Behavioral Management Technique For Patient With Special Needs

Behavioral Management Technique For Patient

With Special Needs

Done by: Abrar , Ala’a , GhadeerSahab , Shahad , Nada

Outline Introduction and definition Classification Tips in dealing with special

need Physical disabilities autism Epilepsy Down syndrome Conclusion Refrences

Introduction The changing

demographics of our population along with advanced in social and medical systems have resulted in the number of people with special need who need oral health treatment rising dramatically

Definition People with special needs refers to

those individuals who have barriers to achieving good oral health primarily because of a disability or medical condition

Classification of patient with special needs

Elderly disabilities

Medical

Physical

Psychological

Mental

Aging and elderly people

The ageing process is of course a biological reality which has its own dynamic, largely beyond human control

These individuals may need more frequent dental visits to monitor tooth wear, pain and the effects of medications that they cannot detect themselves

Medical needsThose individuals, typically living

in the community outside of a medical setting or environment, who need support to maintain an adequate level of health

People with cardiovascular disease, diabetes, Dentists will likely need to collaborate with their physicians.

Individuals with mobility issues

Patients with mobility issues may need assistance in and out of the dental chair, as well as to and from the dental office.

behavioral or emotional condition

• Children with autism, for example, are averse to changes of any kind. children who need medication for ADHD may need to be given their medications at such a time that they are able to sit through a dental appointment

MENTAL ILLNESS An individual with a

mental illness may have difficulty following proper dental hygiene regimens, obtaining dental care and countering the effects of medications that affect oral health

Getting what we want

• We all learn to behave in certain ways in order to get what we want or to avoid things we don’t. people with special needs may exhibit behavior that we find ‘challenging’ or ‘difficult.’

Important Tips For Working With A

Special Needs

1. Interact The biggest mistake that adults

make is failing to interact.  

First, introduce yourself and explain how you are connected to the child.

Depending on the child’s special needs, it may be

necessary to take the child’s hand, place a hand on the child’s

shoulder

Then explain the activity that you will be doing

with the child.

Important tips for working with A special needs

2. Observe• Some children with special needs

perceive sensory input in different ways and may be unable to verbalize discomfort.   

Remember!! That all behavior is

communication   .

Important Tips For Working With A Special Needs

3. Use Common Sense All of these problems could

have been avoided easily with common sense: put safety first and arrange the environment for physical and emotional comfort.

Important Tips For Working With A Special Needs

4. Be FlexibleSome adults say that they will not

change the way they do things to accommodate one person in a group.  But the whole point of teaching is to use a variety of methods to help another person understand and master new skills.  

Important Tips For Working With A Special Needs

5. Be Consistent• If a set of rules is presented to the

group, apply those rules consistently to everyone.

Important Tips For Working With A Special Needs

6. Use visual, auditory or tactile cues

• Having the right cues in an environment can mean the difference between participation and non-participation for many children with special needs.  

• Tactile cues such as gently touching a person’s shoulder, offering a blanket or other soft fabric,  

Important Tips For Working With A Special Needs

7-Have a plan.  And a back-up plan.• You know what they say about the

best-laid plans.  In the world of special needs, there is always a Plan B, and usually a Plan C.

•  Make sure that there is space to calm down and move freely if things go badly.  

Important Tips For Working With A Special Needs

8. Be PositiveA positive attitude is the

single most important quality for anyone who works with children with special needs.  

Important Tips For Working With A Special Needs

Physical Disabilities“ Blindness , Deafness ”

Physical Disabilities“ Blindness , Deafness ”

1) Always treat blind people as just another person as they simply do things differently.

2 ) Identify yourself and others who may be with you when meeting someone who is blind. 

BLINDNESS PEOPLE

3 ) If you offer assistance, wait until the offer is accepted

4 ) Do not clap, or repeat when attempting to guide a blind person

5 ) Do not do for them what they can do for themselves such as serving themselves, finding things, getting things, carrying things etc. The last thing anyone needs is enablement for disablement.

