Chapter 56: The Patient With a Disability

Approximately ___ of ____ persons is affected by a disability; and that number is increasing.

1 in 5

At least part of the furniture will permit easy access during seating and rising. Preferred are chairs with ____-inch-high, flat, firm seats and arms for support when pushing oneself up by the arms. Select chairs that do not slide or tip as the person rises.

18

The dental chair selected is able to be lowered to __ inches from the floor and should be accessible from both sides for wheelchair transfer.

19

A __-foot-wide walkway is needed for wheelchair accommodation. The surface must be solid and nonslip, without irregularities. Curb ramps (cuts) from the street and from the parking area are necessary.

3

The passageways are at least __ feet wide, with handrails along the sides. Passageways are free from obstructions, such as hanging signs that a tall blind person could collide with.

3

The lightweight door with a lever type of handle opens at least __ inches for a person using a tall crutch and for a wheelchair.

32

The tabletop and washbasin built at a height of ____ to ___ inches permit clearance underneath for knees and wheelchair arms.

32 to 34

The infant's early care includes an oral examination by the dentist and dental hygienist within _ months of the eruption of the first tooth and no later than __ months of age.

6 12

If a patient with a disability has a legal guardian, the legal guardian must: A) give consent for treatment, including signing consent forms B) translate what the patient is saying C) be the caregiver for the patient D) be present in the treatment room

A) Give consent for treatment, including signing consent forms, is the correct answer. A legal guardian must give consent including signing consent forms and should give written proof of guardianship. The caregiver may not necessarily be the guardian and may not always be present in the treatment room.

The use of a dental hygiene assistant during the appointment can enhance:

A. Efficiency B. Patient management C. Patient safety and comfort D. Safety and comfort for clinician E. Visibility during intraoral procedures

Patients with disabilities may be treated with various medications. ____ side effects of medications, particularly the oral side effects such as xerostomia, are addressed.

All

a person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment; permanent or long-term

Americans With Disabilities Act definition of an individual with a disability

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

Americans with Disabilities Act (ADA) AwDA: Used to prevent confusion with the ADA (American Dental Association)

Detach patient's safety belt. Face the patient and place feet outside the patient's feet for pivoting. Clinician's knees should be close to or against the patient's knees to prevent buckling. Place hands under the patient's arms and grasp the waist belt in back. Patient places arms around clinician's neck or places hands on wheelchair to push up. Clinician lifts patient to standing position

Approach to Patient

What are some barriers to access for dental care?

Attitude Barriers Health Literacy Barriers Physical Barriers Financial Barriers

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

Barrier-Free

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; accomplished through systematic manipulation of the environmental an behavioral variables related to specific behavior to be modified

Behavior Therapy

an approach to correction of undesirable conduct that focuses on changing observable actions; modification of behavior is accomplished through systematic manipulation of the environmental and behavioral variables related to specific behavior to be modified

Behavioral Modification

A long piece of dental floss should be tied through the holes in a commercially available rubber mouth prop so that, in case of a sudden respiratory change, the prop can be quickly pulled out and breathing normalized.

Bite Block

________floor indicators can be installed beside the numbers on elevators; doorways, steps, and stairways can be outlined with bright colors that contrast with the background for people with limited vision.

Braille

Program content should include....

Caregivers' own biofilm control Facts about cause/prevention Oral inspection Techniques of mouth care and disease control Denture marking

Management of a patient with disabilities can be very complex because the patient is medically compromised. Consultation with the other professionals involved may be required to help determine a plan for patient treatment and continued care. Pertinent information may be obtained from other medical specialists and the social worker. Extra time may be required to access information about the conditions and medications prior to appointment.

Consultations with physicians, other specialists, and sources

In preparing for a wheelchair transfer, what should you do first? A) Move chair padding to dental chair B) Place the wheelchair parallel to the dental chair C) Find someone else in the office to help with the transfer D) Clear the area of any items that may be in the way

D) Clear the area of any items that may be in the way is the correct answer. The first thing to do is to clear the area. The clinician's stool, bracket tray, portable unit, and dental light should all be moved out of the way. Then you, the patient, or a caregiver can place the wheelchair parallel to the dental chair. You do not always need another person to complete the transfer.

returning patients to home and community as quickly as possible after treatment rather than housing them permanently or for long periods in custodial institutions; the elimination of mental health institutions, for example, has been made possible by (1) the use of new medications that control symptoms of illness and (2) community health centers that serve as support

Deinstitutionalization

Provide basic information Disclose and show biofilm Toothbrushing Dentifrice Dental floss

Dental Biofilm Removal

Arrange a time when the patient will not have to wait a long time after arrival. Allow sufficient time so that the patient is not rushed; many persons with disabilities cannot hurry. Consider incontinence issues and the difficulties and time needed for restroom visits; encourage emptying bladder before entering treatment room.

