1 of the lectures from Special Needs Dentistry Course - Common Medical Problems in Special Needs People

1. Dr Zarina Baharin
Pakar Perubatan Keluarga KK Bota Kiri
7 th Mac 2012

2. SPECIAL NEEDS PEOPLE: OKU
 Definisi OKU Mengikut Akta Orang
Kurang Upaya 2008:-
 'Orang Kurang Upaya' termasuklah mereka
yang mempunyai kekurangan jangka panjang
fizikal, mental, intelektual, atau deria yang
apabila berinteraksi dengan pelbagai
halangan, boleh menyekat penyertaan penuh
dan berkesan mereka dalam masyarakat.

3. Klasifikasi
 Kurang upaya fizikal
 Masalah pembelajaran
 Kurang upaya pendengaran
 Kurang upaya penglihatan
 Kurang upaya pertuturan
 Kurang upaya mental
 Kurang upaya pelbagai

4. KURANG UPAYA FIZIKAL
Ketidakupayaan anggota badan samada
kehilangan atau tiada suatu anggota atau
ketidakupayaan di mana-mana bahagian badan
yang mengalami keadaan seperti hemiplegia,
paraplegia, tetraplegia, kehilangan anggota,
kelemahan otot-otot yang mengakibatkan
mereka tidak dapat melakukan aktiviti asas
seperti penjagaan diri, pergerakan dan
penukaran posisi tubuh badan. Keadaan ini boleh
terjadi akibat daripada kecederaan (trauma) atau
ketidakfungsian sistem saraf, kardiovaskular,
respiratori, hematologi, imunologi, urologi,
hepatobiliari, muskuloskeletal, ginekologi dan
lain-lain.

5. PENYEBAB
-Limb defects (congenital/acquired)
-Spinal cord injury
-Stroke
-Traumatic Brain Injury
-Kerdil (Achondroplasia)
-Cerebral Palsy

6. Cerebral palsy

7. Apakah Cerebral Palsy
 Cerebral-cerebrum
 Palsy-pergerakan
abnormal
 Ketidakupayaan fizikal
melibatkan pergerakan
badan
 Non progressive
 Non contagious

8. JENIS

9. PENYEBAB
 Sebelum Kelahiran
 Jangkitan dalam rahim
 ibu mengalami darah tinggi, kancing manis, kurang darah ketika
mengandung
 pendarahan teruk dan kronik ketika mengandung
 Semasa Proses Kelahiran
 Kelahiran tidak cukup bulan
 kecederaan semasa lahir
 lemas semasa lahir
 jangkitan semasa lahir
 Selepas Kelahiran (sebelum berumur 3 tahun)
 meningitis (jangkitan kuman diselaput otak) – demam kuning
 Jaundis yang teruk (kemicterus)
 Kecederaan otak disebabkan oleh kemalangan, penderaan dan
penganiayaan fizikal

11. Tanda-tanda
•Bayi kelihatan lembik
•lewat perkembangan
•menggunakan sebelah tangan (hand preference)
•masalah menyusu
•kerap menangis, meragam, merenggek, tanpa sebab
ataupun terlalu diam dan kurang tindak balas
rangsangan
•refleks primitive yang kekal
•sembelit
•cepat marah

12. rencatan akal (kurang kecerdasan)
kerencatan pertuturan
rencatan penglihatan
rencatan pendengaran
sawan (epilepsy)
kecacatan anggota
kecacatan gigi
masalah mengenai pernafasan
masalah mangenai pemakanan
masalah untuk buang air besar atau
kecil.

14. RAWATAN
 Physiotherapy
 Occupational therapy
 Speech therapy
 Drugs-antiepileptic,analgesics,muscle
relaxants
 Orthotic devices
 Braces
 Standing frame
 Biofeedback
 Surgery

15. Cerebral palsy-Masalah
dental
 PERIODONTAL DISEASE is common in
people with cerebral palsy due to poor oral
hygiene and complications of oral habits,
physical abilities, and malocclusion. Another
factor is the gingival hyperplasia caused by
medications.

16. MASALAH DENTAL
DENTAL CARRIES
 is prevalent among people with cerebral palsy, primarily because of
inadequate oral hygiene. Other risk factors include mouth breathing,
the effects of medication, enamel hypoplasia, and food pouching.
 Caution patients or their caregivers about medicines that reduce
saliva or contain sugar. Suggest that patients drink water often, take
sugar-free medicines when available, and rinse with water after
taking any medicine.
 For people who pouch food, talk to caregivers about inspecting the
mouth after each meal or dose of medicine. Remove food or
medicine from the mouth by rinsing with water, sweeping the
mouth with a finger wrapped in gauze, or using a disposable .

