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unique group of individuals with a chromosomal abnormality with chromosome 21
down syndrome or trisomy 21 syndrome
true or false. prenatal screening has contributed to lowering the incidence of down syndrome
true or false. formerly incidence of births with down syndrome tended to increase with mothers age. more recently mother's age has decreased
Can the father be the source of having chromosomal abnormality that leads to down syndrome?
describe 6 physical characteristics of pts with down syndrome
- stature: short with short neck, awkward waddling gait, general down growth retardation
- head: microcephalus
- Nose: short underdeveloped
- Hair: scanty
- Eyes: oblique slant laterally; narrow opening between eyelids; epicanthic fold is continuous from upper eyelid over the inner angle of eye; nearsightedness, eyes cross inward, and cataracts
- Hands: stubby and short fingers, single, transverse palmar crease may be present on palm
Describe the level of mental retardation of pts with down syndrome. (4)
- IQ under 70
- longer institutionalized person may have a lower IQ score
- socially, many children are more advanced and may appear to have higher intelligence
- they enjoy music and have a good sense of rhythm
Describe 5 personal characteristics of down syndrome pts that may be helpful for the dental hygiene professional to be aware of.
- like attention
- cheerful disposition and easily amused
- sociable and oservant and take initiative
- tendency to imitate and be mischevious
- they have periods of stubbornness
What are 4 oral findings of the lips often found in down syndrom pts?
- holds mouth open with tongue protruded
- lips may be thick, cracked, and dry as a result of bathing in saliva while the mouth is open
- mouthbreathing is common
- respiratory infections are frequent
What are 3 oral findings of the tongue and palate often found in down syndrome pts?
- tongue may be fissured and appear large
- jaw and palate are narrow; tend to fore tongue in protrusion
- cleft lip, palate, or uvula is more common
What are 3 oral findings of the teeth often found in down syndrome pts?
- delayed eruption; irregular in sequence of eruption
- microdontia and congenitally missing teeth
- anomalies such as fused teeth or peg laterals
What are 2 oral findings of occlusion often found in down syndrome pts?
- angle's class III and posterior crossbite are common and relate to the flat face and underdevelopment of midface
- teeth may be spaced because of certain anomalous teeth that take less space
What are 4 oral findings of periodontal infections often found in down syndrome pts?
- periodontal infections are more severe
- bone loss and other effects of perio infection may be present
- leukocyte function is latered
- altered immune response contributes to the increased severity of perio infection
Why is the mortality rate high during the early years of down syndrome pts?
because of high susceptibility to respiratory infections, leukemia, and congential heart lesions
What are 6 contributing factors to obstructive airway problems in the pt with down syndrome?
- increased secretions
- frequent respiratory infections
- enlarged tonsils
- enlarged adenoids
What are some dental hygiene adaptations for obstructive airway problems in down syndrome pts?
- chair position
- fluid suctioning
- gag reflex
What are 3 health problems seen in many down syndrome pts that are significant to dental hygiene care?
- obstructive airway problems
- congenital heart lesions
- relation to alzheimer disease
a complex developmental disability marked by limitations in the ability to understand and communicate
autistic spectrum disorder
condition where brain function is severely disordered, the way the brain uses or transmits information is affected; usually appears during early childhood and persists throughout life; is manifested by a range of impairments rather than by the presence or absence of a certain behavior or symptom
autistic spectrum disorder
a general category of disorders marked by a severe and pervasive impairment in several areas of development;which is how variations of autistic behaviors have been grouped
pervasive development disorder (PDD)
What are the 5 variations of autism that are described?
- autistic spectrum disorder
- asperger's disorder
- pervasive deveolpmental disorder - not otherwise specified
- rett's disorder, or syndrome
- childhood disintegrative disorder
impairments in verbal and nonverbal communication and social interaction, and restrictive or repetitive patterns of behavior, interests, and activities
symptoms are usually measurable by 18 months of age; formal diagnosis is usually made between 2 to3 years of age, when delays in language development are apparent
autistic spectrum disorder
characterized by impairments in social interactions and restricted interests and activities, without clinically significant delays in language, cognitive ability, or developmnetal age-appropriate skills
severe and pervasive impairment in specified behaviors, without meeting all of the criteria for a specific diagnosis (atypical autism)
pervasive developmental disorder
occurs only in girls, causing the development of autism-like symptoms after a period of seemingly normal development
purposeful use of hands i slost and replaced by repetitive hand movements beginning between ages 1-4
in 1999 researchers found a gene responsible for this
characterized by normal development for at least the first 2 years, followed by a significant loss of perviously acquired skills
childhood disintegrative disorder
What are 4 characteristic features of autism?
