What are 6 other health considerations that are often seen in pts with cleft lip or palat?
other congenital anomalies - often accompany the disability
facial deformities
infections - upper respiratory and middle ear
airway and breathing difficulties
speech difficulty
hearing loss
true or false. There is rarely a single cause for cleft lip or palate
true
During what time of pregnency is the significant time for influences from environmental factors for cleft lip and palat?
early in first trimester
What are 5 environmental risk factors for cleft lip or palate?
tobacco use
alcohol consumption
teratogenic agents: phenytoin, vitamin A (isotretinoin), corticosteriods, drugs of abuse
inadequate diet - folic acid
lack of adequate prenateal care
How can a cleft lip or palate affect tooth development?
higher incidence of missing and supernumerary teeth, and abnormalities of tooth forme
how can cleft lip or palate affect occlusion?
high percentage require ortho care because of malocclusion, and new ortho therapy may be required after each surgery
How does an open palate affect a person with cleft palate?
can't suck on a nipple as a baby, and breast milk may pass into the nasal cavity
how can cleft lip or palate affect muscle coordination?
lack of coordination of lips, tongue, cheeks, floor of mouth, or throat
compensatory habits formed to produce normal sounds in speech
How can cleft lip or palate affect periodontal tissues?
dental biofilm accumulates more around irregularly positioned teeth, and inability to keep lips closed around mouth during breathing
early perio with bone loss is often seen at cleft sites
perio loss in layers is greates at cleft sites
Why are dental caries seen so often in pts with cleft lip and palate?
malpositioned teeth
mastication problems
diet selection
biofilm retention
cleft lip and/or palate frequently occur as part of a _________ with other __________
syndrome
birth defects
How often should dental appointments be scheduled for a pt with cleft lip or palate?
every 3 or 4 months
What are 4 objectives for hygiene treatment of pt with cleft lip or palate?
review bioflim control measures
provide encouragement to pt to maintaint health of supporting structures
remove all calc and smooth the tooth surface
supervise dental caries prevention program
What are 3 appointment considerations seen with pts with cleft lip or palate?
pt apprehension - due to being in hospital settings so often
communication - speech or hearing may be compromised
motivation - pts may be quiet, unresponsive, or overly bold
3 important areas to focus on in pt instruction for the pt with a cleft lip or palate include:
personal oral care procedures
diet
smoking cessation
a condition in which injury to parts of the brain has occurred prenatally, natally, or postnatally and has resulted in paralysis or disruption of motor parts
cerebral palsy
What are 5 possible causes of cerebral palsy befor birth?
anoxia during pregnancy
infection during pregnancy
blood type incompatibility
nutrutional lack
maternal diabetes
What are 4 possible causes of cerebral palsy later in life than in pregnancy?
infectious disease - meningitis or encephalitis
lead poisoning
direct trauma from accidents or battering
What are 6 oral manifestations seen in pts with cerebral palsy?
disturbance of musculature - facial grimace, asymmetry, probems chewing and swallowing
maloccluision
attrition
fractured teeth
dental caries
periodontal infections: phenytoin induced gingival overgrowth, biofilm control
How often are patients with cerebral palsy mentally retarded?
in fewer than 50% of individuals
Name 11 other health considerations besides oral manifestations seen in pts with cerebral palsy
spasticity
athetosis
ataxia
rigidity
tremor
flaccidity
mixed combo of symptoms
mental retardation
learning disability
seizures
sensory disorders - seeing and hearing
congenital defect or opening in the spinal column. A portion of the spinal membranes may protrude through the opeing with or with out spinal cord tissue
spina bifida
myelomeningocele
What are 3 important considerations in dental care for a pt with myelomeningocele (or spina bifida)?
premedication - pts with ventriculoatrial shunts require it
latex allergy - common in pts with spina bifida
gingival care - pts who suffer from seizures may be taking phenytoin and suffer from gingival hyperplasia
disease characterized by progressive severe weakness and loss of use of group of muscles
muscular dystrophies
What are the 2 main types of muscular dystrophies?
duchenne
facioscapulohumeral
the duchenne type of muscular dystrophy is limited to ________ and transmitted by _________ carriers
males
female
What is the age of onset for the duchenne type of muscular dystrophy?
usually between ages 2-5, but before 10
What are 6 physical manifestations of duchenne muscular dystrophy?
enlargement of certain muscles
weakness of hips - frequent falls
lordosis - abdominal protuberance
gait - waddle, and difficult balance
progressive muscular wasting
intellectual impairment
true or false. Males and females are equally affected by the facioscapulohumeral muscular dystrophy type
true
What is the age of onset for pts with facioscapulohumeral muscular dystrophy?
between 10 and 18 yrs
What are some characteristics that show a pt has facioscapulohumeral muscular dystrophy?
facial muscles involved - orbicularis oris
prominent scapulae with weak shoulder muscles
difficulty closing eyes completely
no perception of visula stimuli; lack or loss of ability to see
blindness
less than 20/200 vision with corrective eyeglasses
legal blindness
What are the 7 leading causes of age-related blindness?
diabetic retinopathy
age-related macular degeneration
senile cataracts
glaucoma
vascular disease
trauma
infection
What is the origin of at least one half of the blindness in children? Give examples
prenatal origing from:
infections such as rubella
syphilis
toxoplasmosis
What are 3 other, not prenatal, causes of blindness in children?
injuries
neoplasms
retinopathy of prematurity
What are 4 important factors to take into consideration with the blind patient?
Tell pt about things in great detail
pt relies more on other senses cuz of lack of site
keep things neat and orderly, let them know if you've rearranged something
be careful with your tone of voice
How should you handle a situation when the blind pt has a dog guide?
do not disturb the dog
ask pt were the do would be best placed or seated
disease in which the optic nerve is damaged, leading to progressive irreversible loss of vision. It is often, but not always associated with increased pressure of fluid in the eye
glaucoma
true or false. tilting a pt back with glaucoma may increase pain and pressure in the eyts, so avoid it
true
true or false. sensitivity to light is characteristicc of many eye conditions, so avoid shining the light in their eyes
true
When hearing is impaired to the extent that it has no practical value for the purpose of spoken communication, a person is considered what?
deaf
When hearing is defective but functional with or without a hearing aid, what terms are used?
person who is hard of hearing
hearing loss
What are 2 main causes of hearing impairments?
heredity - prenatal infection in mother like rubella or birth trauma
chronic inner ear infections or infectious diseases such as meningitis, trauma, and toxic effects
outer or middle ear invovlement of the conduction pathways to the inner ear
conductive hearing loss
damage to the sensory hair cells of the inner ear or the nerves that supply the inner ear
sensorineural hearing loss
combination of conductive and sensorineural hearing loss
mixed hearing loss
damage of the nerves or nuclei of the central nervous system in the brain or the pathways to the brain
central hearing loss
What act requires clinicians to acquire certain aids and services such as removal of physical barriers, the use of braille materials, having large printed materials, written instructions, taped texts, qualified interpreters, assistive listening head sets, and text telephone devices
Americans with Disabilities Act (ADA)
absence of sense of smell by damage to olfactory nerve
anosmia
lessened sensitivity to odors
hyosmia
a disorder with the sense of smell
dysmosmia
olfactory dysfunction characterized by the inability of the brain to properly identify an odors natural smell
parosmia
olfactory hallucinations
phantosmia
inability to recognize objects by use of the senses
