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Overview of Disabilities

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Title: Overview of Disabilities


1
Overview of Disabilities
  • Considerations for the Dental Health Professional

2
Introduction to disabilities
  • Why is it important to know about disabilities?
  • More people living in the community
  • More people living longer
  • More people returning to the community
  • Americans with Disabilities Act (1991)
  • More people in the community seeking services,
    including dental services

3
Introduction (cont)
  • Many myths and misconceptions regarding
  • People who have a disability
  • Providing dental services for persons who have a
    disability
  • The intent is to provide some basic information
    regarding common disabilities and reduce some
    barriers to oral health care

4
Dos and Donts
  • Offer assistance as you would anyone else
  • Respect no thank you
  • Ask pertinent and appropriate questions regarding
    the disability
  • Always talk directly to a person with a
    disability rather than accompanying person

5
Dos and Donts (cont)
  • When talking to a person in a wheelchair, sit
    down to be at the same eye level
  • Be flexible
  • Be sensitive to architectural barriers that may
    exist in your office
  • Use people first language i.e., a person
    with a disability rather than a disabled person

6
Dos and Donts (cont)
  • You may unintentionally offend someone by use of
    a certain word or phrase if so, apologize and
    move on dont dwell on it
  • Let the patient guide you as to what they prefer
    regarding terms and phrases
  • Be sensitive to and aware of cultural differences

7
Dos and Donts (cont)
  • People with disabilities are a broad and diverse
    minority so politically correct terms may be
    hard to find that please everyone
  • View the person as an individual first with the
    disability as a component of that person, no
    more, no less

8
Format
  • Definition
  • Incidence
  • Etiology
  • Diagnosis
  • Classification
  • Findings
  • Oral findings
  • Medical management
  • Dental management
  • Resources

9
DEVELOPMENTAL DISABILITY
  • A severe, chronic disability
  • Attributable to mental and/or physical impairment
  • Manifested before age 22
  • Likely to continue indefinitely

10
DEVELOPMENTAL DISABILITY
  • Results in substantial functional limitations in
    3 or more areas of major life activities
  • Self care
  • Receptive of expressive language
  • Learning
  • Mobility
  • Self direction
  • Independent living
  • Economic self sufficiency

11
DEVELOPMENTAL DISABILITY
  • Needs special interdisciplinary or generic care
    for an extended duration that is individually
    planned and coordinated

12
Mental Retardation
  • Based on the following three criteria
  • Significant subaverage intellectual functioning
    (IQ)
  • Deficits in 2 or more adaptive skill areas
  • Manifests before the age of 18
  • (AAMR, 1992)

13
Incidence
  • 2.5 - 3 of the general US population
  • (1990 census)
  • 6.2 - 7.5 million people
  • 1 out of 10 American families directly affected
    by MR

14
Etiology
  • Genetic conditions e.g. Down Syndrome, Fragile
    X, Neurofibromatosis
  • Inborn errors of metabolism e.g. PKU
  • Prenatal influence Rubella, Drug abuse
  • Perinatal e.g. Anoxia, Toxemia
  • Postnatal e.g. Poverty, Lead ingestion, Trauma,
    Cultural deprivation

15
Diagnosis
  • Standardized intelligence test and standard
    adaptive skills test
  • Describe persons strengths and weaknesses across
    four dimensions
  • Interdisciplinary team determines needed supports
    across the four dimensions

16
Classification
  • Normal IQ range 80-110 (Stanford Binet)
  • Mild- 85 of MR population
  • Moderate- 10-12
  • Severe- 2-3
  • Profound- 1-2

17
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18
Classification
  • Mild
  • IQ 52-67 (S-B)
  • often undistinguishable from normal
  • independent
  • may need help under stress

19
Classification
  • Moderate
  • IQ 3651 (S-B)
  • bathes and dresses self
  • simple chores or errands

20
Classification
  • Severe
  • IQ 20-35 (S-B)
  • feeds with spoon/fork
  • bathes with supervision
  • often toilet trained

21
Classification
  • Profound
  • IQ 0 19 (S-B)
  • may self-feed with spilling
  • needs assistance with all self help
  • may be non-verbal

