dental care for the special needs child

Question 1

how does paediatric dentistry define those with special needs?

Answer 1

those with chronic physical, development, emotional and behavioural needs require more extensive dental needs

Question 2

does prevalence of disease differ in certain disability groups?

Answer 2

yes e.g p disease and Down syndrome

Question 3

do tx need to be modified for certain special needs children?

Answer 3

yes- depending on patients capabilities e.g cerebral palsy

Question 4

when does an impairment become a disability?

Answer 4

when a child cannot carry out the normal activities of their peer group

Question 5

what categories of impairment are there? give examples of each

Answer 5

intellectual (learning disabilities)- e.g problems during pregnancy/child birth or illness/injury

physical disabilities- cerebral palsy, muscular dystrophy

sensory- visual impairment blindness
hearing impairment-deafness

Question 6

describe intelectual disabilites?

Answer 6

• below average level of intelligence and lack of skills necessary for day to day living

e.g Down syndrome

Question 7

describe learning difficulties?

Answer 7

-normal level of intelligence but difficulty with particular skills

e.g adhd, dyslexia

Question 8

give examples of conditions causing intellectual difficulties

Answer 8

-Down syndrome
-fragile x syndrome
-autism/schizophrenia
-dyslexia
-adhd
-emotional disorders

Question 9

what causes Down syndrome?

Answer 9

trisomy 21- extra copy of chromosome 21
3 instead of 2

Question 10

what are common features with down syndrome?

Answer 10

-large tongue
-chubby fingers/hands
-hypoplastic teeth
-delayed exfoliation of primary teeth
-congenital hypodontia
-high susceptibility to p. disease

Question 11

what is the most important factor of dental management for ds patients?

Answer 11

PREVENTION

Question 12

how else do you manage ds patients in dental setting?

Answer 12

-poor OH- may require toothbrush modification
-difficulty accessing mouth-larger tongue

Question 13

what kind of condition if fragile x syndrome?

Answer 13

-genetic disorder

Question 14

what does fragile x syndrome cause?

Answer 14

-faulty X chromosome
-faulty FMRP gene which is responsible for protein that allows for brain development

Question 15

what are features of fragile X syndrome?

Answer 15

-crowded teeth
-large ears
-large forehead
-logn face
-prominent jaw
-high arch palate

Question 16

how does fragile X syndrome affect dental care?

Answer 16

-difficulty understanding or tolerating treatments
-focus on prevention

Question 17

what is key to patients with autism?

Answer 17

familiarity- same operator and surgery
-often stick to routines/rituals

Question 18

what difficulties to those with autism face?

Answer 18

-difficulties with social communication- often unable to understand facial expressions, jokes, sarcasm
-take things literally

-unable to understand emotions/feeling or express their own
-cannot understand normal etiquette

-difficulty understanding new or unfamiliar situations

Question 19

what visual help may someone with autism use?

Answer 19

makaton visual symbols

Question 20

what are the signs of someone with schizophrenia?

Answer 20

-hostile
-deterioration in personal hygiene
-emotionless gaze
-inappropriate laughter
-depression
-insomonia

Question 21

what are the symptoms of someone with schizophrenia?

Answer 21

-hallucinations
-delusions
-behavioural changes
-muddled thoughts

Question 22

how do you manage autism/schrizophrenia in dental setting?

Answer 22

-on time appts
-short appts
-limit tx to what pt can tolerate on the day

Question 23

what is the main problem of someone with dyslexia in a dental setting?

Answer 23

-understanding- difficulty processing or retaining information

Question 24

how do you manage someone with dyslexia?

Answer 24

-very simple verbal and written explanation of tx with absolutely no jargon

Question 25

what does ADHD stand for?

Answer 25

attention deficit hyperactivity disorder

Question 26

how can adhd affect dental tx?

Answer 26

-difficulty sitting still/opening mouth -difficulty following requests

Question 27

how do you manage someone with adhd in a dental setting?