Dental Facility Considerations for Appointment Time

The same materials and procedures are recommended for the patient with a disability or another person who cares for the prosthesis. What is recommended for patients with prosthesis who cannot grasp them?

Denture Brushes with Suction Cups

Determine what preparation needs to be taken prior to appointment to allow time in the schedule, for example, to move furniture, retrieve and set up special equipment, or premedicate the patient.

Determine special requirements

An ongoing record of the extent of biofilm in graphic form by which the patient and caregiver can watch progress may help to motivate patients.

Disclose and Show Biofilm

General Prerequisites for a self-care aid.....

Disinfectable. Durable. Can withstand exposure to water and saliva. Resistant to absorption of oral fluids. Replaceable. Inexpensive.

Masticatory/feeding issues Overindulgence in sucrose-containing foods Inability to perform biofilm control Lack of professional care and instruction Medications Obesity Food preparation

Factors that Influence Diet Habits

Lengthen the handle of the brush.

For patient unable to lift hand or arm

A manual brush that brushes exposed tooth surfaces simultaneously; The brush has curved outer filaments and a short stiff center row of filaments.

For patient who can hold and position the toothbrush but cannot manipulate to make strokes for biofilm removal (parkinson's)

To fasten the brush handle to the open hand.

For patient who cannot grasp and hold

insert the brush handle into the grasp.

For patient with fingers permanently fixed in a fist

Enlarge the diameter of the handle

For patient with limited hand closure

_______ appointments are encouraged for the following reasons: to decrease length of single appointment by keeping the oral tissues at an optimum level of health. To assist the patient whose disability limits the ability to perform personal oral hygiene adequately. To provide motivation through monitoring biofilm and review of procedures for the patient and the caregiver involved.

Frequent

____ pipes under the sink must be covered or insulated because patients who have no sensation in their legs could be burned.

Hot

Aide __ is positioned behind the wheelchair. Place feet, one on either side of the rear wheel nearest the dental chair; place hands under the patient's arms below the elbows, pressing forearms against the patient's lower thorax area. Clasp hands or wrists under the patient's rib cage.

I

Aide __ may do either of the following, depending on the size and weight of the patient. Face patient and grasp hands under the patient's knees. Face dental chair; place one arm under the thighs and the other under the calves of the lower legs.

II

Position the wheelchair Aide I Aide II Transfer Repeat in reverse

Immobile Patient Transfer

___-____ programs are provided for teachers, registered nurses, other health professionals, parents, and volunteers in school and community preventive programs.

In-service

In addition to the usual topics covered by the questions in Table 9-3 In the text, basic information, medical and dental history, and supplemental questions are asked and are listed in Box 56-2 in the text. To avoid unpleasant situations, do not make assumptions but ask direct questions about a patient's disability.

Information to Obtain

A patient with a disability may depend on a caregiver for daily life activities. Caregivers may or may not be the legal guardian of patient and contact person to plan appointments. Caregivers are an excellent source of information, help, and suggestions for gaining cooperation from the patient, and dental personnel work with them. Solicit help in preparing the patient for the appointments. Invite the caregiver to the office before the appointment to see the facility and become familiar with the surroundings and staff.

Interaction with caregiver

ICF

International Classification of Functioning by the WHO

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.

Legal Guardianship

High Function Level

Level 0

Low Functioning Level

Level 3

Moderate Function Level

Levels 1&2

_____- or ______-type handles on faucets are usable by patients who have difficulty gripping handles or have no hands; prevent burning the patient who cannot sense temperature.

Lever or blade

________ is frequently among persons with developmental disabilities. Factors contributing to problems of occlusion include skeletal and muscular deformities, macroglossia, congenitally missing teeth, and such oral habits as tongue thrust and mouth breathing.

Malocclusion

Position the wheelchair Prepare the dental chair Approach the patient Pivot to dental chair Repeat in reverse

Mobile Patient Transfer

Adjustable arm or leg immobilizer wraps with velcro closures or a padded board with wide fabric wraps around upper body, middle body and legs are available in adult and pediatric sizes, but not recommended unless the clinician has specialized training and informed consent has been obtained.

