Special Care

• Special care dentistry?

  provides preventive and treatment, oral care services for people who are unable to accept routine dental care because of some physical, intellectual, medical, emotional, sensory, mental or social impairment, or a combination of these factors.
• impairment?

  problems in body function such as significant deviation or loss
• disability?

  limitation on activities of daily living
• models for perspective on disability?

  • medical
  • biophysical
  • social
• what do we consider in dentistry?

  • access
  • communication and cooperation
  • consent
  • education
  • surgery
  • spread - cross infection
• features of down syndrome

  • most common
  • characterised physical features
  • delayed physical/cognitive development
  • speech/hearing/vision problems
  • heart operations
  • hypotontia
  • immunity impairment
• oral implication of down syndrome?

  • oral access
  • early inset perio
  • microdontia
  • hypodontia
  • fissured lips
• Label:

  A) Physical disability, epilepsy

  B) Learning difficulties, GA, behavior management

  C) capacity

  D) perio

  E) moisture control/ access

  F) impaired immunity

  
• examples of physical disability:

  • athritis
  • cerebral palsy
  • multiple sclerosis
  • stroke
  • parkinson's disease
• physical access to dentistry:

  • design of premises/surgery
  • transfer equipment
  • domiciliary care
• Arthiritis:

  • pain, swelling and stiffness of a joint
  • modification of tooth brushing, technique may be required depending on manual dexterity
• dental considerations of arthiritis

  • difficulty with access due to pain, swelling, stiffness of joints
  • impaired grip and dexterity, oh may need adapting
  • appointment times, as unable to sit for long periods
• examples of specialist brushes?

  • collis curve toothbrush
  • Dr Barman's super brush
  • suction denture brush
• cerebral palsy?

  • injury to brain around birth
  • motor coordination impariment: movement, posture, sleep
  • variable cognitive impairment
  • epilepsy
• health in cerebral palsy

  • feeding, NG tubes, PEGs, dietary supplements
  • sensory impairment
  • epilepsy
  • involuntary movement
  • muscolskeletal
  • medication
• dental implications cerebral palsy

  • physical impairment - access
  • issues with communication and cooperation
  • limited capacity
  • increases risk of perio, caries, TSL, malocclusion
  • involuntary movements - finger guards, aspiration risk, limited access
• multiple sclerosis:

  • damage to myeline coating of nerve fibres
  • condition of the central nervous system
  • progressive
  • issues with vision, balance, speech, swallowing, fatigue, bladder/bowel, spasms, tremor, memory, emotions
• stroke in 3 steps

  • cerebral ischaemia or haemorrhage
  • impaired blood supple to part of brain
  • loss of function
• Dental implications with stroke

  • unilateral weakness, balance, may rely on carer
  • imparied communications, labile emotions
  • communication issues may impact consent
  • grip, dexterity, diet changes
  • ANTICOAGULANTS
• Parkinson's disease

  • progressive neurological conditions
  • reduced dopamine in brain
  • tremor, rigidity, slow movement/speech, fatigue, pain, depression
• autistic spectrum disorder

  • diagnosis 2-3 yr old
  • eye contact, body language, facial expression, physical contact
  • struggles with: new experiences, pretent play, large busy environments
  • routine and familiarity
  • idiosyncrasies
  • aversions of food, smells, colours
• dental considerations autism: plan the visit

  • likes/dislikes
  • communciation
  • timings
  • associated conditions
  • medications
  • story line
  • tootbrushing
• example of social skills story

  
• dental consideration autism: on the day

  • enviornment
  • support person
  • your communications - avoid jargo, use diagrams, visual aids, use name
  • behaviour management
• Label:

  A) anxiety

  B) pre visit pack

  C) capacity

  D) prevention

  E) GA?

  
• echolalia: meaningless repetition of words just spoken by another person, occurring as a symptom of mental conditions.