case study

Hi. My name's Autumn Slash and are representing this case

study, which will briefly look at the road to improve

dental outcomes for a pediatric patient through evidence based behavioural

management and preventative advice.

A quick overview of our patient.

His name's Andy is 14 years old.

He's got traumatised upper right one.

He's got autism and poor oral health with Kerry's present

in all quadrants.

His social history involves being in a regular attendee at

the dentist, and he's in temporary foster care.

So Andy fits the British Society of Pediatric Dentistry definition

on dental neglect.

He also fits the description that they put forward, which

describes the most vulnerable Children to not attend appointments.

So the Barts Health Special Care Community Dental Service recommended

in their audit reviewing missed appointments by Children to key

areas, which, which could be improved it.

It suggested that there should be an increased engagement with

parents and that dentists should use this opportunity to really

understand a carers perceptions, willingness or maybe the lack of

However, the B S P D do want dentists not

to instantly assume that just because a child has dental

neglect or doesn't show up to their appointments that they

are being abused, and the dentist should be empathetic with

the carers and try and identify barriers and overcome them.

And with regards to Andy's case, I think the dentist

should be cautious that he has had to trauma incidents

to his front teeth in the past six months and

just notice.

Just be aware and vigilant with regard to any other

signs of trauma on the patient's face body and in

their demeanor as well.

And diesel diet and lifestyles Quite poor.

He's got a limited high sugar diet.

Any smokes around 10 a day, which is quite alarming

for his age.

And as we know, the consequences of these factors are

bad breath, gum disease and an increased risk of oral

cancer. With regards to a smoking and the behavioral management

of this, the BMJ released a paper which did highlight

that there is an increased prevalence of teen smokers in

recent years and that there's a low probability that they

will stop on their own without formal intervention.

A study by Brown showed that there's a positive effect

of motivational interviews for smoking cessation in adolescents with psychiatric

disorders. So and this treatment plan consisted of prevention, appointments

and other appointments to deal with these other dental issues.

During the prevention clinic, there are three key areas which

are dentists must visit.

So he dentist must assess the education, the family health

or the social issues around the patient and the carers,

and also understand that individuals have differing life priorities and

understand what they are with regards to Andy's carer and

make them aware that then dental health is very important

to a child's overall well being and that a child

has complex and that the carer might have child complex

childcare arrangements, as Andy does have five younger siblings also

defining needs and tailoring preventative care and treatment to the

situation as it is at present.

And also consider contacting all the professionals, such as the

social worker or support worker, to support the carer and

Andy encourage them to meet their dental appointments.

Specific carries prevention could involve personalized oral health promotion advice,

and this can be hands on brushing instructions for Andy

to help him visualize and understand what's required of him

When brushing a prescription for a 2800 ppm, fluoride toothpaste

can be given a detailed diet advice with specific suggestions,

Um, such as alternative snacks and alternative meals and when

they should have them officious ceiling and a floor I

varnish can also be applied.

So some special considerations with regards to Andy's case is

that he's got autism and there might be a lack

of understanding.

And there might not be, um, you'd have to assess

whether he was a high funk, whether he was high

functioning or low functioning, and he might most probably have

sensory issues as well.

He's a young teenager, and therefore he'll have a desire

to be more in control and independent, which could involve

him telling the dentist when to stop and start drawing

procedures. Also, he's got poor oral health in general due

to his infrequent brushing poor diet and smoking.

So use images and photographs to to aid understanding of

the procedures and also allow the patient to hold objects

to distract them.

Drawing treatment can really benefit compliance.

Also, sound canceling earmuffs have been used in autistic patients

before to block out loud drilling and avoid, um, sort

of an anxiety trigger in the patient.

So here we have a route map of health behavior

change using motivational interviewing, and this can really aid overcoming

bad behaviors such as smoking and poor diet.

And then this involves using sores to gain empathy with

the patient and really illicit change talk.

Then there can be an educational intervention and improving knowledge

and skills, and then an action plan with a set

time, date and place to start and also encouraging habit

formation and repeat all of this at every recall visit.

Thank you for listening to my presentation.

Here are my references.

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