Chapter 51: The Patient with a Disability

Key Objectives

• Understand how disabilities can affect daily activities and oral health care.
• Learn guidelines for modifying dental hygiene care for patients with disabilities.

Preparation for Study and Tests

• Review learning objectives before studying each chapter.
• Pay attention to boxed information in chapters; useful for making note cards.

Disabilities Overview

• Statistics:
  • 10.5% of people aged 17-64 have disabilities.
  • 5.4% of children aged 5-7 have disabilities.
  • 35.4% of people aged 65 and older have disabilities.
• Medical Advances:
  • Increased survival for those born with or acquiring disabilities.
  • Longer lifespans increase likelihood of disability.

Americans with Disabilities Act (ADA)

• Enacted in 1990 to prohibit discrimination.
• Ensures equal opportunities in employment, goods, services, and participation in government programs.
• Definition: Physical or mental impairment substantially limiting major life activities.

Definitions and Classifications

• Disability is an umbrella term for impairments, activity limitations, and participation restrictions.
• Impairments: Problems with body structure or function.
• Disabling Conditions: Developmental, communicative, medical, musculoskeletal, neurologic, or sensory.
• Barriers to Dental Care: Related to patients, caregivers, and dental professionals.

Trends in Community-Based Delivery Services

• Availability of barrier-free or assisted living housing.
• New healthcare delivery models providing access to dental services in various settings.
• Expansion of dental hygienists’ roles in providing preventive services.

Barrier-Free Environment

• External Features:
  • Reserved parking near building entrance (13 ft wide).
  • Curb ramps and walkways (3 ft wide, solid, non-slip).
• Entrances: At least one must be ground-level, accessible by gentle ramps with handrails.
• Internal Features: Doorways must be at least 32 inches wide.

Risk Assessments

• Oral Manifestations:
  • Increased risk for issues like enamel defects, dry gingiva, and facial asymmetry.
• Functional Ability:
  • Assess ability to perform daily living skills (bathing, toothbrushing, dressing).

Oral Disease Prevention and Control

• Regular exams based on patient’s oral disease risk.
• Motivation for patient and caregiver in maintaining oral health.
• Use of aids for brushing and flossing depending on patient’s grasp or mobility limitations.

Patient Management

• Communication: Essential with patient and caregivers.
• Appointment Scheduling: Flexible to accommodate patient comfort and clinician’s physical health.
• Wheelchair Transfer Techniques:
  • Mobile and immobile patient transfer methods.
  • Use of sliding board for patients with limited mobility.

Instructions for Caregivers

• Teach caregivers proper oral care techniques and motivate them for self-care routines.
• Use visuals and examples for care of children and individuals with disabilities.

Final Notes

• Documentation: Record patient conditions affecting care and successful management strategies.
• Factors to Teach Patients: Regular exams, knowledge of medications, and healthy lifestyle practices.