Learning disability

• Learning disability is a significantly reduced ability to understand new or complex information, learn new skills, and the reduced ability to cope independently
• Learning disability can be an IQ of less than 70
• Severity of learning disability = Mild, moderate, severe
• Mild learning disability - can talk and look after themselves. But is variable as some may not be able to communicate at all
• Clinical features of learning disability - Epilepsy, visual defects, hearing and speech disorders, facial deformities, body rocking and self mutilation, feeding difficulties
• Causes of learning disability - Genetic, problems during pregnancy, problems during birth, post - natal problems
• Down syndrome is the most frequent genetic cause of learning impairment. Most common cause is trisomy 21. Likelihood of extra chromosome 21 increases with mothers age.
• Physical features of DS - Atlanto-axial joint instability, short stature, widely spaced upward slanting eyes, weight gain, brushfield spots
• Cardiac, spinal problems, malignant/immune disease, visual defects, dementia, seizures are all associated health conditions of down syndrome
• Oral features of DS include: Large tongue, thick dry and fissured lips, poor anterior oral seal, tongue thrust, early perio disease, cleft lip and palate, delayed tooth eruption, missing teeth, morphological abnormalities
• Fragile X syndrome. Tip of the X chromosome is susceptible to breakage. Dental Mx difficult due to short attention span, hyperactivity, behavioural disorders similar to autism. Frequent open bite and crossbite
• Autism spectrum disorder is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them
• Autism is 4x more common in boys than girls
• Clinical presentation of autism - Live in their 'own world', avoid eye contact, echolalia, unaware of others, practice repetitive actions, obsessional desire to follow routing, self-mutilation, sensitivity to touch, smell and sound
• Oral findings in autistic patients - Bruxism, traumatic lesions, poor OH, poor attendance, prefer sweet foods
• Dental Mx of autistic patients - Patience, empathetic approach, oral hygiene education and support, previous training at school or home with visual aids, pre-visit pack and questionnaire
• Dental Mx of autistic patients - Patient is not kept waiting. Short, quiet visit with same staff, avoid aspirator high speed etc, have a parent/carer present, pain and anxiety control ie LA sedation GA if needed