22
Adaptive skill areas
  • Communication
  • Self care
  • Home living
  • Social skills
  • Community use
  • Work
  • Self direction
  • Health and safety
  • Functional academics
  • Leisure

23
Medical management
  • Variable, dependent on other or associated
    health/behavioral problems

24
Dental management
  • Variable, but usually little different from
    general population
  • Adapt patient management/communication to
    functional level
  • Adapt patient education to cognitive level
  • Involve caregiver

25
Resources
  • American Association of Mental Retardation
  • www.aamr.org
  • The Arc
  • www.thearc.org

26
Down syndrome
  • A chromosomal abnormality 47 chromosomes instead
    of 46
  • An extra partial or complete 21st chromosome
  • Also called Trisomy 21

27
Incidence
  • 1 in 800-1000
  • 5 of cases linked to paternal age
  • Usually linked to maternal age
  • 1 in 400 at age 35
  • 1 in 110 at age 40
  • 1 in 35 by age 45

28
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29
Etiology
  • Caused by an error in cell division
  • Trisomy 21 - 94
  • Translocation - 3-4
  • Mosaic - 2-4

30
Characteristics
  • hypotonia (low muscle tone)
  • flat facial profile
  • underdeveloped midface
  • thick, furrowed tongue
  • upward slant to eyes
  • simian crease
  • hyperflexibility
  • heavy epicanthal folds
  • short stature
  • fifth finger has one flexion furrow instead of
    two
  • atlanto axial instability
  • round face
  • saddle nose
  • low set ears
  • short, stubby fingers
  • speckling of iris (Brushfield spots)
  • wide gap between first and second toes

31
Facial Characteristics
  • Underdeveloped midface
  • saddle nose
  • low set ears

32
Facial Characteristics
  • Upward slant to eyes
  • heavy epicanthal folds
  • round face

33
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34
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35
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36
Oral Characteristics
37
Hypotonia
38
Simian Crease
39
Diagnosis
  • Prenatal tests/amniocentesis
  • Chromosomal studies

40
Medical management
  • Higher incidence of heart problems
  • 35-40 incidence
  • Ventricular septal defect (VSD) common
  • Higher incidence of upper respiratory infections
    and pneumonias
  • Higher incidence of acute lymphocytic leukemia
  • Premature aging

41
Dental management
  • Higher incidence of unresponsive periodontal
    disease
  • Higher incidence of congenitally missing teeth
  • Higher incidence of dental crowding
  • Significantly delayed eruption
  • Tooth size and shapes differ from norm
  • Check need for antibiotic coverage for dental
    procedures (AHA guidelines)

42
Resources
  • National Down Syndrome Society
  • http//www.ndss.org/
  • National Down Syndrome Congress
  • http//www.ndsccenter.org/
  • Down Syndrome Information Network
  • http//www.down-syndrome.info/

43
Videos
  • Educating Peter (30 min)
  • A story of a child with Down syndrome and his
    classmates testing the limits of a law stating
    whenever possible, children with disabilities
    should be included in class with typically
    developing children.
  • Graduating Peter
  • The follow-up to Educating Peter
  • Ambrose Video Publishing
  • 1290 Avenue of the Americas, Suite 2245
  • New York, NY 10104

44
Epilepsy
  • Comes from the Greek word for seizure
  • Recurrent seizures are the major chronic
    recurrent symptoms
  • Symptoms of the brains temporary bursts of
    abnormal electrical activity

45
Incidence
  • 0.5 of the US population has been diagnosed with
    a recurrent seizure disorder
  • 10 of the population will have at least one
    seizure in their lifetime
  • highest prevalence in children between 2 and 5
    and at puberty
  • may still see incidence rates of 9-11 but this
    is due to the inclusion of febrile seizures which
    can occur in infants (these should not be
    included)

46
Etiology
  • Symptomatic (identifiable cause)
  • head trauma (most common)
  • neoplasms
  • metabolic disorders
  • drug withdrawal
  • infections e.g. meningitis, encephalitis
  • Idiopathic

