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.