Table 3.96.

Key considerations for dental management in learning disability (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Unpredictable, occasionally aggressive behaviour; injuries from sharp instruments
Appropriate dental care	2/4	Informed consent; special facilities
Pain and anxiety control
– Local anaesthesia	1	Control lip biting
– Conscious sedation	2/4
– General anaesthesia	3/4	Arrhythmia; hypo- or hypertension; laryngospasm
Patient access and positioning
– Access to dental office	2	Limited access; clinician reluctance
– Timing of treatment	0
– Patient positioning	0
Treatment modification
– Preventive dentistry	2/4	Electric toothbrushes; chlorhexidine
– Oral surgery	2/4/5	Poor cooperation
– Implantology	2/4	Neglected oral hygiene; parafunctions
– Conservative/Endodontics	2/4
– Fixed prosthetics	2/4/5
– Removable prosthetics	2/4	Use viscous impression material; possibly a mouth prop; mark dentures
– Non-surgical periodontology	2/4
– Surgical periodontology	2/5
Imaging	2	Poor cooperation
Hazardous and contraindicated drugs	1	Some patients receive sedatives

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.