17. MASALAH DENTAL
 MALOCCLUSION in people with cerebral palsy usually involves more
than just misaligned teeth--it is also a musculoskeletal problem. An open bite with
protruding anterior teeth is common and is typically associated with tongue
thrusting. The inability to close the lips because of an open bite also contributes to
excessive drooling.
 DROOLING affects daily oral care as well as social interaction.
Hypotonia contributes to drooling, as does an open bite and the inability to
close the lips.
 BRUXISM is common in people with cerebral palsy, especially those with
severe forms of the disorder. Bruxism can be intense and persistent and
cause the teeth to wear prematurely. Before recommending mouth guards
or bite splints, consider that gagging or swallowing problems may make
them uncomfortable or unwearable.

18. Malocclusion Bruxism

19. Oral Trauma
Dental carries

20. Periondotal gum
disease Gingival overgrowth

21. ACHONDROPLASIA

22. Apakah Achondroplasia
 Ketidakabnormalan genetik
 Autosomal dominan
 Mutasi DNA sporadik (85%)
 Berkait dengan usia bapa advance->35 tahun
 Formasi kartilage tidak normal
 “short stature” : M (131 cm) F (123 cm)
 1: 25 000

25. ACHONDROPLASIA
 Penyebab: Perubahan DNA Faktor Pertumbuhan
Fibroblast Reseptor 3
 Diagnosis
-Prenatal Ultrasound:Discordance between femoral
length and biparietal diameter
Berlebihan amniotic fluid
-Survey skeletal (rangka)
-Large skull
-Broad hand with short metacarpals and phalanges
-small and squared iliac wings

26. SIMTOM
 Abnormal hand appearance with persistent space
between the long and ring fingers
 Bowed legs
 Decreased muscle tone
 Disproportionately large head-to-body size difference
 Prominent forehead (frontal bossing)
 Shortened arms and legs (especially the upper arm and
thigh)
 Short stature (significantly below the average height for
a person of the same age and sex)
 Spinal stenosis
 Spine curvatures called kyphosis and lordosis

27. DENTAL PROBLEM
 Dental problems caused by overcrowding of
teeth (especially those of the upper jaw) may
occur. Malocclusion (poor bite) often results
and makes good oral hygiene difficult. In
addition to ordinary dental care, orthodontic
treatment may be necessary.

29. Complications
 Clubbed feet
 Fluid buildup in the brain (hydrocephalus)
Treatment
Not known treatment currently

30. MASALAH PEMBELAJARAN
Masalah kecerdasan otak yang tidak selaras
dengan usia biogikal. Mereka yang tergolong
dalam kategori ini adalah lewat
perkembangan global, Sindrom Down,
lembap dan kurang upaya intelektual.
Kategori ini juga merangkumi keadaan yang
menjejaskan kemampuan pembelajaran
individu seperti Austisme (Autistic Spectrum
Disorder), Attention Deficit Hyperactivity
Disorder (ADHD) dan masalah pembelajaran
spesifik seperti Dyslexia, Dyscalculia dan
Dysgraphia.

31. DOWN SYNDROME
-Trisomi 21
-Tambahan satu kromosom 21
-Kerap pada ibubapa yang meningkat
usia kerana berlaku mutasi gen
-Perkembangan fizikal dan kognitif
terganggu
-Kecerdasan otak yang rendah: IQ-50

32. DOWN SYNDROME
Mother
20-24-1:1562
35-39: 1:214
>45: 1:19
However 80% <35 yrs
old
Paternal >42 yrs

33. KROMOSOM 44 XX/XY

34. TRISOMI 21 (45 XY/XX)

35. DIAGNOSIS-PRENATAL
AMNIOCENTESIS
CHORIONIC VILLOUS
SAMPLING
ULTRASOUND
PERCUTANEOUS
UMBILICALCORD
SAMPLING
BETA HCG
OESTRIOL
ALPHA FETOPROTEIN

36. SINDROM DOWN

37. DOWN SYNDROME

39. BRUSHFIELD EYES

40. Treatment
 screening for common problems, medical
treatment where indicated, a conducive
family environment, and vocational training
can improve the overall development of
children with Down syndrome. Education and
proper care will improve quality of life
significantly, despite genetic limitations.