Pediwrap or Papoose Board

Pivot together slowly until the patient is backed up to the side of the dental chair, with the backs of the legs touching. The patient is gently lowered to a sitting position. Reposition the arm of the dental chair. Grasp the patient's legs together between the ankles and knees, and lift him or her onto the dental chair

Pivot to Dental Chair

(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) Two people participating with small child between. One holds patient for stabilization while the other holds the head for toothbrushing and flossing.

Positions for child or disabled patient during biofilm removal.

Patient and caregivers are informed of the risks and reassured that all stabilization devices are for comfort and to make the work easier and that they are in no way meant to hurt or punish. Mobile teeth could be knocked out and aspirated. Loose primary teeth in young patient. Mobile teeth in advanced periodontal infection. Fatigue of the patient's facial and masticatory muscles and temporomandibular joint.

Precautions for the use of a mouth prop.

Information may be obtained from the patient, or with legal authority from the guardian, parent, relative, advocate, or other person responsible for the patient. The essential information can be obtained in advance by telephone interview, or medical forms can be mailed to the home for completion. Advanced information permits the dental team to be prepared to make the appointment successful and a positive experience for the patient and dental professionals.

Preliminary Contact

Antibiotic coverage as indicated for susceptible patients. Sedative for control of selected patients.

Premedication

Education. Dental biofilm control. Fluorides. Pit and fissure sealants. Diet counseling. Smoking cessation. Regular professional examinations and treatment at intervals as recommended by the dentist and dental hygienist.

Preventive Program Components

The most stable mouth prop is a sterilized prop that can be nearly closed for insertion between the teeth. It can be opened gradually to hold the jaws to the necessary position. The tips are covered with rubber tubing and are positioned over the maxillary and mandibular teeth on one side while the clinician treats the opposite side.

Ratchet type (Molt's mouth prop)

Start to tip the chair back _____, bringing the feet up first to provide balance so that the patient cannot fall. While tipping the chair back, place one hand on the patient's shoulder to offer assurance and support. Slowly advance the chair position in steps to allow the patient to adjust. A patient with a respiratory or cardiac complication is positioned with the chair back raised to a level that is comfortable for the patient. The patient can be asked, "How many pillows do you use at night?" and the chair can be adjusted accordingly.

SLOWLY

Alternative methods of pain and anxiety control for patients who are unable to cooperate during dental treatment include:

Sedation General Anesthesia

Factors to Teach the Patient

Seek regular health care Learn about disability Recognize disease complications Recognize side effects of medications Practice healthy lifestyle Overcome barriers to dental care

Determine whether the patient's daily schedule influences time selection. The cooperation of the patient may be decreased if basic routines are disturbed, for example: appointment for the patient with diabetes must not interfere with medication, meal, or between-meal 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. Child's nap schedule should be respected. Early morning appointment may be difficult for a patient who requires a long time for morning preparation, such as a patient with a spinal cord injury or colostomy.

Time of Appointment

A patient may be reliant on another for transport to an appointment. A wheelchair patient may need to reserve a wheelchair transport vehicle and be limited by the time schedule. The patient may arrange a ride transportation service that must be contacted when the patient has completed the appointment; forms may need to be completed.

Transportation Requirements

True or False? Medical advances and life expectancy are reasons for the increase of persons with a disability.

True

True or False? Patients with disabilities can be treated in the private dental office setting. Only a relatively small number need hospitalization due to difficulties in management or a systemic condition that requires special medical supervision.

True

True or False? People with disabilities experience a diminished oral health status and reduced access to dental services compared to the general population.

True

_______ mirrors are recommended for use with a patient subject to spasm or sudden closure.

Unbreakable

(A) The floss is held over the proximal contact for insertion. A hand rest is maintained on the chin to prevent excess pressure. (B) As the floss is lowered gently and drawn through the contact area, the holder is pulled mesially when the floss is applied to the distal surface and pushed distally when the floss is applied to the mesial surface. (C) Floss is lowered slightly below the gingival margin. (D) Floss cut in the papilla when used incorrectly.