6 ) Do not shout; just speak in a normal tone of voice as usual. Remember: they are blind, not deaf

7 ) Relax. Don’t be embarrassed if you use common expressions such as “See you later” or “Did you hear about this?” that seems to relate to a person who is blind. Just as a person who uses a wheelchair still goes for a walk.

Deaf Patient

1 ) the patient how he prefers to communicate and whether he needs any special accommodations.

some deaf patients communicate by speaking and speechreading, or lip reading. others use sign language. some patients that do not speak or speechread will bring someone with them to interpret, while others prefer to communicate by writing notes.

still others will request an interpreter.!

3 ) Speak directly to the patient, even if he communicates with the assistance of an interpreter . 4 ) Ask questions if you aren't sure you understand what the patient is trying to communicate to you or if you aren't sure he understands what you are trying to communicate

2) Arrange for an interpreter if necessary.

Autism

• Is A Type Of Neurodevelopmental Disorder, And Usually Appears Within The First Three Years Of A Child’s Life.

• The Hallmark Of Autism Is The Lack Of Communication Skills.

• Affected Children Also Have Problems With Language, Behavior, And Social Skills.

Autism

Autism affects three different developmental

areas

Language

There are communication delays, not just

language delays

Social Skills

Lack of interaction with

others. Kids with autism

don’t have the same kind of socialization

skills

Behavior

There is often a display of repetitive

behaviors, such as turning in

circles or flapping their

hands

Autism

• Autism is a lifelong condition, and its cause is unknown. Environmental and genetic factors do contribute to the development of autism, but most children with autism have normal physical health.

Autism

WHAT IS AUTISM ?!..• It's defined behaviorally as a syndrome

consisting of abnormal development of social skills, limitations in the use of interactive language, and sensory motor defects.

• Incidence : 7 per 10,000 Common in male

Autism

CAUSES OF AUTISM• The exact cause of autism is

unknown, although it may be linked to brain injury and genetics. There are many biologic causes, but none of them are unique to autism.

Autism

SIGNS AND SYMPTOMS OF

AUTISMEARLY SYMPTOMS

A baby who doesn’t babble or gesture by the age of 12 months.

A baby who lacks eye contact with its mother by the age of 12 months.

A baby who resists being held or cuddled by its mother.

A baby who doesn’t respond when its mother says its name.

A baby who appears to be deaf.

An infant who doesn’t say single words by the age of 16 months.

INDICATIONS FOR FORMAL

DEVELOPMENTAL EVALUATION • No babbling, pointing, or other

gestures by age 12 months. • No single words by 16 months of age. • No two-word spontaneous phrases by

24 months of age. • Loss of previously learned language

or social skills at any age

BEHAVIORAL PROBLEMS IN

AUTISNM • Impairment of social skills. • Echolalia. • Sensorimotor deficiencies. • Limited interactive language

skills. • Seizure disorders. • Mental retardation. • Stereotypic behavior. • Self-injurious behavior. • Problems with symbolic

thinking.

Behavioral Tips For Dentists : • Take a tour of the office prior to the first

appointment to familiarize the patient with the environment

• Make the first appointment short and positive.

• Autistic children are hypersensitive to loud noises, sudden movement. So Approach the autistic child in a quiet, non-threatening manner. Don’t crowd the child.

• · Use a “tell-show-do” approach to providing care. Explain the procedure before it occurs. Show the instruments that you will use.

• · Invite the child to sit alone in the dental chair to become familiar with the treatment setting

• · Autistics will want to know what’s going to happen next. Explain what you’re doing so it makes sense to them. Explain every treatment before it happens.

Behavioral Tips For Dentists :

• Talk in direct, short phrases. Talk calmly. Autistics take everything literally – so watch what you say. Avoid words or phrases with double meanings.

