Читать книгу A Practical Approach to Special Care in Dentistry - Группа авторов - Страница 145

1 Why is the hypoacusis/loss of hearing in this patient particularly significant?The patient has mixed bilateral deafness (which implies sensorineural impairment)The auditory threshold is very low in one ear and severe in the otherThe onset of the deafness was prelingual

2 What other factors impact on the ability to communicate with this patient?Does not tolerate her hearing aids (often removes them)Additional visual deficit which will impact on her ability to:Figure 3.2.1 Bimaxillary compression resulting in a narrow, pointed/ogival arched palate.Engage with other communication management techniques such as pictograms and ‘tell–show–do’ (Figure 3.2.2)Ability to lip read or use sign language effectivelyNo prior dental experience so unable to relate to surroundings, including the feel and smells associated with a dental officeLearning disabilityFigure 3.2.2 Sign language can be used to enhance communication.Behavioural issues which may be worsened by heightened anxiety

3 What factors are considered important in assessing the risk of managing this patient?SocialLack of spoken languageLimited co‐operationPotentially aggressive behaviourMedicalAuditory deficitVisual deficitIntellectual deficitDentalNo previous experience of dental visits and hence limited co‐operation; will require acclimatisationCertain behavioural control techniques are not applicable (e.g. tone of voice)Delayed dental development, malocclusion, tooth agenesis and high arched palate in relation to the foetal alcohol syndrome

4 The foster parent explains that the child is being bullied at school because she looks different. What would you do?Discuss that improving the appearance of the child's teeth may not stop the bullying as the child may have other distinctive facial features of foetal alcohol syndrome which may appear different (small eyes, thin upper lip, short, upturned nose and a smooth skin surface between the nose and upper lip)Explain that the child is too young for dental extractions, orthodontics and/or orthognathic surgery to be planned (she is in the mixed dentition stage)She also has limited co‐operationThe most important focus is to acclimatise her to visiting the dentist regularly so that her oral health can be maintained and enable more invasive treatment at a later stageEncourage the foster parent to discuss the bullying with the school and social services

5 Tooth crowding in anterior sectors has promoted the localised accumulation of dental calculus. What factors would you need to consider when choosing the appropriate technique for removal of these deposits?Manual instruments (curettes) may be preferable to minimise the background noiseUltrasonic instrumentation can cause interference with hearing aids

6 The patient is not co‐operative for calculus removal. What factors are important to assess prior to the adjunctive use of inhalational sedation?

 The nasal hood may not be tolerated or may have a further negative impact on communication

 Sedation itself may further impede communication

 The patient has developmental delay – it is important to consider her weight and height before deciding on the appropriate concentration

 Risperidone and nitrous oxide both have CNS depressant effects