Physical Disability

• Prevalence of disability increases with age
• Equality Act 2010 prohibits discrimination against someone because of age disability gender reassignment marriage and civil partnership race religion or belief sex sexual orientation
• According to the equality act 2010. A person has a disability if: They have a physical or mental impairment. The impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities
• A physical disability is any condition that permanently prevents normal body movement and/or control
• Causes of physical disabilities - Inherited or genetic disorders, Conditions present at birth, Serious illness affecting brain, nerves or muscles. Spinal cord injury, brain injury, accidents
• Osteogenesis imperfecta - Inherited condition where bones are fragile and break easily. Autosomal dominant or recessive. Collagen defects. Short stature, hearing loss, blue sclera, dentigenesis imperfecta
• Dentinogenesis imperfecta - Discoloured teeth (blue/grey/yellow/brown). Translucent. Teeth are weaker. Bulbous crowns. Obliteration of pulp chambers. Reduced root length
• Spina bifida and cerebral palsy are 2 conditions present at birth
• Spina bifida is a neural tube defect that occurs when the neural tube fails to close properly. Exact cause is unknown, but lack of folic acid before and in early pregnancy increase the risk
• Spina bifida - weakness or paralysis of legs. Bowel and urinary incontinence. Loss of skin sensation. Hydrocephalus. Can also repeated seizures, drooling problems and dysphagia
• Hydrocephalus - fluid build up around the brain causing increased pressure on the brain. Symptoms include headache, vomiting, drowsiness, irritability, convulsions, difficulty walking
• Cerebral Palsy - damage to motor control centres in the developing foetal brain. Caused by hypoxic-ischaemic encephalopathy during childbirth, infection, trauma, stroke, bleeding into the brain, jaundice, prematurity
• Cerebral Palsy - muscle stiffness, spasticity, involuntary movements, poor balance and coordination, learning difficulties, epilepsy, visual impairment, speech and language difficulties, dental anomalies such as malocclusion, enamel hypoplasia, caries, periodontitis, tooth agenesis, delayed eruption, abnormal tooth shape, dental attrition, dental discoloration, dental calculus, dental plaque, dental decay, dental pain, dental sensitivity, dental fractures, dental restorations, dental extractions, dental prostheses, dental implants, dental hygiene, dental treatment under general anesthetic
• Cerebral palsy is a condition that affects the brain and nervous system
• Serious illnesses affecting brain, nerves or muscles - Motor neurone disease, parkinsons disease, multiple sclerosis
• Motor Neurone Disease (MND) - progressive degenerative neurological disorder which attacks nerve cells in the brain and spinal cord. Muscle wasting, loss of mobility, slurred speech, breathing difficulties, swallowing difficulties, weight loss, depression, anxiety, fatigue, sleep disturbances, cognitive changes, behavioural changes.
• Parkinson's Disease - chronic neurodegenerative disorder caused by death of dopamine producing neurones in substantia nigra region of midbrain. Movement disorders including tremors at rest, bradykinesia, rigidity, postural instability, gait freezing, mask like face, micrographia, soft voice, reduced facial expression, drooling, constipation, urinary retention, sexual dysfunction, dementia, depression, anxiety, insomnia, hallucinations, delusions, apathy, social withdrawal, suicidal thoughts.
• MND - Death within 5 years due to respiratory paralysis
• Multiple sclerosis - a disease of the central nervous system that causes the loss of function in the brain and spinal cord. Affects the myelin sheaths and mainly affects females
• Multiple sclerosis can result in weakness/paralysis of limps, nystagmus, ataxia, dysphagia, loss of sphincter control leading to urinary incontinence. May present as V neuralgia or facial palsy
• Levels of spinal cord injury - Tetraplegic and Paraplegic
• Tetraplegic - damage to spinal cord in the neck. Affects all four limbs and torso
• Paraplegic - Damage to mid/lower part of back. Affects legs and lower body
• Causes of spinal injury - Falls 41%, RTAs 36.8%, sports injuries, trauma and work related accidents make up the rest
• Brain injury there are 2 types of trauma. External and internal events
• External events - Closed head trauma, or missile penetrating the brain
• Internal events - CVA, tumour
• CVA (Cerebral vascular accident = STROKE) - a sudden loss of blood supply to the brain
• CVA clinical features - Face drooping, weakness/numbness in one arm, dysphagia, aphasia, slurred speech (dysarthia), sudden loss or blurring of vision, confusion, sudden and severe headache
• Stroke and dental health - Difficulty: wearing dentures, brushing teeth, consent, accessing surgery ie need wheelchair transfer
• Domiciliary care is care provided in the home of the patient, usually by a family member or friend. Pt's personal circumstances make it unfeasible to attend a dental clinic