47
Diagnosis
  • Computed tomography (CT) and magnetic resonance
    imaging (MRI)
  • Electroencephalography (EEG)
  • History

48
Seizure Type
  • Determined by
  • Part of brain involved
  • Number of brain cells involved
  • Duration of electrical discharge
  • Symptomatology

49
InternationalClassification
  • Partial
  • Complex partial
  • Generalized
  • tonic clonic
  • absence
  • myoclonic
  • atonic

50
Medical management
  • Anticonvulsants
  • Neurosurgery
  • Vagal nerve stimulation (electrical stimulation
    through implant)
  • Ketogenic diet

51
Dental management
  • Thorough history
  • What happens during the seizure? What do they
    look like?
  • How long do they last?
  • Is there an aura and what is it?
  • Are there triggers that tend to set off the
    seizures?
  • How frequent are the seizures?
  • Control does NOT mean no seizures

52
Dental management
  • Thorough history (cont)
  • What happens after the seizure?
  • How long has the person been on the current drug
    schedule?
  • When was the last time the person was seen for an
    evaluation of the seizure activity?
  • Has there been any change in frequency of
    seizures or alertness recently?

53
Dental management
  • Seizures are NOT an emergency, but
  • Be prepared to establish airway
  • Be prepared to provide positive pressure
    oxygen/air
  • No contraindication to local anesthetic
  • If using sedation, be aware of potentiation of
    drugs and effects

54
First Aid
55
People with Epilepsy
  • Socrates
  • Martin Luther
  • Napoleon
  • Handel
  • Lord Byron
  • Gary Howatt
  • Former hockey player
  • Alexander the Great
  • Julius Caesar
  • William Pitt
  • Alfred Nobel
  • Van Gogh
  • Tony Coelho
  • Former US Rep Ca

56
First Aid
  • Prolonged or clustered seizures sometimes develop
    into non-stop seizures, a condition called status
    epilepticus
  • Status epilepticus IS an emergency

57
Incidence status epilepticus
  • 3-8 in people diagnosed with epilepsy
  • Malefemale ratio is equal
  • 75 of cases in childhood occur before age 3

58
Status epilepticus first aid
  • Brain equivalent to a heart in ventricular
    fibrillation
  • Can occur with no previous history of seizure
    disorder
  • First aid
  • CPR/BLS prn
  • Call 911

59
Resources
  • Center for Disease Control
  • www.cdc.gov
  • American Epilepsy Society
  • www.aesnet.org/
  • www.Epilepsy.com
  • Epilepsy Foundation
  • www.efa.org

60
Videos
  • How to Recognize and Classify Seizures (25
    min.)
  • Demonstrates how seizures are diagnosed and gives
    classification of seizures types
  • The Comprehensive Clinical Management of the
    Epilepsies (17 min.)
  • Discusses the diagnosis, treatment and follow-up
    with regards to medical, psychosocial,
    educational, rehabilitative and prognostic
    components.
  • Epilepsy Foundation of America

61
Cerebral Palsy
  • Any disorder of movement and posture that results
    from a nonprogressive abnormality of the immature
    brain

62
Incidence
  • .5-1
  • Incidence has been reduced due to improved
    neonatal intensive care units (NICUs)
  • Usually manifests by 1 year old

63
Diagnosis
  • No specific diagnostic criteria
  • Persistence of primitive reflexes
  • Asymmetric tonic neck response, (ATNR) e.g.,
    should not persist beyond 4 months
  • Moro reflex (embrace response), e.g., should not
    persist beyond 6 months

64
ATNR
  • Turn head to the side and opposite side arm and
    leg rise in fencers position. Will not
    release until head is moved back to the front.

65
MORO reflex
  • Infant in semi upright position. Head allowed to
    fall backward with immediate resupport. Arms
    abduct and extend. Upper extremities flex and
    adduct.

