DH Chapter 57: The Patient with a Disability

What are some damaging oral habits that can affect both the soft and hard oral tissues?

- Bruxism - Mouth breathing - Tongue thrusting - Self-injurious behavior - Rumination (regurgitation of chewed food) - Pica (eating unusual objects and substances such as cigarette butts or clay.)

What are Some oral and craniofacial anomalies that may be present, particularly in individuals with developmental disabilities?

- Enamel defects - High lip lines and dry gingiva due to air exposure - Variations in number, size, or shape of teeth - Facial asymmetry and hypoplasia of the midfacial region - Cleft lip or palate

What are physical barriers to care for the patient?

- Fear of not being able to cope with architectural barriers - Fear of falling - Fear of attracting attention in an embarrassing way

What is an attitude barrier to care for the patient?

- May not comprehend importance of dental health - May not be aware of needing dental care - May not want to or be able to cooperate.

What are some examples of barrier-free environments?

- More space for turning and positioning for patients with wheelchairs. - Braille floor indicators beside numbers on elevators - Doors, steps, and stairways can be outlined with bright colors to contrast with the background for people with limited vision.

What are Internal features of a barrier-free environment?

- Passageways are free from obstructions - Level floors with nonslip surfaces - Thick or small, unattached movable rugs or carpets present obstacles for wheelchairs or walkers and hazards for a patient with crutches, cane, or leg brace. - At least part of the furniture in reception area will permit easy access during seating and rising - Preferred chairs are 18-inch height, flat, firm seats, and arms for support when pushing oneself up by the arms. - Chairs don't slide or tip as person rises.

What are some external features of barrier-free environment?

- Reserved parking area, marked, near the building. Curb ramps from the street and from the parking area. - 3-foot wide walkway for wheelchair accommodation. The surface is solid and nonslip, without irregularities. - At least one entrance to the building on ground level accessible by a gently sloping ramp - Easily grasped handrail on both sides - Lightweight door with a lever type handle that opens at least 32 inches

How much door way clearance should there be for a person in a wheelchair to easily access?

32 inches

An estimated ____% of individuals 16-64 and almost 6% of children 5-15 are affected by a disability and the number is increasing.

8

Paralysis or facial weakness may create difficulty with maintaining adequate oral hygiene. The deficiency of the self-cleansing motion of the tongue can result in decreased biofilm control. Some additional effects of facial paralysis or weakness may include which of the following? Impaired swallowing Drooling Rumination A and C A, B, and C

A, B, and C

Caused by chronic disease (such as MS), acute medical conditions (such as stroke), or trauma (such as spinal cord injury).

Acquired Disabilities

Usually after age 65 and related to a chronic health condition (such as arthritis or Parkinson's disease).

Age Associated Disabilities

Determine whether the patient's daily schedule influences the time selection for their appointment. Examples of daily schedule considerations that may have an influence on the success of the appointment include which of the following? Appointments for the patient with diabetes must not interfere with medication or eating schedules The elderly person who rises early may feel better during a morning appointment Patients with arthritis may have greater mobility late in the morning or in the afternoon A child's nap schedule should be respected A, B, and C only All of the above

All of the above

Having adequate access to dental and dental hygiene services can make a significant contribution to the oral health of a patient with a disability. Some of the other benefits the patient experiences can include which of the following? Overall well-being Independence Sense of personal esteem None of the above All of the above

All of the above

Instrumentation on the patient with a disability can be challenging. Experience and basic knowledge of maintaining patient stability are essential. Which of the following are important for effective instrumentation to occur? Adequate visibility Secure instrument grasps and finger rests Well-controlled strokes Saliva control Patience All of the above

All of the above

Pit and fissure sealants have been used for children with developmental disabilities with satisfactory results. The principles for application are the same as those for all patients. Use of a dental assistant can help maintain a dry field and enhance long-term sealant retention. The use of a rubber dam is particularly helpful when which conditions exist? Excessive saliva Hyperactivity Lack of control of tongue Behavior management difficulties All of the above

All of the above

T or F: If a person is declared incapacitated in a legal process, a guardian is appointed. The guardian must give consent for any treatment, including signatures on consent forms. Written proof of guardianship is obtained and kept in the patient record.

