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BDS3 Special Care Dentistry > Intellectual Impairment (c) > Flashcards

Intellectual Impairment (c) Flashcards

1
Q

Intellectual disability involves problems with general mental abilities that affect functioning in which 2 areas?

A

intellectual disability involves problems with general mental abilities that affect functioning in 2 areas:

  • intellectual functioning
    • learning, problem solving, judgement
  • adaptive functioning
    • activities of daily life such as communication and independent living
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2
Q

Who is more likely to be diagnosed with an intellectual disability - males or females?

A

males are more likely to be diagnosed with an intellectual disability than females

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3
Q

What learning disability labels are appropriate to use?

A

appropriate learning disability labels:

  • person with an intellectual impairment
  • person with a learning difficulty
  • person with a learning disability
  • person with additional care needs
  • person with additional support needs
  • person who requires special care
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4
Q

What is a problem in body function or structure known as?

A

an impairment is a problem in body function or structure

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5
Q

What is activity limitation?

A

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

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6
Q

What is participation restriction?

A

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

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7
Q

What is the social model of disability?

A

the social model of disability is the theory that disability is caused by the way that society is organised, rather than by a person’s impairment or difference

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8
Q

The X model of disability is the thinking that disability is caused by the way that society is organised, rather than by a person’s disability or difference

A

X - social

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9
Q

What is the medical model of disability?

A

the medical model of disability is the thinking that people, are disabled by their medical impairments or differences

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10
Q

What are barriers to a social model of disability?

A

barriers to a social model of disability:

  • segregated social provision
  • inflexible organisational procedures and practices
  • inaccessible information
  • inaccessible buildings
  • inaccessible transport
  • negative cultural representations
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11
Q

Whta are causes of learning disability?

A

causes of learning disability:

  • pre-conception
    • hereditary - parental genotype
    • environmental - maternal health
  • pre-natal
    • hereditary - chromosomal, genetic
    • environmental - infection, maternal health, nutrition, toxic agents
  • peri-natal
    • environmental - prematurity, injury
  • post-natal
    • hereditary - untreated genetic disorders (PKU)
    • environmental - infection, trauma, toxic agents, nutrition, sensory social deprivation
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12
Q

What are examples of syndromes associated with learning disability?

A

syndromes associated with learning disability:

  • autistic spectrum disorders
  • Down’s Syndrome
  • cerebral palsy
  • fragile X syndrome
  • prader willi
  • PKU
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13
Q

Down’s Syndrome is a neurodevelopmental disorder of genetic origin affecting chromosome X

A

X - 21

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14
Q

What is the single greatest risk factor for Down’s Syndrome?

A

the single greatest risk factor for Down’s Syndrome is advanced maternal age

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15
Q

Women over the age of X are more likely to have a child with Down’s Syndrome and this risk continues with advancing age

A

X - 35

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16
Q

Prader Willi is a condition affecting which chromosome?

A

Prader Willi is a syndrome affecting chromosome 15

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17
Q

What is there a constant desire to do in people with Prader Willi?

A

with Prader Willi, there is a constant desire to eat food

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18
Q

With Prader Willi, there is X growth

A

X - restricted

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19
Q

With Prader Willi, what can be said about muscle tone?

A

with Prader Willi, there is reduced muscle tone (hypotonia)

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20
Q

With Prader Willi, there is a lack of X development

A

X - sexual

21
Q

With Prader Willi, what are common behavioural problems?

A

with Prader Willi, there are behavioural problems such as temper tantrums or stubborness

22
Q

What medical condition is being described?:

  • neurological condition affecting movement and coordination
  • muscle stiffness or floppiness (hypotonia)
  • muscle weakness
  • random and uncontrolled body movements
  • balance and coordination problems
A

cerebral palsy:

  • neurological condition affecting movement and coordination
  • muscle stiffness of floppiness (hypotonia)
  • muscle weakness
  • random and uncontorlled body problems
  • balance and coordination problems
23
Q

Learning disability is more common in families of X socioeconomic status

A

X - lower

24
Q

What are the benefits of people with intellectual impairment accessing primary care services?

A

benefits of people with intellectual impairment accessing primary care services:

  • proximity usually good for transport
  • relationships may already have been established
  • family members may already attend the practice
  • longitudinal care - prevention and floow up
  • equal opportunity to services
25
Q

What are steps to take to geting people with an intellectual impairment to your surgery?

A

getting a person with an intellectual impairment into the surgery:

  • preparation
  • social stories (autism)
  • hospital/health passport
  • pre-visit to scout the place out is a good idea
  • multiple visits with slow progress
  • liaise with community disability nurse/team for help
26
Q

When a patient with intellectual impairment is attending for an appointment, you should limit their time spent in the X

A

X - waiting room

27
Q

What are adjuncts to communication?

A

adjuncts to communication:

  • Makaton
  • picture boards
  • letter boards
  • talking mats
  • drawing
  • writing
28
Q

What is the right environment when treating patients with intellectual impairment?

