Disability and Oral Health Flashcards
(20 cards)
What is special care dentistry?
Concerned with providing and enabling the delivery of oral care for people with an impairment or disability
For people who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability
Why know about special care dentistry?
Recognise their duty of care in the attainment of achievable tx outcomes for patients with specific medical, physical, mental health problems
Where is special care dentistry delivered?
Salaried primary dental care services
Hospital services
General dental services
Salaried primary dental care services care for patients with special needs, give examples
Learning disabilities Mental health Physical, acquired disability Elderly Housebound Med compromised Anxious Homeless Migrants Refugees Prisoners Substance misusers
When is communication a mild restriction?
With or without use of aids
Pt speaks english but not first language
Pt has mild learning difficulty
Pt has hearing impairment
Autism Mild learning disability Sensory impairment: - Blind - Deaf - Aphasia Stroke Cerebral palsy Dementia
When is communication a moderate restriction?
Pt does not speak English - interpreter needed
Communication needed in writing; sign language/makaton/communication aids
Pt communication needs carer
Moderate learning difficulty
Pt has mild dementia
Autism
Recent stroke
Down’s
Advancing parkinson’s
When is communication a severe restriction?
No ability to communicate Profound learning disability Advanced dementia Pt with advanced huntington's disease Severely debilitating brain injury
Autism in adults
Downs in older adult
Psychiatric conditions
Advanced dementia
How to overcome communication barriers?
Lip reading Sound loops Interpreters Carers/relatives Sign language Pen and paper Pictures
When can there be some difficulty with co-operation?
Able to complete examination but not all other procedures required
Tx completed with limited interruption
Pt requires 50% longer appt
Pt requires up to 2 behaviour modification visits before tx
Dental anxiety Autism Mental health Mild learning disability Downs Substance abuse
When can there be considerable difficulty with co-operation?
Limited examination possible
Formal risk assessment relating to any physical intervention that maybe required
Considerable interruption disrupts tx
Precautions due to violence/inappropriate behaviour
More than 50% longer appts
3 or more behaviour modification/acclimatisation visits
Dental phobia ADHD Moderate learning disability Mid stage parkinsons and dementia Gag reflex
When is cooperation extremely difficult?
Unable to examine without GA
Sedation or GA for tx
Pt requires 5 or more behavioural modification/acclimatisation visits prior to tx
Severe dental phobia Poorly controlled mental health problems Severe learning disability Violent/aggressive Substance misuse Profound cerebral palsy
How to overcome cooperation barriers?
TLC Acclimatisation TSD Shorter appts More appts CBT Acupuncture Hypnosis Inhalation/IV sedation Oral sedation GA Music therapy Visual therapy Aromatherapy Restraint
Department of health in England definitions:
Restraint?
Positive application of force with the intention of overpowering the person’, which is without that person’s consent
Department of health in England definitions:
Holding still?
Immobilisation, which may be used to help a person cope with a painful procedure effectively and is carried out with the person’s consent
Department of health in England definitions:
Containing?
As physical restraint or a barrier aims at preventing the person from harming themselves or others
Types of restraint?
Physical intervention = with consent of pt/parent of child/carer of person who cannot consent for self
- Handholding
- Cradling/supporting
- Clinical holding
- Papoose boards - Parkinson’s, Huntington’s, Cerebral palsy, any condition where uncontrolled/sudden movements
Chemical restraint
GA
Contraindications to physical intervention?
History of cardiac disease
Existing breathing difficulties
Osteo-pathology
Down’s syndrome with atlanto-axial joint instability
When may tx be modified slightly due to the patient’s medical status?
Med history obtained but some slight modifications to pt management needed:
- Antibiotic cover
- Stable epilepsy
- Mental health - drug interactions, xerostomia
- Rheumatic disease - Sjogrens
- MRSA
- Substance misusers - DVT, liver damage
When can the patient’s medical status have a moderate impact on the tx?
Complex med condition affects ability to treat and choice of tx
Tests and special arrangements needed
Med/psychiatric history not able to be obtained without investigations
Poorly stabilised mental health condition Steroid therapy Warfarin Stroke patients Unstable epilepsy, diabetes, asthma Por oro-facial ca and radiotherapy Bisphosphonates
When can the med status have a severe impact on tx?
Requires multidisciplinary review in order to decide whether or not to treat and precautions required e.g. case conferences, joint review with anaesthetics
Blood disorders
Brain/spinal injury who are bedbound