All statements are true.

Prohibits discrimination on the basis of a disability and requires public and commercial facilities to meet standards of accessibility by removing architectural, transportation, and communication barriers.

Americans with Disabilities Act (ADA or AwDA)

Area freely accessible to all without discrimination on the basis of a disability; obstacles to passage or communication have been removed.

Barrier Free

An approach to correction of undesirable conduct accomplished through systematic manipulation of the environmental and behavioral variables related to the specific behavior to be changed.

Behavior Modification

An approach in which the focus is on the patient's observable behavior rather than on conflicts and unconscious processes presumed to underlie the maladaptive behavior.

Behavior Therapy

T or F: Communication strategies are adapted to the specific patient needs. Unless the patient has extreme cognitive impairment, the patient should always be addressed first and the caregiver second.

Both statements are true

T or F: The use of a power toothbrush can be a benefit to many patients with disabilities. However, a power toothbrush can cause significant trauma if used incorrectly.

Both statements are true

T or F: Approximately one of five persons is affected by a disability. Progress in medical care has increased initial survival for those born with a disability and survival rates for those experiencing disabling conditions.

Both statements are true.

T or F: Deinstitutionalization is the trend in care for people with disabilities. It allows people to return home as quickly as possible following treatment rather than keeping them in institutions.

Both statements are true.

T or F: For the patient with limited hand or arm movement, lengthening the handle of the toothbrush is helpful. One method is to tape tongue depressors to the brush handle.

Both statements are true.

Returning patients to home and community rather than housing them permanently or for long periods in custodial institutions; elimination of mental health institutions, for example, made possible by (1) use of new medications to control the symptoms of illness and (2) community health centers to provide support.

Deinstitutionalization

The treatment of phobias and related disorders by intentionally exposing the patient, in imagination or real life, to emotionally distressing stimuli; desensitization to accept dental treatment might consist, for example, of short exposures to the dental chair, instruments, air syringe, and sound of a handpiece along with building trust in the dental team members.

Desensitization

Hereditary conditions that manifest symptoms before age 21.

Developmental Disabilities

A substantial handicap of indefinite duration with onset before the age of 18 years. Examples include autism and cerebral palsy.

Developmental Disability

What are the different types of disabilities?

Developmental, Acquired, Age Associated

(Individual dimension) restriction or lack of ability (resulting from impairment) to perform an activity in the manner or within the range considered normal for a human being of the same age, sex, and background.

Disability

The clinician should encourage the patient with a disability to engage in as much independence as possible. Providing adaptations for tooth brushes and other oral health care devices allows the patient to maintain some level of self-care. What criteria must be met when designing a self-care aid? Disinfectable Durable Colorful Water resistant Expensive

Disinfectable Durable Water resistant

All but one of the following are factors to teach the patients and caregivers. Which is the exception? Seek regular dental and medical examinations Practice Healthy Lifestyles Recognize disease complications and medication side effects Practice Healthy Lifestyles and overcome barriers to dental care Engage in high-risk behavior to expand health options

Engage in high-risk behavior to expand health options

T or F: Protective stabilization or medical immobilization techniques are the same as patient restraint.

False

(social dimension) a disadvantage for an individual, resulting from an impairment or a disability, that limits or prevents fulfillment of a role that is within the normal range for a human of the same age, sex, and social and cultural factors as the affected individual.

Handicap

What is the level of function? - Capable of flossing and brushing their own teeth. - Many patients, particularly children and those of all ages who are disabled mentally, need varying degrees of encouragement, motivation, and supervision.

High Function Level: ADL/IADL Level 0

(organ or body dimension) any loss or abnormality of psychologic, physiologic, or anatomic structure or function.

Impairment

What is the level of function? - Includes those who are unable to attend to their own care and are therefore dependent. - Patients in this group may be bedridden and nonambulatory, although others may be confined to wheelchairs. With training, some may be able to attempt a part of their own care.

