Self-Assessment Quiz Question #4 Developmental disabilities can be grouped according to various classification systems, all of which can have genetic components, including: a. Musculoskeletal. b. Neurological.
c. Neuromuscular. d. All of the above. Intellectual disabilities
A diminished capacity of intellectual functioning—what used to be called mental retardation —is defined by a general decrease in the ability to learn, problem-solve, and reason. Although the etiology of an intellectual disability is typically unknown, these disabilities are believed to result from any number of environmental, toxic, traumatic, metabolic, or genetic conditions. Patients with intellectual disabilities tend to have many extreme medical, behavioral, psychosocial, and economic challenges. There are four subcategories of intellectual disabilities based on the Stanford-Benet Intelligence Quotient test. (See Table 6.) Patients who are tested educable can master a number of subjects. Trainable patients can develop skills that are repetitive and repeatable. Patients who are severe or profoundly disabled require constant care. Dental treatment implications As a result of this patient population’s reliance on caregivers, patients with intellectual disabilities have a higher incidence of dental caries and periodontal disease. One type of syndrome that falls under the intellectual disabilities category is Down syndrome, or trisomy 21. This patient population may present with one or more pathognomonic (characteristic) conditions of concern to the oral health provider. Hypodontia, microdontia, and anterior open bite are commonly encountered. Patients with Down syndrome tend to have attenuated leukocyte chemotaxis (impaired leukocyte function), which can predispose the patient to periodontal disease. Of interest is the finding of saliva that has an alkaline pH, which can reduce the risk for developing caries. However, this must be balanced with risk factors such as dietary habits and oral hygiene practices. Patients with Down syndrome have a higher than average risk of cardiac abnormalities, which the provider should thoroughly Seizure disorder The symptoms of seizure disorder were described by the Assyrians and Babylonians more than 3,000 years ago. In ancient Greece, Hippocrates recognized that the symptoms were caused by a brain disorder, not by supernatural agency. In 1873, British physician John Hughlings Jackson described the symptoms as resulting from a brief electrochemical discharge in a localized area of the brain (Bobelmann, 2021). Epilepsy, now called seizure disorder , is defined as a spontaneous, synchronous, inappropriate, and excessive electrical discharge of cerebral neurons. This confluence of activity results in alterations in consciousness levels, sensory phenomena, behavioral abnormalities, and mental impairment, and it is typified by convulsive movements. Seizure disorder is one of the most commonly diagnosed neurological disorders in the U.S. today. Affecting 1.2% of the U.S. population, there are roughly 3 million adults and almost 500,000 children up to age 17 that have active seizure disorder (CDC, 2020). Among children ages 3 months to 6 years, up to 4% in this age group may have febrile seizures associated with a high fever (Xixis et al., 2022). An isolated seizure does not indicate the presence
Table 6: Intellectual Disabilities Level
IQ Range
Mild/educable
50–55 to approximately 70
Moderate/trainable
35–40 to 50–55
Severe
20–25 to 35–40
Profound Below 20–25 Note . Adapted from Saad, M., Mourad, A. E., & ElAdl, A. M. (2019). Defining and determining intellectual disability (Intellectual Developmental Disorder): Insights from DSM-5. International Journal of Psycho-Educational Science, 8(1), 51-4. investigate prior to treatment. Perhaps the finding of most concern is the high potential for atlantoaxial instability (increased flexibility between the first and second bones of the neck; Bull, 2020). This flaccidity of the ligament that attaches to the first two cervical vertebrae may predispose the patient to spinal cord trauma if precautions are not taken in properly stabilizing the head during forceful procedures such as dental extractions. Additionally, care must be taken with the young, pre-cooperative child in the knee-to-knee position to avoid atlantoaxial instability. For the patient population with intellectual disabilities, it is important to determine communication ability, social skills, responsiveness, and emotional development. By matching patient abilities with the level of care delivered, such as performing small procedures in less time, a stress-free dental experience can be achieved (Alamri, 2020). of seizure disorder. Patients must have at least two seizures before a diagnosis of seizure disorder or epilepsy can be made (Patel & Moshe, 2020). There are various types of seizures, including: ● Partial. ● Simple partial. ● Complex partial. ● Secondary generalized. ● Generalized. There are many classifications and subclassifications within the general diagnosis of seizure disorder, but the most prevalent type will be discussed here. The majority of people diagnosed as having a seizure disorder present with partial seizures, which can sometimes result in tonic-clonic movements typical of what is called a grand mal seizure (Barrow Neurological Center, n.d.). Patients usually describe a visual, auditory, or olfactory aura or warning sign that is part of the disorder’s prodromal symptoms. There are several phases to a grand mal seizure. After the prodromal symptoms , the tonic phase lasts about 15 seconds, during which time the patient’s body stiffens. Breathing may cease, the heart becomes tachycardic (beats
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