66
Causative Factors
  • 60 known cause 40 unknown
  • Numerous factors/causes
  • Pre-term, low birthweight (most common)
  • Fetal malformations, intrauterine infections,
    neonatal complications, anoxia, hypoxia, sepsis,
    meningitis
  • More frequent in twins

67
Apgar scale
  • Assessed at 1 and 5 minutes and may be repeated
    at 5 minute intervals for depressed infants
  • If 20 minute Apgar is 0-3, likelihood of cerebral
    palsy is 57
  • 10 point scale
  • 5 signs
  • 0-2 score

68
Apgar Scale
69
Classification
  • Classified by site of injury to brain and
    extremities or body parts effected
  • Diplegia legs effected more than arms
  • Paraplegia legs only (rare)
  • Quadriplegia arms and legs effected
  • Hemiplegia one side, arms more than legs are
    effected

70
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71
Classification site
  • Spastic motor cortex or pyramidal tract is the
    site of injury
  • Athetoid injury is extrapyramidal, usually at
    the basal ganglia
  • Mixed

72
Spastic cerebral palsy
  • Muscle tone increased with characteristic
    clasped knife quality
  • As extremity is moved, much resistance initially,
    then it gives way abruptly like a closing pocket
    knife
  • 35 will develop seizure disorders

73
Athetoid cerebral palsy
  • Major problem is controlling movement and
    maintaining posture
  • Variable changes in muscle tone
  • Facial muscles are more effected
  • Speaking problems are more common
  • Head and neck involvement common

74
Oral Manifestations
  • Increased salivary flow decreased ability to
    control it leads to increased drooling
  • May have increased or decreased gag reflex
  • Higher incidence of bruxism
  • Higher incidence of primitive bite reflex
  • Class II Division I malocclusion common
  • Anterior dental trauma common due to malocclusion
    and poor self-protective mechanisms

75
Medical Management
  • Aim is to prevent secondary problems due to
    abnormal or asymmetrical tone
  • Botox injections being used with success to
    reduce muscle tightness
  • Neurosurgical procedures have had limited success

76
Dental Management
  • Diazepam to decrease tone in spastic cerebral
    palsy
  • Nitrous oxide can help reduce muscle tone in
    spastic cerebral palsy
  • Positioning in dental chair
  • Maintain bend in hips avoid extension
  • Good head/neck support avoid extension
  • Bite block or mouth prop if primitive bite reflex
    is active

77
Autism
  • Now part of Autism Spectrum Disorder
  • Classified under DSM IV as a Pervasive
    Developmental Disorder (PDD)
  • Characterized by profound withdrawal from contact
    with people including parents
  • Often obsessive problems with change

78
DEFINITION DSM IV
  • Qualitative impairment in social interaction
  • Qualitative impairment in communication
  • Restricted, repetitive and stereotyped patterns
    of behavior
  • Abnormal or impaired development prior to age 3
    years

79
Pervasive Developmental Disorder
  • Includes
  • Autistic disorder
  • Retts disorder (only females)
  • Childhood disintegrative disorder
  • Aspergers disorder (less language delay)
  • PDD-NOS (not otherwise specified)

80
Autistic Disorder
  • Also has been called
  • Early infantile autism
  • Childhood autism
  • Kanners autism
  • Childhood schizophrenia

81
Incidence
  • 5/10,000
  • Third most common developmental disability in the
    US
  • Seems to be increasingly diagnosed
  • Boysgirls 4-51
  • Girls more likely to exhibit more severe mental
    retardation

82
Etiology
  • Essentially unknown, however
  • Some strong evidence for linkage to chromosomes
    2q, 7q, 16p and 17q

83
Diagnosis
  • Usually appears before 3 years old
  • Exhibits a number of symptoms
  • Poor social interaction and communication
  • Deviant patterns of behavior/interest/activity
  • No imaginative play
  • Delay in attaining milestones
  • Question hearing impairment

84
Diagnosis
  • Symptoms (cont.)
  • Stereotyped behavior e.g. rocking, hand waving,
    spinning
  • Little to no spontaneous speech echolalia
  • May exhibit self-injurious behavior (SIB)
  • Make little or no eye contact
  • Dont like to be touched
  • Emotionally flat affect usually but can flare

