disability and legislation

Question 1

disability entitlement

Answer 1

equal standards of health and care as their able-bodied cohorts

Question 2

disability prevalence

Answer 2

Disability affects a wide segment of the population.
- All ages and social classes

3% of children under 16 have one or more disability

Over 4 million adults have mobility problems

2.5 million adults have difficulty with personal care

Prevalence of disability increases with age
- 46% of over 75’s have impaired mobility

Implications for access to services and management of oral care

Question 3

3 concepts of disability

Answer 3

impairment

disability

handicap

Question 4

impairment

Answer 4

any loss or abnormality of psychological, physiological or anatomical structure or function

concerned with abnormalities in the structure or functioning of the body or its parts

Question 5

impairment concerned with

Answer 5

abnormalities in the structure or functioning of the body or its parts

Question 6

disability concerned with

Answer 6

the performance of activities

Question 7

disability

Answer 7

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

concerned with the performance of activities

Question 8

handicap

Answer 8

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 function) for that individual.

concerned with the broader social and psychological consequences of living with impairment and disability

Question 9

handicap concerned with

Answer 9

the broader social and psychological consequences of living with impairment and disability

Question 10

interrelations between impairment, disability and handicap

diseases - arthritis

Answer 10

An individual with arthritis (disease) will have pain and swelling in involved joints which will be stiff and limited in their range of motion (impairment).

Consequently, there may be difficulty in carrying out activities such as walking or climbing stairs (disability).

This may disadvantage the individual in terms of mobility around the community or finding a job, which in turn may lead to social isolation of relative poverty (handicap).

Question 11

interrelations between impairment, disability and handicap

facial disfigurement

Answer 11

A person with a severe facial disfigurement which is present at birth or as the result of an accident would be impaired.

They would not experience any limitations in the tasks or activities of daily life and would not be disabled.

However, they may be handicapped in the sense that social attitudes towards physical attractiveness could lead to low self-esteem and difficulty in forming romantic relationships.

Question 12

disability discrimination act 2004

Answer 12

The Disability Discrimination Act (DDA) aimed to end the discrimination which many disabled people faced.

This Act gave disabled people rights in the area of:

• employment
• access to goods, facilities and services
• buying or renting land or property

Question 13

the equality act 2010

Answer 13

The UK Government’s Equality Act 2010 provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. The Act restated and simplified 116 separate pieces of earlier equality legislation into one Act, the bulk of which came into force in October 2010.

requiring public bodies to meet a new integrated Equality Duty

strengthening protection from discrimination for disabled people.

Some people or organisations like employers, shops, local authorities and schools must take positive steps to remove the barriers faced because of disability.
- This ensures people with a disability receive the same services, as far as this is possible, as someone who’s not disabled.

Question 14

The Disability Discrimination Act defines a disabled person as someone with

Answer 14

“a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities.”

Question 15

examples of normal day-to-day activities

Answer 15

mobility

manual dexterity

physical coordination

continence

ability to lift, carry or move everyday objects

speech, hearing or eyesight

memory or ability to
concentrate, learn or understand

understanding of the risk of physical danger

Question 16

discrimination barriers (5)

Answer 16

physical access to premises

lowered educational expectations

excluded from employment

social policies imposed

Question 17

prejudice barriers (5)

Answer 17

unwanted centre of attention

denied anonymity

patronised

imposed identity

denied respect

Question 18

3 key components to independence and choice

Answer 18

information

access

transport

Question 19

principles of advocacy

Answer 19

Any person, whatever the nature of their disability, has the right to:

• Be treated in a dignified manner and valued as equals
• Be consulted about their needs and influence plans
• Be neither over-protected nor under-protected
• Avoid being segregated from the rest of the community in work, education, recreation or where they live

Question 20

implication for dentistry of advocacy

Answer 20

Ensure physical accessibility of premises
- Responsibility of the practitioner

Don’t assume it is always the disabled person who is the problem - it could be the dental team
- Reception desk at level accessible for wheelchair and standing

Remember disabled people are capable of expressing views and having preferences – listen to them

impaired mobility

• ability to reach service (transport)
• physical access to dental premises - e.g. can’t get into chair – may need hoist

all affect the uptake of dental care

Question 21

failure in providing equity disabled people in dental care

Answer 21

irregular dental attendance

delay in obtaining treatment and preventive advice

which in turn leads to:
- crisis management - pain relief and extractions

Question 22

minor adaptations needed to make equity dental service

Answer 22

designated parking close to the premises

appropriate signposting for those with sensory impairment

ground floor level access

ramps for wheelchair access

handrails for support on steps and ramps

wide doors and corridors for wheelchairs

unisex disabled toilet facilities

wheelchair turning circle within surgery layout

Question 23

domiciliary dental care

Answer 23

a growing area of dental practice
– e.g. visit in home, care home, hospice

Those with a physical disability may be dependent on others for many or all activities of daily living including oral care

Question 24

issue for dental care of those dependent on others (e.g. carers, nurses etc)

Answer 24

poor attitude to oral care
lack of knowledge
inadequate training

can be considered abuse if not helping

Question 25

why is there evidence for professional reluctance in providing dental care for disabled

Answer 25

Many dentists feel inadequately trained to deal with this group.

Question 26

special care dentistry training provides

Answer 26

• Knowledge and understanding of impairments
• Behaviour management
• Communication skills
• Special techniques

Important role for Dental Therapists and Dental Hygienists

Liaison necessary between: 
- Hospital Dental Services (HDS)
- Public or Community Dental Services (PDS/CDS)
- General Dental Services (GDS) 
Seamless dental care

Question 27

SCD works with which professional groups

Answer 27

Liaison necessary between: 
- Hospital Dental Services (HDS)
- Public or Community Dental Services (PDS/CDS)
- General Dental Services (GDS) 
Seamless dental care

Question 28

oral health services should

Answer 28

be responsive to needs

take account of views and demands

show consideration for QOL (quality of life)

respect the individual’s dignity

target high risk populations

work in partnership with carers and other professionals

Question 29

professional societies in SCD (3)

Answer 29

The International Association for Disability and Oral Health (IADH)

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

British Society for Disability and Oral Health (BSDH) – Has a student population
- Journal of Disability and Oral Health

Question 30

BSDH objectives

Answer 30

centred on improving and protecting individuals

• To improve, preserve and protect the oral health of people of all ages with disabilities
• To undertake study and research into the provision of dental care for people with disabilities and to publish useful results thereof
• To develop undergraduate and postgraduate teaching in the subject

Question 31

BSDH guidelines

Answer 31

• Oral health care for long stay patients and residents
• Oral care for people with a disability
• Oral care for people with a learning disability
• Sedation and day case general anaesthesia for people with special needs
• Oral health care for people with mental health problems
• The oral management of oncology patients requiring radiotherapy, chemotherapy, bone marrow transplantation

Question 32

the essentials for SCD (4)

Answer 32

Maintenance of a high standard of oral hygiene

Multidisciplinary teamwork

Education

Effective communication

Question 33

oral health link to holistic health

Answer 33

Oral health and quality oral care can contribute to holistic health. It should be a right not a privilege for all.

Perhaps I simply need to explain that if special care dentistry is about humanity then dental public health is about equality. It is about identifying those people whose oral health is most compromised and taking action to make it better. It is to bring them in from the periphery and put them at the centre; to bring them up from the lowest level and put them at the top. For those who are neither seen nor heard it is to see them and be heard on their behalf
J.Sinclair-Cohen, 1999