Low Functioning Level: ADL/IADL Level 3

Integration of people with disabilities into their community through programs of rehabilitation; process by which persons with special needs (educational, physical, psychologic) are included within the mainstream of society rather than segregated.

Mainstreaming

What is the level of function? - Includes those capable of carrying out at least part of their oral hygiene needs but who require considerable training, assistance, and direct supervision. - The assistance may be verbal, gestural, or hand over hand.

Moderate Functioning Level: ADL/IADL Levels 1 and 2

Establishing patterns and conditions of everyday life as close as possible to the norms and patterns of the mainstream of society.

Normalization

Chemotherapy lowers resistance and increases the incidence of oral manifestations including which of the following? Oral ulcerations Mucositis Lymphadenopathy Gingival bleeding and petechiae Trauma Drooling

Oral ulcerations Mucositis Lymphadenopathy Gingival bleeding and petechiae

Which of the following is NOT a positions for a child or disabled patient during biofilm removal? A. Patient seated on floor with head turned back into the lap of the caregiver B. Patient's arms restrained by legs of caregiver C. Patient reclining on couch with head in lap of caregiver D. One person holds patient for stabilization while the another holds the head for toothbrushing and flossing E. Patient's head restrained by the legs of the caregiver

Patient's head restrained by the legs of the caregiver

Sensory functions include which of the following? Seeing Hearing Tasting Touching Thinking

Seeing Hearing Tasting Touching

1. Position the wheelchair parallel to dental chair, set brakes, and remove footrests. Adjust seat of dental chair to slightly lower than wheelchair seat. Move arm of dental chair out of the transfer area, remove arm of wheelchair. 2. Adjust sliding board well under hip of patient so board extends across the dental chair. 3. Patient shifts weight, balances hands, and walks buttocks across the board. Clinician can assist or do the transfer by holding patient under the axillae. Two persons are needed when patient is heavy or less mobile. Board is removed and replaced after appointment. 4. Repeat in reverse when appointment is over. Dental chair is positioned slightly higher than the wheelchair seat for return transfer.

Sliding Board Transfer

Structures of the nervous system include which of the following? Spine Spinal Cord Meninges Nervous System Blood Vessels

Spine Spinal Cord Meninges Nervous System

T or F: Attitude is the observable consequences of customs, practices, ideologies, values, norms, factual beliefs, and religious beliefs that influence individual behavior and social life.

True

T or F: Behavior therapy is an approach in which the focus is on the patient's observable behavior rather than on conflicts and underlying maladaptive behavior.

True

T or F: Guidelines and specifications for a barrier-free environment represent general features based on governmental regulations for accessibility standards, along with suggested applications for a dental clinic or office.

True

T or F: Parents and caregivers can help interpret changing moods of the patient, identify problems, and note changes in behavior that may indicate a problem.

True

T or F: Patients with disability may be at higher risk for oral disease due to characteristics related to the specific disability or disease.

True

T or F: The international Classification of Functioning, Disability, and Health (ICF) is a universal classification of disability and health that provides a standard for the description of health.

True

T or F: Treating the patient with a disability requires a clean mouth, and biofilm should be removed prior to scaling procedures.

True

T or F: When the use of protective stabilization is warranted, the least restrictive method of stabilization is always selected for each patient.

True

T or F: Whenever possible, instruction for the parents, family members, or other caregivers begins with their own personal oral care. Success comes when those who care for the patient have knowledge and understanding of the purposes and techniques.

True

T or F: A transfer board may be used to facilitate the wheelchair transfer. A sliding board is only used for completely immobile patients.

True; False

T or F: Additional precautions regarding instrument use may include using unbreakable mirrors and single-ended instruments. The reason is to protect the clinician in case of a seizure.

True; False

What is a legal guardianship?

When a person is declared incapacitated by a legal process, a guardian is appointed.

ICF Part 2: Contextual Factors, includes activities and participation. Which of the following are examples? Interpersonal communication and relationships General tasks and demands Communication Mobility and self-care a and d all of the choices

all of the choices