85
MH? MR?
  • Arguments have persisted whether autism is a
    psychiatric/emotional disorder or an intellectual
    deficit
  • Has swung back and forth
  • Difficult to test for IQ because of inconsistent
    responses
  • Currently viewed as both emotional disorder and
    intellectual deficit

86
Coexisting conditions
  • Seizure disorder
  • Fragile X
  • Tuberous sclerosis
  • PKU

87
Medical management
  • Many drugs and combinations and therapies have
    been used with inconsistent results
  • Some advocate use of positive physical supports
    because there is some evidence that deep pressure
    has a calming effect
  • Behavior can be very inconsistent

88
Dental management
  • Keep directions simple - do not give multiple
    commands at the same time
  • Many are sound sensitive and react strongly,
    especially to suction however, if turned on
    BEFORE entering the treatment area so it is part
    of ambient sound, response is much less or absent

89
Dental management
  • Use a calm, consistent voice when giving
    guidance/speaking
  • May take multiple appointments before treatment
    is accepted
  • Persistence and patience will prevail

90
Attention Deficit Hyperactivity Disorder
  • ADHD is a behavioral disorder characterized by
    impulsivity, inattention, and motor restlessness

91
Incidence
  • 3 5 of school-aged children
  • Male predominance 31
  • It typically affects children and adolescents
    with an onset prior to age 7

92
Etiology
  • Unknown
  • Hereditary
  • Some evidence linked to maternal alcohol
    consumption and cigarette smoking during pregnancy

93
Diagnosis
  • Based on behavioral observations and assessments
    from multiple sources including family members,
    educational professionals and physicians
  • Most frequently diagnosed at school age

94
Dental/Oral Considerations
  • Shorter dental appointments
  • Give patient clear rules or instructions to
    follow one at a time
  • Make eye contact during each request
  • Reinforce good behavior
  • Stop unacceptable behavior before it escalates

95
Medical management
  • Behavioral programs
  • Medication (when required)
  • Psychostimulants
  • Ritalin
  • Adderall
  • Dexedrine
  • Concerta
  • Strattera (non-stimulant)

96
Resources
  • Children and Adults with Attention Deficit
    Disorder
  • http//www.chadd.org/
  • Attention Deficit Disorder Association
  • http//www.add.org/
  • National Institute of Mental Health
  • http//www.nimh.nih.gov/publicat/adhdmenu.cfm

97
Hearing Impairment
  • 25-45 dB loss mild
  • 45-70 dB loss moderate
  • 70-90 dB loss severe

98
Hearing Impairment
  • When hearing is impaired to the extent it has no
    practical value for purpose of communication

99
Incidence
  • 10 of US Population (28 million)
  • 30 people over 65
  • 14 people between 45-64
  • 8 million age 18-44
  • 7 million children

100
Etiology
  • Heredity
  • Pre /peri /post natal influences
  • Prematurity

101
Hearing impairment
  • Determine ability to read lips
  • Maintain eye contact
  • Use face shield rather than mask so patient can
    see lips
  • Speak clearly (no need to shout)

102
Hearing aids
  • Use gestures and facial movements and written
    materials to communicate
  • Sometimes, it is best to remove or turn off the
    aids due to feedback and/or the amplified
    sounds of the dental office, e.g., suction,
    handpiece

103
Hearing impairment
  • Patient is NOT a good lip reader
  • If it is a basic procedure and the patient can
    read and write, develop 3x5 cards with what you
    want to say
  • Interpreter?

104
Interpreters
  • Required under Americans with Disabilities Act?
    NO
  • Under Title III, places of public accommodation,
    it says there should be effective communication
  • Patient requests, are you required? NO
  • Act calls for reasonable accommodation

105
Interpreter services
  • If negotiated and determined that interpreter
    would be helpful, cost is borne by the office
  • Patient cannot be billed
  • Insurance cannot be billed
  • Average cost is 40/hr

106
Interpreter services
  • Address patient and not interpreter
  • Interpreter cannot clarify message
  • Interpreter is merely translating the message
    into another format
  • Speak a little slower so interpreter can keep up
    use natural pauses