Use of a Floss Holder

In general, a facility that is ______-_____ for a patient in a wheelchair is accessible to all other individuals. The patient in a wheelchair requires more space for turning and positioning.

barrier-free

Patients who do not have control of urine discharge, such as those with paraplegia or quadriplegia, have a bag with tubing for collection. The bag may be attached to the leg of the patient or to the wheelchair. After transfer, the tubing must be checked to be sure it is not _____ or _____.

bent or twisted

What can occur when a patient has a muscle weakness or paralysis of one side of the face?

bilateral mastication or self-cleaning motion of the tongue may not be possible; biofilm usually collects more heavily, and food debris is retained, on the involved side

After the transfer, release the wheelchair ____ to move it aside. In a small treatment room, the wheelchair may be folded and set aside.

brake

The ____ can help interpret the changing moods of the patient, identify problems, and note changes in behavior that may indicate a dental problem.

caregiver

The schedule of the _______ who accompanies the patient is considered.

caregiver

. The dental hygienist is able to work with the ______ to teach them appropriate techniques and to motivate them to incorporate oral care into the daily routine for each resident or patient.

caregivers

The two principal oral diseases found in all patients are dental _____ and ______ infections.

caries periodontal

heredity, systemic disease or disorder, and trauma

causes of disabilities

oral ulcerations, mucositis, and susceptibility to infection are frequent manifestations following....

chemotherapy

Before starting a transfer, ____ the area: move the clinician's stool, bracket tray, portable unit, and dental light.

clear

Patient shifts weight, balances on hands, and walks the buttocks across the board. The _____ can assist or do the transfer by holding the patient under the axillae. Two persons are needed when the patient is heavy or less mobile. Board is removed and replaced after the appointment.

clinician

Parents and other caregivers can explain how best to ______, if appropriate.

communicate

The dental team must have its objective to _______ to the patient's general health through, for example, prevention of tooth loss, which increases the ability to masticate food to prevent malnutrition and increase resistance to infection.

contribute

Whether or not the assessment and treatment plan are completed at the initial visit, the personal oral _____ care program is introduced.

daily

The dental team must prevent the need for ______ or other removable prostheses can be hazardous, difficult, or impossible for certain patients to tolerate.

dentures

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

desensitization

a substantial handicap of indefinite duration with onset before the age of 18 years, attributable to mental retardation, autism, cerebral palsy, epilepsy, or other incurable neuropathy

developmental disability

The patient and caregiver are given general ______ requirements for oral health and how to put the principles into daily practice are a distinct part of the total preventive program.

dietary

(individual dimension) any restriction or lack of ability (resulting from an 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 amount of gingival enlargement is usually related to the _________of daily biofilm control; effective daily biofilm removal is associated with less enlargement.

effectiveness

Firm, dependable ______ _____ are needed. Supplemental or reinforced rests can contribute to instrument stability. External finger and hand rests may be safer for the clinician.

finger rests

The ______ appointment includes and, when necessary, may be devoted entirely to a basic orientation to the facilities, the dental chair, and the personnel. The examination of the oral cavity is started, and dependent on the degree of patient cooperation, various steps in the assessment may be completed. Preventive personal care instructions are initiated, and participation of the caregiver is solicited. Several orientation visits may be necessary to acclimate the patient to surroundings and to desensitize.

first

Unless the patient has an extreme cognitive impairment, the patient is always addressed ______ and the caregiver ______.

first secondly

Water fluoridation has beneficial anticaries effects. Patient is encouraged to drink _______ water; bottled water may not have optimal fluoride level.

fluoridated

A dentifrice-containing _______ is recommended for patients who can use a dentifrice.

fluoride

When the ______ level is below optimum in the community water supply, or the water intake by a child is low, a supplement is recommended. Fluoride can be prescribed in the form of a chewable tablet, lozenge, drops, or mouthwash to swallow after swishing depending on the masticatory function of the child.

fluoride

refers to the daily living skills (bathing, toothbrushing, dressing, for example) an individual can do alone, what range or degree of assistance is needed, or whether the person depends on others for complete care

functioning level

a patient treated with phenytoin (Dilantin) or other antiepileptic medication may be susceptible to a slight to severe ______ _______.

gingival enlargement

The dental team must aid in one's personal appearance of oral health and social acceptance without ________.

halitosis

(social dimension) a disadvantage for an individual, resulting form an impairment or 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 cultural factors as the affected individual

handicap

A portable _______ may be attached to the wheelchair handles.

headrest

After telling patient, slowly rise the chair to upright position, with the seat slightly ______ than the patient's knee level to minimize need to bend knees when rising. Allow time for adjustment to upright position in order

higher

Dental chair is positioned slightly ____ than the wheelchair seat for the return transfer.