41. MASALAH DENTAL-DOWN
SYNDROMEPERIODONTAL DISEASE is the most
significant oral health problem in people with
Down syndrome. Children experience rapid,
destructive periodontal disease.
Consequently, large numbers of them lose
their permanent anterior teeth in their early
teens. Contributing factors include poor oral
hygiene, malocclusion, bruxism, conical-
shaped tooth roots, and abnormal host
response because of a compromised immune
system.

42. MASALAH DENTAL DALAM DOWN
SYNDROME
Tooth anomalies are
variations in the number,
size and shape of teeth.
People with Down
syndrome, oral clefts,
ectodermal dysplasia or
other conditions may
experience congenitally
missing, extra or
malformed teeth.

43. TOOTH ANOMALIES
Congenitally missing teeth
Third molars, laterals, and mandibular second
bicuspids are the most common missing teeth.
Delayed eruption of teeth
Primary teeth may not appear until age 2, with
complete dentition delayed until age 4 or 5.
Primary teeth are then retained in some
children until they are 14 or 15.

44. TOOTH ANOMALIES
Irregularities in tooth formation, such as
microdontia and malformed teeth, are also
seen in people with Down syndrome. Crowns
tend to be smaller, and roots are often small
and conical, which can lead to tooth loss from
periodontal disease. Severe illness or
prolonged fevers can lead to hypoplasia and
hypocalcification.

45. MASALAH DENTAL-DOWN
MEDICAL CONDITIONS.
Some problems are manifested in the mouth.
For example, oral findings such as persistent
gingival lesions, prolonged wound healing, or
spontaneous gingival hemorrhaging may
suggest an underlying medical condition and
warrant consultation with the patient's
physician.

46. CARDIAC DISORDERS are common in Down
syndrome. In fact, mitral valve prolapse
occurs in more than half of all adults with this
developmental disability. Many others are at
risk of developing valve dysfunction that
leads to congestive heart failure, even if they
have no known cardiac disease. Consult the
patient's physician if having questions about
the medical history and the need for
antibiotic prophylaxis

47.  COMPROMISED IMMUNE SYSTEMS lead to more
frequent oral and systemic infections and a high incidence
of periodontal disease in people with Down syndrome.
Aphthous ulcers, oral Candida infections, and acute
necrotizing ulcerative gingivitis are common. Chronic
respiratory infections contribute to mouth breathing,
xerostomia, and fissured lips and tongue.
 Treat acute necrotizing ulcerative gingivitis and other
infections aggressively.
 Talk to patients and their caregivers about preventing oral
infections with regular dental appointments and daily oral
care.
 Stress the importance of using fluoride to prevent dental
caries associated with xerostomia.

48. DENTAL CARIES.
Children and young adults who have Down
syndrome have fewer caries than people without
this developmental disability. Several associated
oral conditions may contribute to this fact:
delayed eruption of primary and permanent
teeth; missing permanent teeth; and small-sized
teeth with wider spaces between them, which
make it easier to remove plaque. Additionally,
the diets of many children with Down syndrome
are closely supervised to prevent obesity; this
helps reduce consumption of cariogenic foods
and beverages.

49. AUTISMA

50. Apakah autisma ini?
Kanak-kanak autisma biasanya dilabelkan
Bodoh,degil, berkelakuan pelik,tercicir dlm
pelajaran
Buat perangai,tidak mengendahkan orang
lain,ulang perkara yg sama, melakukan perkara
yg boleh mencederakan diri

51. Apakah autisma?
Hidup dlm dunia tersendiri
Seolah-olah pekak
Tidak bertutur/bertutur dgn cara yang aneh
Jarang tersenyum
Tidak pernah meminta utk didukung

54. STATISTIK
2-6 kes setiap 1,000 orang
4:1-Lelaki:Perempuan
Lebih kerap dikalangan lelaki kulit putih
Di Malaysia: 1:500 kanak-kanak
Jumlah: 47,000 orang
Berlaku sebelum kanak-kanak berusia 3 thn

55. AUTISMA
Gangguan perkembangan otak
Kecacatan neurologi
Masalah dengan perhubungan
sosial,komunikasi dan emosi
Kurang kebolehan imaginasi dan
bermain
Tingkahlaku terhad dan berulang
Boleh dirawat tetapi tidak dpt
dipulihkan