107
Relay service
  • Exists throughout the US
  • Enables hearing impaired person to send and
    receive messages to/from anyone
  • Non hearing impaired person does not need TDD/TTY
    to communicate
  • Available through the local phone company
  • Ohio 1-800-750-0750

108
Muscular Dystrophies
  • Muscular dystrophy (MD) refers to a group of
    genetic diseases characterized by progressive
    weakness and degeneration of the skeletal or
    voluntary muscles which control movement

109
Muscular Dystrophies
  • The muscles of the heart and some other
    involuntary muscles are also affected in some
    forms of MD, and a few forms involve other organs
    as well
  • The major forms of MD include myotonic, Duchenne,
    Becker, limb-girdle, facioscapulohumeral,
    congenital, oculopharyngeal, distal and Emery
    Dreifuss

110
Incidence
  • 0.14 per 1,000 children
  • MD can affect people of all ages
  • Although some forms first become apparent in
    infancy or childhood, others may not appear until
    middle age or later
  • Duchenne is the most common form of MD affecting
    children
  • Myotonic MD is the most common form affecting
    adults

111
Etiology
  • Unknown
  • Inherited

112
Diagnosis
  • Enlargement of certain muscles
  • Progressive weakness of muscles
  • Lordosis (forward/inward curvature of the spine
    with abdominal protuberance)
  • Gait waddling
  • Progressive muscle wasting

113
Dental/Oral Manifestations
  • Facial musculature may be affected
  • Gaping lips
  • Eyes difficult to close completely (protective
    eye wear during treatment)

114
Spinal Cord Injury
  • Impairment of the spinal cord function resulting
    from the application of external traumatic force
  • The effect is partial or complete paralysis to a
    degree related to spinal cord level and extent of
    injury

115
Incidence
  • 32 injuries per million population
  • 7,800 injuries in the US each year
  • 250,000 - 400,000 living with SCI
  • 82 male vs. 18 female
  • Avg. age at injury - 33.4
  • Most frequent age of injury - 19

116
Etiology
  • Motor vehicle accidents (44)
  • Acts of violence (24)
  • Falls (22)
  • Sports (8) (2/3 from diving)
  • Other (2)

117
Classification
  • Dependent on level of spinal cord injury

118
Levels of the Spinal Cord
Figure from National Spinal Cord Injury
Association.
119
Levels of the Spinal Cord
Figure from sci resource center
120
Dental/Oral Considerations
  • Adaptive techniques if hands are affected
  • Wheelchair considerations
  • Oral hygiene instructions to caregivers

121
Spina Bifida
  • A neural tube defect in which the spine fails to
    close properly during the first month of
    pregnancy
  • In severe cases, the spinal cord protrudes
    through the back and may be covered by skin or a
    thin membrane

122
3 Types of Spina Bifida
123
3 Types of Spina Bifida
                                         
124
Incidence
  • 1 out of every 1,000 newborns in the US
  • Women who have a child with spina bifida, who
    have spina bifida themselves or have already had
    a pregnancy effected by any neural tube defect,
    are at higher risk

125
Etiology
  • Unknown

126
Diagnosis
  • Ultrasound
  • Amniocentesis

127
Physical Characteristics
  • Bony deformities
  • Hydrocephalus
  • Loss of sensation
  • Bladder and bowel paralysis
  • Paralysis below the lesion

128
Oral/Dental Considerations
  • No specific oral manifestations
  • 18 73 of children and adolescents with spina
    bifida are sensitive to latex
  • If a shunt is present (hydrocephaly), antibiotic
    coverage will be necessary (AHA guidelines)

129
Visual Impairment
  • Limitations of sight include the following
  • Partially sighted
  • Low vision
  • Legally blind
  • Totally blind

130
Incidence
  • 12.2 per 1,000 under the age of 18
  • Severe visual impairments (legally or totally
    blind) occur at a rate of .06 per 1,000
  • 10 million persons in the U.S. (American
    Federation for the Blind)

