Test 2 Flashcards
(19 cards)
Definition of “special needs”
In the context of oral health care, “Special needs” refer to
patients who require accommodations or specialized care
due to physical, cognitive, sensory, or other impairments
Examples of physical disabilities
– paralysis (wheelchair lift)
– amputations (lower dental chair and footrests)
– mobility impairments (wider doorways or accessible ramps)
Intellectual or developmental
disabilities
– Down syndrome (specialized communication techniques)
– **Autism **use of sensory tools or specialized communication techniques)
– Cerebral palsy
Sensory disabilities
– Deafness (use of sign language interpreters, written or visual communication aids, or amplified sound systems)
– Blindness (tactile diagrams or verbal descriptions)
– **Sensory processing disorders **(weighted blankets or noise-cancelling headphones during dental treatment)
Medical conditions
Diabetes (adjustments to their medication regimen or dietary restrictions prior to treatment)
** Cancer** (infection control measures or coordination with their oncology team during dental treatment)
Autoimmune disorders ( increased risk of oral infections or inflammation increased risk of bleeding or delayed healing after dental procedures)
Anxiety or other mental health
conditions
– Phobias,
– Post-traumatic stress disorder (PTSD)
– Depression
What is pain
Pain is an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage
Types of pain in elderly patients and
those with special needs
* Acute pain
– sudden onset and typically lasts less than 3 months.
e.g postoperative pain, trauma, and acute illness.
– Elderly patients falls, fractures, and infections.
*** Chronic pain: **persistent pain lasting longer than 3 months osteoarthritis, neuropathic pain, and cancer-related pain.
* Nociceptive pain
caused by tissue damage or inflammation, and is often described as a dull or aching pain musculoskeletal pain, visceral pain, and inflammatory pain arthritis, osteoporosis, and cancer.
* Neuropathic pain
– caused by damage to the nerves, and is often described as a shooting, burning, or stabbing pain e.g. diabetic neuropathy, postherpetic neuralgia, and spinal cord injury.
*** Psychogenic pain **
– caused by psychological factors, such as anxiety or depression, and can be difficult to diagnose and treat.
Causes of pain in elderly patients
– Chronic conditions (arthritis, neuropathy, and cancer)
– Physical impairments such as limited mobility and falls
–** Medications** such as opioids and NSAIDs may cause side effects such as constipation and gastrointestinal bleeding, which can result in pain.
Causes of pain in patients with special needs:
– Underlying medical conditions such as cerebral palsy and multiple sclerosis.
– Disability-related pain such as musculoskeletal pain due to wheelchair use.
– Medications used to treat their underlying conditions may also cause pain as a
side effect.
Effective pain management can improve
– Improved physical function and mobility.
– Reduced anxiety and depression.
– Improved sleep and
– overall quality of life
Adaptations to pain
management strategies
* Communication Barriers:
* Using visual aids (picture boards or communication apps)
* simplifying language,
* involving caregivers in the communication process.
* Sensory Sensitivities:
* sensory-friendly environments,
* using noise-cancelling headphones, and
* adjusting the intensity of stimuli
* Mobility Issues:
* providing accessible equipment,
* arranging for transportation, and
* collaborating with physical therapists or occupational therapists
Pain assessment tools and strategies
**– Behavioral measures **
* used to assess pain in infants and young children
* Include the
a. FLACC scale
b. Wong-Baker FACES Pain Rating Scale.
**– observational tools **
c. Pain Assessment in Advanced Dementia (PAINAD) scale
d. Doloplus-2 scale
– self-report measures
e. verbal and numeric rating scales,
f. visual analog scales
g. faces scales
Different types of analgesics can be used to manage pain.
– Nonsteroidal anti-inflammatory drugs (NSAIDs)
– Paracetamol
– Opiods
– Adjuvant analgesics:
* Examples include antidepressants, anticonvulsants, and corticosteroids
Non-pharmacological management
– Physical Therapy
– Occupational Therapy
– Massage
– Cognitive-behavioral Therapy (CBT)
* Focuses on changing thoughts and behaviors related to pain.
– Other Non-pharmacological Approaches:
* Heat and cold therapy
* Acupuncture
* Transcutaneous electrical nerve stimulation (TENS)
Palliative Care Team:
– physicians,
– nurses,
– social workers,
– chaplains, and
– other healthcare professionals
Ethical considerations
Autonomy:
– refers to a patient’s right to make their own decisions about their healthcare.
– In pain management, this means respecting the patient’s preferences for pain management,
including the use of medication and other interventions.
* Beneficence:
– refers to the obligation to do good and act in the best interests of the patient.
– In pain management, this means balancing the benefits of pain relief with the risks of side
effects and potential harm.
* Non-maleficence:
– refers to the obligation to do no harm to the patient.
– In pain management, this means avoiding or minimizing the risks of side effects and potential
harm from medication and other interventions.
* Justice:
– refers to the fair and equitable distribution of resources and care.
– In pain management, this means ensuring that all patients have access to appropriate pain
management, regardless of their age, disability, or other factors.
Self-Care Instructions for Special
Needs Patients
Brushing:
– Use a soft-bristled brush and fluoride toothpaste
– Brush at least twice a day for two minutes each time
– Use circular or back-and-forth motions to clean all tooth
surfaces
– Consider using an electric toothbrush or a timer to help
with brushing or a mouth prop to make brushing easier
* Especially for patients with physical disabilities
* electric toothbrush requires less dexterity
* Flossing:
– Use floss or an interdental cleaner at least once a day
– Be gentle and avoid snapping the floss or injuring the gums
– Consider using floss holders or other aids if manual
dexterity is an issue
Use of Oral Hygiene Aids
– Toothbrushes with larger handles or modified grips
– Toothbrushes with bristles of different lengths or textures
– Interdental cleaners, such as floss picks, water flossers, or
interdental brushes
– Mouthwashes or rinses that contain fluoride or
antibacterial agents
Caregivers may include
Family members and nursing home staff
Role of Caregivers
**– Brushing and flossing: **
* Helping patients brush and floss their teeth properly and regularly
**– Dietary needs: **
* Providing healthy and balanced meals that meet the patient’s
nutritional requirements and restrictions
**– Oral hygiene aids: **
* Choosing and using oral hygiene aids that are appropriate for the
patient’s needs and abilities
**– Dental visits: **
* Scheduling and accompanying the patient to dental appointments and communicating with the dental team about the patient’s needs and concerns
* Caretakers can also monitor the patient’s oral health
and report any changes or issues to the healthcare
provider