- problems with social interactions
- problems with verbal and nonverbal communication
- ritualistic or compulsive behaviors
- atypical responses to the environment
describe 4 types of impairments in social interaction of pts with autism
- impairment in use of nonverbal behaviors
- failure to develop peer relationships appropriate to developmental level
- lack of spontaneous seeking to share enjoyment, interests, or acheevements with others
- lack of social or emotional rediprocity
describe 4 types of impairments in communication of pts with autism
- delay or total lack of spoken language
- individuals with adequate speech, impairment in conversational abilities
- repetitive use of language
- lack of spontaneous make-believe play
describe 4 restricted repetitive and stereotyped patterns of behavior of pts with autism
- preoccupation with stereotyped and restricted patterns of interest
- inflexible adherence to routines or rituals
- repetitive body movements and mannerisms
- persistent preoccupation with parts of objects
describe 3 delays or abnormal functioning prior to age 3
- social interaction
- language as used in social communication
- symbolic or imaginary play
true or false. Autism occurs in all racial, ethnic, and social groups world wide
autism occurs 4 times greater in males or females? And it is usually the first born.
What are 4 related factors of the etiology of autism?
- inadequate oxygen at birth
Is there a cure for autism?
What is the purpose for pharmacological treatments of autism?
relief of negative behavioral symptoms
What are 4 types of drugs used in pharmacological treatments for autism?
- stimulants: methylphenidate, ritalin
- opiate blockers
What medication has been shown to be significantly more effective than placebo in improving behavior, representing the largest positive effect by a medication ever observed in children with autism?
risperidone, an atypical antipsychotic medication
What is the purpose of behavioral therapty treatments for pts with autism?
to help people with autism lead more normal lives by decreasing symptoms and increasing their abilities
What are 7 examples of behavioral therapy treatments for pts with autism?
- special teachers in intensive structured programs directed toward individual instruction
- applied behavior analysis
- sensory integration
- music therapy
- occupational therapy
- speech and language therapy
- auditory integration training
What is the life-expectancy of pts with autism?
true or false. except when autistic spectrum disorder is combined with a developmental disability of a different nature, no specific oral manifestation exists
What are 3 general factors that can contribute to poor oral care for autism pts?
- previous dental care: low priority, caregivers not seeking dental care, dental negect; fear of embarassment of care taker, fear of discomfort or injury
- dental caries: feeding problems leading to offering foods that will be accepted without regard for nutrient content, dietary selection may have been limited by needs for sameness, sweet food for rewards
- oral hygiene: daily oral care procedures may be inadequate for pt
What are 3 ways that the dental staff can prepare to treat the autistic pt?
- learn to work with pt: rvw histories, discuss info with parents, doctors, teachers, and others involved with pt, gather specific info about motivators and effective rewards
- plan several short orientation and familiarization appointments initially
- involve the same members of the dental team at each appointment
What are 2 factors to include in the dental hygiene care plan for the autistic pt?
- four-handed dental hygiene
- frequent appointments to include all phases of prevention
What are 4 means of appointment interventions that may be necessary with the autistic pt?
- predictable and consistent experience
- create a quiet environment; pts may be senstitive to light, sounds, touch, and smell
- desensitization: begin with orientation, instrumentation may not be included at first appointment, "show-tell-do", patience and firmness, have caregiver condition pt by giving them films and mouth mirrors to practice, use behavior modifications; involve caregiver, reinforcing rewards, use inedible rewards
- physical immobilization: restraints, obtain written consent
What are 2 types of multicomponent treatment packages available for autistic pts?
- behavioral interventions
- D-TERMINED dental program of repetitive tasking and familiarization in dentistry
Many resistant pts can cooperate more, and can learn these cooperative behaviors of multicomponent treatment packages when what 4 things?
- 2 or more active behavioral interventions are used
- individualized tangible reinforces are used and provided frequently
- pts can be actively involved in the behavior intervention
- the behavior intervention is practiced repetitively
What is a behavior management approach for dental professionals to use specifically for pts with autistic spectrum disorder?
D-TERMINED dental program
What program has techniques that have allowed many pts with autistic spectrum disorder to receive apporpriate dental treatment in standard practice environments without sedation?
the D-TERMINED program involves what 3 things?
- pretreatment assessment
- familiarization visits
- learning cooperation skills
What are 5 cooperation skills that the autistic pt needs to learn in the D-TERMINATED program?
- positioning in dental chair
- sitting with legs strait and hands at sides or on tummy
- making eye contact as instructions are given
- opening the mouth and remaining consistently open
- allowing instrumentation and responding appropriately
What are the 5 "D" steps for learning cooperation skills in the D-TERMINED program?
- divide the skill into smaller parts; each step one at a time, and master it before moving ahead
- drill the skill; repeat the skill many times until it is second nature
- delight the learner; reward successfull attainment of any small protion of the task
- delegate the repetition; involve other members of the dental staff in reinforcint the skills, and rehearse at home