56. APAKAH PENYEBAB AUTISMA?
Tidak pasti
Kedua-dua faktor genetik dan persekitaran
Beberapa kawasan otak yang tidak sekata
Tahap serotonin atau neurotransmiter lain di
otak
Gangguan pertumbuhan otak diawal
perkembangan fetal

57. FAKTOR KETURUNAN
Jika seorang kembar terlibat-90% kembar kedua
Seorang anak autisma-risiko anak kedua 5%
Ibu bapa dan saudara mara ada menunjukkan
gangguan didalam perhubungan sosial dan
komunikasi
Manic depression-lebih kerap didalam keluarga
autisma

58. Bolehkah Autisma sembuh?
 Tidak
 Pengesanan awal,rawatan dan pendidikan boleh
membantu mereka membesar dan belajar dgn baik
 Pengesanan awal sangat penting
 Ujian Saringan penting: eg: M-CHAT(Modified
Checklist Autism In Toddlers)-soalan berkenaan
perkembangan dan tingkah laku

59. PROGNOSIS
Ditentukan oleh kecerdasan otak (IQ) dan
penguasaan bahasa pada usia 5 thn.
Baik jika IQ >60 dan penguasaan bahasa baik
pada usia 5 thn
2/3 pesakit autisme-ketidakupayaan serius
semasa dewasa
5-17%:boleh bekerja dengan sokongan
Kebanyakan: perhubungan sosial abnormal

61. KOMPLIKASI
Peringkat awal kanak-kanak: Hiperaktif,panas
baran
Peringkat akhir kanak-kanak: Suka
menyerang,mencederakan diri sendiri
Peringkat remaja dan dewasa: Kemurungan dan
epilepsi

62. MASALAH DENTAL DLM AUTISME
 DAMAGING ORAL HABITS are common and
include bruxism; tongue thrusting; self-
injurious behavior such as picking at the
gingiva or biting the lips; and pica--eating
objects and substances such as gravel,
cigarette butts, or pens.

63. It is presumed that children with Autism have
a high threshold for pain, and what pain is
much worse than a toothache. It is not an
area that is easy to inspect and if the
Autistic child has no speech as 50% of them
do, then they may not have a way to tell you
and may be in some considerable amount of
pain for some time before you suspect
anything is wrong.

64.  DENTAL CARIES risk increases in patients
who have a preference for soft, sticky, or
sweet foods; damaging oral habits; and
difficulty brushing and flossing.
 PERIODONTAL DISEASE occurs in people with
autism in much the same way it does in
persons without developmental disabilities.
Some patients benefit from the daily use of
antimicrobial agent such as chlorhexidine.
Stress the importance of conscientious oral
hygiene and frequent prophylaxis.

65. Sometimes a visit before treatment is initiated is helpful
for the child with Autism to get them used to the setting.
Make sure that you are not stressed before or during the
visit as the Autistic child seems to pick this up from you
and will react accordingly.If you remain calm and positive
throughout the visit, they are also likely to be more
manageable.

66.  TOOTH ERUPTION may be delayed due to
phenytoin-induced gingival hyperplasia. Phenytoin is
commonly prescribed for people with autism.
 TRAUMA and INJURY to the mouth from falls or
accidents occur in people with seizure disorders.
Suggest a tooth saving kit for group homes. Emphasize
to caregivers that traumas require immediate
professional attention and explain the procedures to
follow if a permanent tooth is knocked out. Also,
instruct caregivers to locate any missing pieces of a
fractured tooth, and explain that radiographs of the
patient's chest may be necessary to determine whether
any fragments have been aspirated.

67. CLEFT LIP AND PALATE
Orofacial clefts are birth defects in which there is
an opening in the lip and/or palate (roof of the
mouth) that is caused by incomplete development
during early fetal formation.

68.  Cleft lip and cleft palate are treatable. Most
kids born with these can have surgery to
repair these defects within the first 12-18
months of life.
 Cleft lip-3-6 mths
 Cleft palate-6-9 mths

69. TYPES

70. CAUSES
 Part of syndrome
 Genetic
 Medication-anti epileptic
 Cigarette smoke
 Lack of certain medications-folate acid
deficiency

71. Associated problems
 Feeding difficulties
 Middle ear effusion
 Hearing loss
 Speech difficulties
 Dental abnormalities

72. DENTAL ABNORMALITIES
 Small teeth, missing teeth, extra teeth (called
supernumerary), or malpositioned teeth.
They may have a defect in the gums or
alveolar ridge (the bone that supports the
teeth). Defects of the alveolar ridge can
displace, tip, or rotate permanent teeth, or
prevent permanent teeth from coming in
properly.