Answer 27

-short appts -short tx -continuous breaks from mouth being open -encouragement from parents -distraction -firmer management

Question 28

how can emotional disorders affect dentistry?

Answer 28

-eating disorders can lead to toothier (bulimia) -focus on prevention

Question 29

what is the main aim when dealing with intellectually impaired children?

Answer 29

acclimatisation- always start of simple and build trust/cooperation before moving on -focus on prevention and parental support -will take time

Question 30

what are good aids for operators when treatmting patients with intellectual difficulties/

Answer 30

-fidget toys -bedi shield to protect finger

Question 31

how can physical impairments affect movement?

Answer 31

-impaired movement -uncontrolled movement

Question 32

what are examples of physical impairments?

Answer 32

-cerebral palsy -spina bifida -muscular dystrophy

Question 33

what is cerebral palsy?

Answer 33

-neurological disorder which affects movement and coordination -due to damage of cerebrum before or after birth- controls movement, learning, memory and communications skills

Question 34

what is spina bifida?

Answer 34

-when the spinal cord and overlying vertebrae are poorly formed at birth- lower limb paralysis

Question 35

what is muscular dystrophy?

Answer 35

diseases which lead to progressive atrophy and weakening of skeletal muscles- causing disability and deformity

Question 36

what are the dental implications of physical impairments?

Answer 36

-poor OH-trouble performing on OH -difficulty getting on chair -self-inflicated (factitious) oral wounds -trouble opening mouth or trouble controlling movement of mouth -gag/cough reflexes -hypomineralised/hypoplastic teeth -excessive saliva

Question 37

how do you manage those with physical impairment?

Answer 37

-aggressive early prevention-FS/FV -educate parental support -may require GA- extract all teeth of poor prognosis to avoid repeat GA -modify toothbrush-electric? -special chair for lifting wheelchairs -perform as much tx as possible- which they can handle

Question 38

what forms of sensory impairment is there?

Answer 38

-visual -hearing

Question 39

how can visual impairments affect dental care?

Answer 39

-OHI affected- cannot see plaque removal -trust- cannot see instruments being used -operating light may cause sensitivity to those visually impaired

Question 40

how can operators aid those who are visually impaired?

Answer 40

-tell, feel, do -explain procedures before you start -reassure pt -give instructions suitable to their sight- e.g large print/brail -cant see OHI- explain feelings of brushes -address the patient not carer -do not shout-they are not deaf

Question 41

what may those with hearing impairments use?

Answer 41

-hearing aids -sign language

Question 42

what are dental challanges of someone with hearing impairments?

Answer 42

-communication -may be more sensitive to vibratory sounds of instruments- uncomfortable

Question 43

how do you manage those with hearing impairments?

Answer 43

-document severity -use visual aids -sit infront of patient -speak clearly if they can lip read -interpretor if first language is BSL -use full face visor instead of mask -use positive body language/facial expressions

Question 44

discuss prevention and tx on those with impairments?

Answer 44

-aggressive early prevention is essential as treatment should be avoided due to difficulties for both the operator and the patient.

Question 45

how does parental support affect OH?

Answer 45

- it is important to be realistic -educate parent/carer on OH to assist with any at home OH advice

Question 46

discuss plaque control for those with impairments

Answer 46

-supervised toothbrushing if able to do it themselves -educated parent/carer if unable to do it themselves -electric toothbrush if suitable -modified toothbrush if needed- e.g moulded to their hand grip -if cannot tolerate tb/tp- use cholarhexidine on gauze swabs to clean teeth

Question 47

discuss fluoride use for those with impairments

Answer 47

-duraphat may be prescribed as mild risk of fluorosis and systemic ingestion is outweighed by benefits of high fluoride tp

Question 48

discuss diet for those with impairments

Answer 48

-likely more spoiled with sweets/sugar than other children -normal diet advice-reduce frequency and consumption and before bed -avoid cariogenic medicine- use sugar free alternatives