higher

Patient or clinician places the sliding board well under the ____ of the patient. The board is extended across the dental chair.

hip

To avoid the effects of postural _________. Ask or assist patient to move feet down to the floor. Retrieve assistive aids and hold them for patient to grasp with the dominant hand. Ask patient and, if assistance is needed to rise from the chair, offer support by placing arm under the patient's arm on the nondominant side until balance is obtained for walking.

hypertension

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

impairment

The frequency of maintenance appointments for all patients is __________.

individualized

Attrition caused by bruxism is common among which individuals?

individuals with cerebral palsy and intellectual disability

Trauma to teeth and soft tissues is common among which individuals?

individuals with epilepsy and cerebral palsy

Always inform the patient of intended actions before starting.

inform

Patients with ________ have a high incidence of oral manifestations, including lymphadenopathy, gingival changes with bleeding, and petechiae, which are more severe following chemotherapy.

leukemia

_____ floors with _______ surfaces are important. 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.

level nonslip

Mirrors and dispensers are positioned ____; a _____ mirror could provide better viewing of the teeth during instruction for most patients. An unattached _____ mirror, preferably on a pedestal that tilts, supplements the wall mirror. A _______ mirror can provide an excellent aid for viewing the disclosed biofilm and the devices for biofilm removal.

low tilt hand magnifying

Position the wheelchair in the same direction as and parallel with the dental chair; set the brakes; remove the footrests. Adjust the seat of the dental chair to slightly ______ than the wheelchair seat. Move the arm of the dental chair out of the transfer area, and remove the arm of the wheelchair.

lower

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

mainstreaming

The dental team must have as its objectives to _______ the patient and the caregiver to establish and maintain healthy oral tissue with freedom from infection.

motivate

A _____ _____can be used to assist the patient who has difficulty maintaining an open mouth.

mouth prop

________ communication using facial expressions, pointing, body language, and demonstration helps certain patients to respond.

nonverbal

making available to all individuals patterns and condition of everyday life that are as close as possible to the norms and patterns of the mainstream of society

normalization

When a patient cannot control saliva, rinse, or expectorate, a dentifrice should _____ be used.

not

When the patient is in a total support wheelchair, transfer to the dental chair may ___be advisable.

not

The ________ in patient positioning and stabilization during treatment are to let the patient feel comfortable and secure while the clinician provides care in a position that provides adequate illumination, visibility, and accessibility.

objectives

At least ____ entrance to the building on ground level accessible by a gently sloping ramp (rise of 1 inch for every 12 inches). An easily grasped handrail (height 30 to 34 inches) is needed on at least one side, and preferably both sides, to accommodate left- and right-handed cane and one-crutch users.

one

The ________ of a patient with a disability paves the way for long-term success of dental and dental hygiene supervision and care.

orientation

Special ________ is used in a wheelchair as protection from pressure sores. Depending on the length of the appointment, the patient will decide whether the ______ should be moved to the dental chair.

padding

Position the wheelchair in the same direction and _____ with the dental chair; set brakes; remove footrests. Adjust the dental chair to the same height as or lower than the seat of the wheelchair. Move the arm of the dental chair out of the transfer area, and remove the arm of the wheelchair.

parallel

The wheelchair is placed beside and _______ to the dental chair for patient transfer.

parallel

a reserved area, clearly marked, near the building entrance and 13 feet wide (8-foot car space with 5-foot access aisle) to permit opening car doors for exiting and reboarding.

parking

Ask _______ how much and what kind of assistance is needed. Raise chair slightly above the patient's knee level and adjust chair arm out of the way. Stand aside or assist while patient moves until back of legs touch chair and then bends knees to lower into dental chair. If assistance is needed grasp ankles, lift legs, and turn patient into dental chair. Remove assistive aides and store out of the way; service dogs that accompany a patient are allowed to lie quietly nearby during the dental appointment.

patient

Biofilm formation and disease development are described on a level at which the ______ and ____ can learn and be motivated.

patient caregiver

Provide a clean mouth for professional instrumentation (conditioning). Disclose and present or review information on biofilm. Continue practice on biofilm removal methods selected for the particular patient. The ______ and _______ demonstrate correct technique.

patient and caregiver

Although a caregiver may be willing to brush the patient's teeth, as much as possible should be carried out by the ______.

patient.