• Once the dental patient is seated, begin a cursory examination using only your fingers. Keep the light out of the eyes.

• Next, use a toothbrush, or possibly a dental mirror to gain access to the mouth.

• Praise and reinforce good behavior. Ignore poor behavior.

Behavioral Tips For Dentists :

• Invite the parent of caregiver to hold the child’s hand during the dental examination.

• They can be calmed by using moderate pressure as opposed to a “light” touch.

• Some children will need sedation or general anesthesia so

Behavioral Tips For Dentists :

EpilepsyIs a brain disorder

characterized by excessive neuronal discharge that can produce seizures

Manifestations Of Epilepsy

• Confusion• Electric Shock

Feeling• Loss of

consciousness. • Out of body

experience • Falling down• Inability to move• Incontinence • Fear/Panic• Depression and

sadness

• Breathing difficulty •Drooling•Making sounds•Shaking•Staring•Sweating•Teeth clenching/grinding•Tongue biting•Heart racing

Oral Manifestations Of Epilepsy

Increased risk for dental caries Increased risk for oral trauma Medication-induced gingival

hyperplasia, bleeding gums, and delayed healing

:Behavior Management Of Epilepsy

Take historyEnsure medication has been taken as prescribed before treatment to reduce risk of seizure. Schedule appointment during time of day when seizures are less likely to occur. Children with severe, uncontrolled epilepsy may require general anesthesia for restorative and surgical needs.

:Behavior Management Of Epilepsy

Minimize seizure triggers. Reduce stress and anxiety . Keep bright light out of child’s eyes or allow child to wear dark glasses. Position the patient in as

upright a position as possible Use low amounts of water and

high volume suction to minimize aspiration.

SEIZURE MANAGEMENT DURING TREATMENT

Remove all dental instruments from the mouth.

clear the area around the dental chair.

Monitor airway to reduce risk of aspiration.

Note time seizure begins: if seizure continues >3 min call EMS

Down syndrome• is a genetic condition in which a

person has 47 chromosomes instead of the usual 46 and is the most common birth defect also called Trisomy 21, is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically.

•  

• The physical and medical of Down syndrome can vary widely

from child to child. While some kids with DS need a lot of medical

attention, others • lead healthy lives.

Down syndrome

Some Oral And Dental Health Concerns Are Periodontal

DiseaseDelayed Eruption Of Primary

And Permanent TeethIncreased Risk Of Dental Caries

Tooth Anomalies Including Missing Teeth And Irregularities

In Tooth Formation

Down syndrome

 Behavioral

Management in Patients with Down

Syndrome1-First discuss the child's communicative and intellectual abilities with the parent.

2-find out what time of day would be best to schedule the dental appointment;

3-Make sure the entire dental team has been educated concerning the proper attitude and treatment of patients with special needs.

4-Praise, praise, praise!

 Behavioral

Management in Patients with Down

Syndrome

5-Attempt to reduce distractions as much as possible.

6-Try beginning the oral examination by using only your gloved fingers, then progress to the use of dental instruments.

 Behavioral

Management in Patients with Down

Syndrome

• 8- Modeling dental treatment on an older sibling, or another cooperative child may prove useful for some children.

7-Remember that children with Down syndrome may experience difficulty processing sequential information.

 Behavioral

Management in Patients with Down

Syndrome

ConclusionPeople with special need have

the most dental disease and the least access to

treatment services..

Working with children with special needs will teach you

very important lessons in life..

Refrences • Behavioral dentistry edited by D.I Mostofsky,

A.G. Forgione, and D.b. Giddon• Tan, H., Gurbuz, T., Dagsuyu, IM. (2004)

Gingival enlargement in children treated with antiepileptics. J Child Neurol, 19(12): 958-63.

• Stoopler, ET, Sollecito, TP., Greenberg, MS. (2003) Seizure disorders: update of medical and dental considerations .

• www.dentalresource.org• www.brightsidedental.com