131
Etiology
  • Pre-natal influences
  • Glaucoma
  • Diabetic retinopathy
  • Cataracts
  • Macular degeneration

132
Dental management
  • Move equipment out of clients path
  • Guide to chair
  • Notify if leaving room and re-entering
  • Describe each step/procedure during appointment
  • Demonstrate OHI in clients mouth
  • Inform before perform
  • Turning on suction, turning on sound

133
Resources
  • American Federation for the Blind
  • http//www.afb.org
  • Blind Walk Simulation
  • students are blindfolded and guided by
    classmates/faculty both inside and outside.
    Dependence on others, even classmates, is
    difficult. Likewise, giving unlimited trust is
    very challenging. The message for dentistry is
    that we place people in dependent/trust
    situations all the time and expect them to trust
    us, even when they have just met us. What is
    most interesting is that we are successful as
    often as we are.

134
Adjuncts to Treatment
  • Patient positioning devices
  • Bite blocks
  • Mouth props

135
Vac-Pac
  • Vacuum activated positioning aid
  • (Olympic Medical, Seattle, WA)

136
Vac-Pac Hoses
137
Vac-Pac
138
Vac-Pac
139
Vac-Pac
140
Vac-Pac
141
Mouth Props
142
Mouth Props
  • Be sure the mouth prop is resting on teeth distal
    to the canine
  • Once in place, it must be stabilized to prevent
    dislodging

143
Bite Blocks
144
Bite Block with Saliva Ejector
145
Disposable Bite Block
146
Wheelchair Transfer
147
Wheelchair Transfers
  • Unassisted
  • One person transfer
  • Two person transfer

148
Components of a Wheelchair
149
Armrest
  • Can be removed for transfer

150
Foot Pedal
  • Remove or move away prior to transfer

151
Brakes
  • Always engage the brake prior to transfer

152
Unassisted Transfer
  • Unassisted transfers are a patient-directed
    process
  • Ask the patient how you can best assist
  • There will be individual variation in transfer
    technique

153
Unassisted Transfer
  • Block wheels to prevent pivoting of chair as
    person is making transfer

154
Unassisted Transfer
  • Raise arm of dental chair

155
Unassisted Transfer
  • Raise dental chair to approximately the level of
    the wheel

156
One Person Transfer
  • Position your feet outside of the patients feet
    for balance and stability

157
One Person Transfer
  • Block the knees of the patient with your knees
  • Coordinate lift with patient
  • There will be individual variation in transfer
    technique

158
One Person Transfer
  • Position patient for comfort in the dental chair

159
Two Person Transfer
  • Place wheelchair next to dental chair which
    should be positioned at the same height as the
    wheel of the wheelchair

160
Two Person Transfer
  • Gently grasp left wrist with left hand right
    wrist with right hand to stabilize shoulders

161
Two Person Transfer
  • Position hands above the knees
  • Lift with legs, not arms or back

162
Two Person Transfer
  • Coordinate lift verbally e.g. 1,2,3 or ready,
    set, go

163
Two Person Transfer
  • To return patient to wheelchair, you may need to
    lean them forward in the dental chair for proper
    lift position

164
Communication
  • Video The Ten Commandments of Communication
    with People with Disabilities (25 min)
  • Training that uses humorous vignettes to deliver
    its disability awareness message.
  • Program Development Associates
  • 1-800-543-2119

165
Disability Awareness
  • Video Look Whos Laughing (60 min)
  • A funny and compelling documentary about the
    lives, experiences and humor of six working
    comedians who have various types of disabilities.
  • Video Without Pity A Film about Abilities
    (56 min)
  • A documentary celebrating the efforts of people
    with disabilities who live full productive lives.
  • Program Development Associates
  • 1-800-543-2119

166
Disability Awareness (cont)
  • Video Finding a Way (28 min)
  • The history of disabilities is discussed
    including portrayals of institutions and insane
    asylums. It shows how much progress has been
    made, but how much further there is to go toward
    equality for all.
  • Video A Video Guide to (Dis)Ability Awareness
    (26 min)
  • An orientation to the human side of the Americans
    with Disabilities Act.
  • Program Development Associates
  • 1-800-543-2119

167
Additional Web Resources
168
Additional Web Resources
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