_____ and ______ sealants have been used for children with developmental disabilities with satisfactory results.

pit fissure

The dental team should Make appointments _______ and _______ experiences.

pleasant and comfortable

A ____ toothbrush can be a beneficial adjunct for many patients with disabilities and can motivate patients.

power

The dental team must have the objective to ______ the need for extensive dental and periodontal treatment that the patient may not be able to undergo because of lowered physical stamina or the inability to cooperate.

prevent

Patients with a spinal cord injury do a "_____ ____" and patients with quadriplegia _____ their weight every 20 minutes for 10-15 seconds to maintain good circulation in the tissues that do not have sensation, such as the buttocks.

push up shift

For many patients, treatment by ______ under local anesthesia is the procedure of choice. The occurrence of generalized heavy calculus deposits in disabled patients is not unusual due to factors related to the disabling condition. The objective of the clinical procedures is the complete removal of calculus and periodontal pocket debridement.

quadrants

when __________ therapy of the head and neck area involves the salivary glands, _________ can result and contribute to an increased incidence of dental caries.

radiation xerostomia

After the appointment, return the patient to the wheelchair in the ______ order of procedure.

reverse

After the appointment, the patient is returned to the wheelchair in the _____ order of procedure.

reverse

An x-ray machine in the ____ treatment room can simplify the problems of moving the patient into a separate radiography room.

same

Face the wheelchair in the ____ direction as the dental chair at approximately an angle of ___ degrees; set brakes; remove footrests and wheelchair armrests. The patient will adjust a power-driven chair and set the brakes before turning it off.

same 30

Adjust the dental chair to the ______ height as or _____ than the wheelchair; clear a path for transfer by uplifting the dental chair arm.

same lower

Introduce each procedure and sound to prevent startling a patient. Follow the basic instruction rule to "____, ______, ____ ____."

show, tell, then do

When protective support of any type is to be used, it is explained completely to the patient and or the legal guardian and a _____ informed consent is obtained. The least restrictive method of stabilization is selected for each patient and communication-based or desensitizing techniques are tried first.

signed

Use _____-end sharp instruments to prevent accidents. When an unrestrained patient moves involuntarily, the nonworking end of an instrument can be a hazard.

single

A patient may bring a ______ board or one may be kept in the office or clinic.

sliding

Ask the patient about susceptibility to _____ and about procedures to follow for prevention.

spasms

Some types of impairment can manifest as a ______ condition; others may cause _____ disability.

stable progressive

When a patient can support his or her own weight, the "______ ____ ____" technique can be used.

stand and pivot

On a prearranged signal and a ______ motion, lift and gently transfer the patient to the dental chair.

steady

Extreme care is given to slightly raising the head of any patient with a ________ defect or ______ compromise; the patient may be unable to prevent aspiration of fluids or object placed in the mouth during treatment.

swallowing respiratory

A _____disability can result from a physical impairment such as a broken leg or because of a physiologic conditions such as the limitations that occur during pregnancy

temporary

A practical, disposable mouth prop can be made from three to six ______ _______ taped together. A folded sponge should be placed under the tape to provide a cushion.

tongue depressors

Selection of a ______ technique is influenced by the size, weight, and mobility of the patient, along with any special physical conditions and patient preferences.

transfer

Ask the patient, family member, or caregiver how best the clinician can help during the ______. The patient must be allowed to do as _____ as possible.

transfer much

When the patient is unable to support his or her own weight, ____ aides are required. The parent or other caregiver may serve as the ____ person.

two second

There is a ____ responsibility to teach and supervise the patient and the patient's caregivers.

twofold

Use of an ______ scaler is contraindicated for a patient at risk for aspiration and should not be used for patients who overreact to sensory stimuli, such as a patient with autism.

ultrasonic

Each patient is ______, and members of the dental team must watch, listen, and learn procedures that will develop the patient's cooperation.

unique

The wheelchair of a patient who is unable to transfer can be positioned for direct _______; some wheelchairs are self-reclining and have headrests.

utilization

Fluoride _______ is particularly beneficial for use with patients who have difficulty with placement of fluoride gel or foam.

varnish

An automatic _______ ______ that tilts the chair back to a usual working position can be obtained for a clinical facility where wheelchair patients are treated frequently.

wheelchair lift

Certain patients do better ________assistance because they have developed their own method of balancing; many patients gain balance by holding both hands on the partially flexed forearm of a person walking beside them.

without