NEURODEVELOPMENTAL, INTELLECTUAL & PHYSICAL DISABILITIES IN THE DENTAL PATIENT (NDID)

5 Essential Concepts: first

Anatomical/ physiological dysfunction results in a neurodevelopmental disorder

5 Essential Concepts: Second essential concept

Neurological, intellectual and physical disabilities can be traced back to the
neurodevelopmental disorder

5 Essential Concepts: Third essential concept

Each neurodevelopmental disorder is associated with multiple primary complications.

Cognitive impairment ( Mental retardation)

Sensory impairment (Deafness/ Blindness)

5 Essential Concepts: Fourth essential concept

Each primary complication of the neurodevelopmental disorder is associated with secondary effects on health

Tooth decay and oral disease may be due to patient’s inability to maintain hand dexterity and coordination

5 Essential Concepts: Fifth essential concept

Neurodevelopmental disorders may have an association with predictable primary conditions

Macroglossia and micrognathia in Down syndrome

Down Syndrome

Trisomy 21 is a chromosomal defect caused by the presence of a 21st Chromosome

It is named after John Langdon Down 1866

Incidence is estimated at 1 per 733 births

Statistically more common with older parents due to increased mutagenic exposures of reproductive cells as age increases

Occurs in all human population

Can be detected intrauterine with CVS (chorionic villous sampling) and
amniocentesis

Down Syndrome: Physical signs

Microgenia (Abnormally small chin)

Oblique eye fissures

Hypotonia of muscles

Flat facies

Flat nasal bridge

Single palmer fold

Protruding tongue

Macroglossia

Short neck

Short stature

Bowed legs

Down: Mental Features

Intellectual disability (IQ- Mild: 50-70/ Mod: 35- 50)

Behaviour: ‘Affectionate, playful, imitative, shy’

Learning disability

Physical delay (walking) → bowing of the legs

Delayed cognitive functions

Speech delay

Fine motor skills are delayed

Vision impairment

Hearing impairment

Down: Co-morbidities

Congenital heart conditions (AV septal defect)

Malignancies: Leukemia (ALL)

Hypothyroidism (Congenital absence) (cretinism if it is in a baby)

Gastrointestinal disease (Hirschsprung’s Ds.)

Infertility/ Miscarriage/ Difficult labor

Epileptic convulsions

Vision disorders : Glaucoma

Diseases of aging and dementia

Teeth and Oral cavity

Susceptible to gingivitis, severe periodontal disease necrotizing ulcerative gingivitis and early tooth loss

Research suggests that the severity is likely a result of a weakened immune system.

Increased incidence of Candida albicans in the mouth

Higher rates of tooth wear and bruxism

Enlarged hypotonic tongue, crusted and hypotonic lips, mouth breathing, narrow palate with crowded teeth.

Oral cavity

Class III malocclusion with an underdeveloped maxilla and posterior crossbite

Delayed exfoliation of baby teeth and delayed eruption of adult teeth

Shorter roots on teeth, and often missing and malformed (usually smaller) teeth

Less common manifestations include cleft lip and palate and enamel hypocalcification (20% prevalence)

Macroglossia is defined as__________?
A. Large skull
B. Small chin
C. Large mandible
D. Large tongue

D. Large tongue

Autism, or autism spectrum disorder (ASD)

refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication

CDC: 1 in 54 children in the US are affected by ASD

Subtypes: combination of genetic and environmental factors

ASD may require significant support in their daily lives, while others may need less or live independently.

Often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression and attention issues

Autism Spectrum Disorder

Signs of autism usually appear by age 2 or 3 yrs.

Associated development delays can appear even earlier, and often, it can be diagnosed as early as 18 months

Early intervention leads to positive outcomes later in life

American Psychiatric Association merged four distinct autism diagnoses into one umbrella diagnosis of autism spectrum disorder (ASD)

1. Autistic disorder

2. Childhood disintegrative disorder

3. Pervasive developmental disorder-not otherwise specified (PDD-NOS)

4. Asperger syndrome