Behavior Management Lecture 8

Behavior Management: Lecture 8

• Special health care needs encompass physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairments requiring medical management, healthcare interventions, and specialized programs.
• Classification includes mental, physical, and medical conditions.
• Parents of children with special needs experience disorganization, reintegration, mature adaptation, overprotection, and rejection.
• Common difficulties for special needs parents include long wait times at clinics, extensive travel distances, frequent hospital visits, needed home adjustments, financial hardships, and societal bias.
• Initial demonstration of sincere interest from a dentist during a first visit is beneficial, saving time during treatment.

Variables Affecting Dental Care Provision

• Access to dental care, degree of independence, caregiver support, availability of trained professionals, effect of illness and medications, systemic diseases, and financial factors affect the extent of care provided.
• Acceptance, accessibility, and availability of care are influenced by a perception of the situation by parents and the care provider. Examples include Down syndrome and porcelain crowns.

Treatment Considerations

• Diagnosis and treatment planning are critical factors.
• Infection control is imperative.
• Treatment modifications are necessary for special patients.

Common Dental Disorders in Special Patients

• Dental caries rates may vary based on the type of disability, with some showing lower rates than others.
• Oral and dental defects, malocclusion, oral habits, trauma, and gingival/periodontal disease are common problems.
• The severity of problems may differ from normal patients in degree, but not in kind.

Trauma

• Epileptic patients have a higher rate of traumatic injuries to teeth compared to other patients with disabilities.
• Blind children may also be at risk for trauma, although it isn't widely documented.

Malocclusion and Oral Habits

• Malocclusion and oral habits often result from facial development abnormalities and/or muscle issues. Cleft lip and palate are examples.

Prevention of Dental Disease

• Home care, diet, nutrition, fluorides, pit/fissure sealants, and regular professional supervision are crucial for reducing dental disease.

Modification of Toothbrush Handles

• Modification of toothbrush handles can help assist individuals with mental impairments who have difficulty grasping the brush.

Managing the Special Patient

• Behavioral shaping, physical restraints (used cautiously), sedation, and general anesthesia are among management strategies.

• Physical restraints are cautionary; they should never be used for punishment or convenience.

Classification of Mental Retardation

• Mental retardation is classified from mild to profound, based on Intelligence tests (IQ).

Difficulties with Mental Retardation

• Common impairments include short attention span, restlessness/hyperactivity, distractibility, and poor motor coordination. Management may require reduced distractions and mild sedation.

Mental Retardation Management

• To manage hyperactive and restless children, reduce distractions and use mild sedation.
• Short visits are recommended for short attention spans.
• Physical assistance may be necessary for poor motor coordination.
• Nonverbal communication aids are helpful for communication challenges.

Hyperactivity

• Usually due to hypocalcemia, encephalitis, or nutritional deficiency.
• Characteristics include a short attention span, lacking social integration, scheduling accommodations for short appointments, and potential use of restraints, sedation, or general anesthesia as needed.

Physical Impairments (Neuromuscular, Blindness, Deafness)

• Specific behavioral management techniques are necessary for individuals with disabilities.

Cerebral Palsy

• Neurological disorder of muscle control, motor function, typically caused by reduced oxygen during birth, anoxia, or other prenatal or postnatal factors affecting brain development or function.

• Multiple clinical presentations are possible, including muscle weakness, poor balance, abnormal gaits, seizures, various sensory impairments (visual, hearing).

• Types of cerebral palsy have different characteristics (monoplegia, hemiplegia, paraplegia, diplegia, quadriplegia). Note variable symptoms including muscle weakness, balance issues, involuntary movements, and irregular gait among others.

Oral Findings in Special Patients

• Average dental caries rates are typical; however, specific conditions like Down's syndrome may have noticeably lower rates.
• Trauma to anterior teeth or tongue thrust are characteristics.

Oral Reflexes

• Oral reflexes may present as increased gag reflexes, depressed coughing reflexes, and disturbed biting reflexes.

Management of Special Patients

• Medical consultation, oral hygiene measures, providing a comfortable position, premedication, physical restraints, mouth props, and short appointments.

Dental Office Access

• Dental offices should be accessible to special needs patients, including ramps, wide doorways, parking, elevators.
• Staff responsiveness to special needs and accommodations are important.

Communication Abnormalities: Hearing and Visual Impairment

• Strategies for working with hearing and visually impaired patients need to be modified to accommodate any communication barriers.

Hearing Impairment

• Hearing impairment may be associated with cleft palate, cerebral palsy, Down's syndrome, or other craniofacial abnormalities.
• Communication levels range from mild to profound hearing loss, and will influence suitable communication methods (hearing aids, lip-reading, or manual communication methods).

Visual Impairment (Blindness)

• Oral hygiene and trauma risk to teeth are common concerns.
• Visual impairments may arise from congenital, or acquired causes associated with other conditions.
• Methods of communication between clinician and the patient should adapt to the needs of the visually impaired.

This quiz covers the challenges faced by parents of children with special health care needs, including various impairments and the impact on dental care provision. It discusses the importance of understanding these needs for effective management and intervention. Explore the classification of conditions and the variables affecting access to dental care.