHS Dental Treatment +/- other as appropriate
Must be appropriate & tailored to each patient

36
Q

considerations for SCD Tx

A

Patient Medical History
Patient Previous Dental History
Patient Social History
Clinical Holding

Treatment will fail if not maintained
Holistic approach essential
Multi-Disciplinary Team Care

37
Q

where is SCD carried out

A

Dental Practice

Community Dental Surgery / Public Dental Service

Hospital - MAINLY

Own homes/care homes/hospice not safe to extract – clutter

38
Q

Oral health importance

A

enables a person to eat, speak and socialise without active disease, discomfort and embarrassment.

Quality oral healthcare contributes to holistic health.

Oral Health Strategy Group, Department of Health, 1994

It should be a RIGHT and NOT a privilege.

BDS3 Special Care Dentistry (21 decks)

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