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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.
Disabled (by americans with disabilities act)
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occurance of disabilities
1 in 5
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Rehab trends are towards?
deinstitutionalization
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Barries to dental care involve?
- patient
- family,
- caregivers,
- guardians
- dental professionals
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Types of barriers
- Attitude barriers,
- Physical barriers, and
- Financial barriers
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Objectives to DH care
- Motivate
- Contribute
- Prevent
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Pretreatment planning
- Preliminary contact
- Guardian
- Information to obtain
- Consultations with other care providers Interaction with caregiver
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Information to obtain about the patient before the app
- Basic Info
- Medical history
- dental history
- Supplemental info
- open-ended other info
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Supplemental Info includes
- Muscular coordination,mobility, walking
- sitting tolerance
- sitting position
- ability to cooperate/involunatry movements
- communcation: speech, hearing, vison
- breathing, including when reclined
- swallowing, control of saliva
- bowel or bladder control
- mental capacities
- dexterity, ability to brush and floss teeth
- ability to chew or eat
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External features of an office
- Parking: reserved area near building and 13 feet wide
- Walkways: 3 foot wide, solid non-slip surface, ramps for curbed areas
- Entrance: one entrance must on ground level with gentle slope (rise
- of 1 inch for every 12inches)
- Handrail: 30-34” high on at least one side, preferably two
- Door: Lightweight, lever type, opens at lest 32”
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Internal Features
- Passageways: 3 feet wide with handrails; Free from obstacles
- Floors: Level with non-slip surfaces
- Reception areas: Easy access sitting and rising from chairs; Arms for support
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wheelchair use during treament
- Portable headrest
- Position of dental chair
- Wheelchair lift
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Patient instruction area
- Dimensions: the tabletop and washbasin built at a height of 32 to 34 inches permit clearance underneath for knees and wheelchair arms
- Washbasin: Lever or blade-type; Hot pipes covered
- Mirror: Positioned low, tilted, portable
- Magnifying
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Main prep for wheelchair transfer
Clear the area
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Special needs of patient during wheelchair transfer
- Chair padding
- Bags and catheters
- Spasms
- Advice concerning transfer
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Mobile patient transfer
- Postition the wheelchair: same direction oas the dental chair at approx. angle of 30 degrees; set brakes; remove footrests adn armrests
- Prepare dental chair: geight should be lower than wheelchair; clear path
- approach to patient: hands under patient's arms and grasp the waist belt in back
- Pivot to dental chair
- Repeat in reverse
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Immobile patient transfer
- Postition wheelchair: same as other
- Aide I: behi,d wheelchair, hands under arms, pressing foreharms against the patient's lower thorax area; clasp hands or wrists under the patient's rib cage
- Aide II: face patient and grasp hands under the patient's knees. Or face dental chair; place one arm under the thighs adn the other under the calves of the lower legs
- Transfer: on a prearraged signal adn steady motion, left and gently transfer the patient to the chair
- Repeat in reverse
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Sliding board transfer
- Position the wheelchair: same direction as // with dental chair, dental chair slightly lower
- Adjust the sliding board: Patient or clinicain places sliding board well under the hip of the patient
- Transfer: patient shifts weight, balances on hands, and walks the butt acreoss the board. Use two people if person is heavy.
- Repeat in reverse
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Patient Position and stabilization
- Objectives: patient feel comfortable and secure. Hyperactive patient w inboluntary muscle movements can war a special stabilizing device to enable the clinicain to work and to prevent damgae to the ora tisssues by accidental movement of instruments
- Chair Position: tip chair back slowly, chair up (respiratory or cardiac complications)
- Body adjustments: (push up for spinal cord injury every 20 min; shift 10-15 seconds for quadriplegia)
- body stabilization: body enclosure (pediwrap-neck to ankles, paoose board-board with padded wraps to enclose patient) Head stabilization (arm of clinician, mouth prop)
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shifting prevents which kind of ulcers
decubitus
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oral manifestations
- Dental Caries
- Periodontal Infections
- Congenital malformations
- Oral injuries
- Attrition
- Trauma to teeth and soft tissues
- Facial weakness or paralysis
- Malocclusion
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Therapy related oral findings
- Drug-induced gingival overgrowth: Phenytoin (Dilantin) (antiepileptic med)
- Chemotherapy: oral ulcerations, mucositis, susceptibility to infection
- Radiation therapy: when involving salivary glands, xerostomia results
- Other medications
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disease prevention and control
- Preventive program components: education, denal biofilm control, fluorides, pit adn fissure sealants, diet couseling, smiling cessation, regular professional exams
- Cooperation: failure to cooperate can be due to lack of knjowledge, lack of motivation, lack of mental/physical ability
- Functioning levels: high, moderate, low
- Preparation for instruction: ask questions
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High functioning level
- Self-care group
- capable of lossing and brusing their own teeth
- need varying degrees of encouragement, motivation,a dn supervision
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moderate functioning level
- partial-care group
- capable of carrying out at least part of their oral hygiene needs
- require considerble training, assistance, adn direct supervision
- assistacne may be verbal, gestural, hand-over-hand
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low functioning level
- total-care group
- unable to atend to their own care; dependent
- may be bedredden and nonambulatory
- may be confined to wheelchair
- with training may be able to attempemt a part of their own care
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components of Dental biofilm removal
- Provide basic information
- Disclose and show biofilm
- Toothbrushing
- Dentifrice (use fluoride: but when control of saliva, expectoration, and rinsing is lost, dentifrice should not be used)
- Dental floss
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Self-care aids benefit who and how?
- Benefits to patient:
- Self-esteem,
- accomplishment
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General prerequisites for a self-care aid
- cleanable
- durable (withstand water and saliva)
- resistant to absorption of oral fludis
- replaceable
- inexpensive
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patient who cannot hold/position brush
- Specially designed toothbrush
- Patient moves head instead of hand
- Use of a power brush or device
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When should you place sealants in disabled children?
as soon as reuption of the tooth will hold a rubber dam
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Factors that invluence diet habits
- Masticatory/feeding issues
- Overindulgence in cariogenic foods
- Inability to perform biofilm control
- Lack of professional care and instruction Medications
- Obesity
- Food preparation
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What preceeds scaling
biofilm control instruction
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types of stabiliazation
- Ratchet type (Molt’s mouth gag)
- Bite blocks
- Tongue depressors
- Precautions: mobile teeth could be knocked out; loose primary teeth in young patient; mobile teeth in advanced periodontal infection; fatigue of patien't facial adn masticatory muscles and tmj; patient must know the risks and that all stabiliation devices are for comfort and to make the work easier and that they are in now way meant to hurt or punish.
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treatment by quadrants
- scaling requirements
- need for assistance (4 handed DH; stabiliztion and visibility; precaution during evacuation with lung disorders)
- instruments (unbreakable mirrors, single-ended instruments, use of ultrasonic scaler may be contraindicated for a patient at risk for aspiration or who overeact to stimuli)
- tequnique suggestions (show tell do, and finger rests/external
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