Dental Care for Children and Adults With DD: Special Considerations - - PDF document
19th Annual Developmental Disabilities: An Update for Health Professionals March 5-6, 2020 Dental Care for Children and Adults With DD: Special Considerations Dr. Allen Wong (awong@pacific.edu) Nothing to Disclose Dr. Allen Wong 2015
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Nothing to Disclose
2015
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2020
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Patients w ith special needs:
Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning.
number concepts; and self-direction.
esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized.
schedules/routines, safety, use of money, use of the telephone.
Standardized tests can also determine limitations in adaptive behavior, which comprises three skill types:
2015
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Neurodevelopmental Disorder Fragile X Syndrome Down Syndrome Cerebral Palsy Autism Fetal Stroke ID
2015
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# 1 unmet healthcare need for those with
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* Dr Rick Rader study 5y ago
General public
than the general population.
Training of Health Care Professionals
school deans, 56% of students and 32% of medical residency program directors responded that graduates were “not competent” in treating people with ID.
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Standard 2-1 Curriculum Content b) Assess, diagnose and plan for the
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Biases Diagnostic Overshadowing Medication changes
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Behavior Complaint Behavior Complaint
to autism
just due to Down syndrome
just due to Cerebral Palsy 1.5% Profound 3.5% Severe 10% Moderate 85% Mild
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Pandemic disease Preventable disease Infectious like disease Multifactorial disease
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Management By Risk Assessment
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New Concept…
Old Dental philosophy Consistency…
Some common questions
Why didn’t my other dentist mention? I can’t afford that kind of care My insurance doesn’t pay for it, I don’t want it I never had problems before with caries
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25% more likely to get a prescription 300% more likely to continue a prescription 46% of psychotropic drugs don’t have a corresponding psychiatric diagnosis 13% of anti-seizure drugs don’t have a corresponding seizure diagnosis
Major Health Risk Categories
Cardiovascular Disease (CAD and
Poor Pregnancy Outcomes (Fetal
Diabetes Bacterial pneumonia (VAP) Orthopedic Implant Failure Kidney Disease
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Young et al., 2011
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A) Disease Indicators B) Socioeconomics Factors C) Biologic Factors D) Protective Factors E) Salivary pH
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J CA Dent Assn. Oct 2 0 0 7 , p 7 0 4
62 Young DA, Novy BB, Zeller GG, et al. The American Dental Association Caries Classification System for Clinical Practice: A report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015; 146(2): 79-86. 9% 50% 77% 88% 100% 100%
Prevention, prevention, prevention Evaluate hard tissue (teeth) , soft tissue
Monitor hard tissue, soft tissue and saliva
Follow prescriptions to counteract effects
Even MD’s can Fluoride Varnish?
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Young et al., 2011
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Restorative plan Antimicrobial Strategies: CHX, PI,
Remineralization Strategies: Fluoride,
Bacteriostatic/ Probiotic Strategies: Xylitol pH Strategies: Neutralizing and buffering
Behavior Modification: Counsel specific
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Visible Plaque Inadequate saliva flow Hyposalivary Medications Acidic Beverages Frequent Snacking (1-3 times daily) Appliances present Deep Pits and Fissures
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Young et al., 2011
Guide for patient assessment for caries risk Covers all Disease Indicator and Risk Factors
Cavitations Radiographs Bacterial Test Risk Factors
2012
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time 0 1 day 1 week J Dent Res 88: 116 Courtesy of Jeremy Horst, Steve Duffin, and John Frachella
Courtesy of Steve Duffin Courtesy of John Frachella
Seton J Scocca 49yom DD 3/ 29/ 16
UCSF Consent Courtesy of Jeremy Horst, Steve Duffin, and John Frachella
Allen’s Thoughts…
Discuss with office the disparity of care
Schedule an introductory Tour of the
Send medical forms and have returned a
Review the Diagnosis and discuss the
At the tour, spend some time with
Set goals for the next meeting based on
If patient cannot tolerate, don’t
Talk TO the patient, when possible, SMILE Give homework to caregiver ( such as
Truly inform..wait…
Keep instructions simple Don’t use analogies, many are literal Think about giving reasonable time
Use picture books or mirrors Walk in their shoes and understand their
Final Cautions MI Paste (Amorphous Calcium Phosphate) Xylitol Chlorhexidine
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Allen Wong, DDS, EdD, DABSCD awong@pacific.edu