A

creating the right environment with patients with intellectual impairment:

  • non-threatening environment
  • friendly
  • acclimitise them to the environment with multiple visits
  • consider augmentive techniques such as relaxation and music
  • the environment can be fun - singing, laughing
29
Q

What things should be kept in mind during the patient’s first visit?

A

the patient’s first visit:

  • find out what you can prior to the first visit
  • keep it simple
  • don’t expect too much
  • build trust and relationships
  • sometimes managing to see inside the mouth is an achievement
30
Q

What adjuncts can be used in the examination?

A

examination adjuncts:

  • bedi shield
  • open wide mouth rests
  • head support
31
Q

When can clinical holding take place?

A

clinical holding should only take place if:

  • the patient consents
  • there is no capacity and it is deemed of benefit - the patient may present a safety risk to them self or others
  • unplanned emergencies, where a patient presents a significant risk
32
Q

What should you obtain from the patient’s social history?

A

social history:

  • living arrangements
  • support
  • transport
  • likes and dislikes
33
Q

What may the complexity of treatment provided be influenced by in patients with intellectula impairment?

A

the complexity of treatment provided may be influenced by the severity of the learning disability

34
Q

What are risk factors for oral disease in patients with intellectual impairment?

A

risk factors:

  • poor motor control
  • imbrication of teeth
  • lack of cleansing
  • pouching and limited food clearance
  • mouth breathing → reduced saliva
  • medications
  • rewarding - less common
35
Q

What toothbrushing advice can be given for patients with intellectual impairment?

A

toothbrushing advice - patients with intellectual impairment:

  • pick a good time of day/night, when the patient is relaxed
  • wear gloves
  • stand behind the patient, slightly to one side of them
  • may vary according to what is comfortable for the patient and carer
  • adapted toothbrush may be useful
  • keep brushing systematic
  • encourage the person to do as much as possible
36
Q

What is self-injurious behaviour?

A

self-injurious behaviour is self biting of hands, arms, lips and tongue

37
Q

What are treatment strategies for self injurious behaviour?

A

treatment strategies for self injurious behaviour:

  • symptomatic relief
  • reassurance for patients, parents and carers with monitoring of the situation
  • distraction when this behaviour is observed
  • pharmacological treatment (haloperidol, diazepam, carbamazepine)
  • behavioural psychology such as positive reinforcement
  • construction of oral appliances
  • extraction of specific anterior teeth (although this may transfer the self-injurious behaviour to another area of the mouth rather than resolve the behaviour)
  • orthognathic (jaw) surgery to create an open bite and prevent self injurious biting
38
Q

Construction of X in bruxism/NCTSL may be helpful

A

X - splints

39
Q

What is appropriate erosion advice to give these patients?

A

erosio advice:

  • fluoride mouthwash unless there are swallowing difficulties
  • toothpaste which is low in abrasion, low acidity, high fluoride and anti-hypersensitivity
  • brushing should be delayed for at least one hour after consuming acidic foods or drinks
  • dentine bonding agents may be of value
  • referral to an appropriate dental specialist may be advised
  • reduce or eliminate intake of carbonated and acidic drinks and acidic fruits, or include these as part of meal times
  • chew sugar-free gum, suck a sugar-free lozenge or eat cheese after an acidic meal
40
Q

What adjuncts can be helpful and advised in patients with dry mouths?

A

dry mouth:

  • saliva replacements
  • sugar-free chewing gum/fluids
  • fluoride rinses or high fluoride containing toothpastes
41
Q

A low X toothpaste is recommended in patients with feeding problems

A

X - foaming

42
Q

What are the aims of conscious sedation?

A

aims of conscious sedation:

  • reducing fear and anxiety
  • augmenting pain control
  • minimising movement
  • incraesing safety
43
Q

What is more flexible, GA or conscious sedation?

A

conscious sedation is more flexible than GA

44
Q

What kind of access is needed in conscious sedation?

A

IV access is needed in conscious sedation

45
Q

What are the indications for GA?

A

indications for GA:

  • clear inability to co-operate with the provision of dental care using other patient management techniques including sedation
  • contraindications to the use of sedation
46
Q

What are positives for general anaesthesia?

A

positives for general anaesthesia:

  • comprehensive care
  • potentially more controllable environment if there are medical diseases
  • opportunity for joint working
  • aftercare and monitoring - inpatient
47
Q

What are negatives to general anaesthesia?

A

negatives to general anaesthesia:

  • risk of death or brian damage
  • need support for at leats 24 hours post-op
  • organisation of procedure
  • complex restorative dental treatment is not possible
  • teeth of dubious prognosis are removed to reduce the risk of future GAs being scheduled
  • difficult working environment
  • no improvement in coping mechanisms
48
Q

The role of the dental practitioner in adult protection is three-fold - what are the 3 Rs to represent this?

A

the role of the dental practitioner in adult protection is three-fold:

  • recognise - being able to identify an adult at risk
  • respond - manage the acute situation and informt other services as required
  • record - document and report in detail the information obtained and the actions taken

BDS3 Special Care Dentistry (9 decks)

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