73. TREATMENT
 geneticist
 pediatrician
 plastic surgeon
 ear, nose, and throat physician (otolaryngologist)
 oral surgeon
 orthodontist
 dentist
 speech-language pathologist
 audiologist
 nurse
 social worker
 psychologist
 team coordinator

74. KURANG UPAYA PENDENGARAN
 Tidak dapat mendengar dengan jelas di kedua-dua
telinga tanpa menggunakan alat bantuan pendengaran
atau tidak dapat mendengar langsung walaupun dengan
menggunakan alat bantuan pendengaran. Terdapat
empat (4) tahap yang bolh dikategorikan sebagai OKU
Pendengaran, iaitu:
 Minumum (Mild) - (15 - <30 dB) (Kanak-kanak)
- (20 - <30 dB) (Orang Dewasa)
 Sederhana (Moderate) - (30 - <60 dB)
 Teruk (Severe) - (60 - <90 dB)
 Sengat Teruk (Profound) - (>90 dB)

75. TAHAP KECACATAN
NORMAL - Mengesan bunyi
pada intensiti lebih daripada
25dB
RINGAN - Mula mengesan
bunyi antara 25dB hingga
40dB
SEDERHANA - Mula
mengesan antara 41dB hingga
70dB
TERUK - Mengesan pada
intensiti 71dB hingga 90dB
SANGAT TERUK - Mengesan
pada intensiti 90dB ke atas

76. Mekanisma pendengaran

77. 3 masalah kurang upaya
pendengaran
Masalah pendengaran konduktif berlaku apabila
terdapat masalah atau jangkitan pada telinga luar
dan telinga tengah
Contoh masalah dan jangkitan yang boleh
menyebabkan masalah pendengaran konduktif ialah
ketiadaan lubang telinga (atresia), cuping telinga
kecil atau tiada cuping telinga (mikrotia / anotia),
sumbatan tahi telinga di salur telinga, jangkitan
kuman pada salur telinga atau telinga tengah dan
gegendang telinga bocor/pecah

78. PEMERIKSAAN TELINGA

79.  Masalah pendengaran sensorineural pula berlaku
apabila terdapat masalah atau jangkitan pada
telinga dalam, tempat di mana koklea dan saraf
pendengaran berada
Masalah ini tidak dapat dilihat secara fizikal
(tiada rembesan nanah atau kecacatan fizikal)
tetapi hanya dapat dikenalpasti melalui
pemeriksaan pendengaran secara menyeluruh.
Masalah ini tidak dapat dirawat, tidak seperti
masalah pendengaran konduktif yang boleh
dirawat secara pengambilan ubat atau
pembedahan

80. Masalah pendengaran campuran pula berlaku
apabila terdapat kehadiran kedua-dua masalah
pendengaran serentak iaitu masalah
pendengaran konduktif dan sensorineural hadir
Contohnya, seseorang yang mempunyai
masalah pendengaran sensorineural juga
mempunyai mampatan tahi telinga
dikategorikan sebagai mempunyai masalah
pendengaran campuran. Apa jua masalah yang
berlaku di telinga luar/tengah beserta masalah di
telinga dalam disebut sebagai masalah
pendengaran campuran

81. KURANG UPAYA PENDENGARAN
CIRI-CIRI
 Meminta percakapan diulang berkali-kali
 Bercakap dengan nada suara yang lebih kuat daripada biasa
 Tidak memahami arahan yang diberikan atau silap memahami arahan
 Sukar memahami perbualan di tempat bising
 Terpaksa memalingkan kepala ke arah sumber bunyi dalam usaha untuk
memahami apa yang didengari
 Sukar memahami perbualan telefon
 Toleransi terhadap bunyi bising berkurang
 Suka memencilkan diri dari bergaul dan berbual
 Terdedah kepada bunyi yang sangat kuat
 Terlibat dalam kemalangan yang melibatkan kecederaan di bahagian
kepala dan leher.
 Terdapat ahli keluarga yang juga mempunyai masalah pendengaran
 Pengambilan ubat ototoksik (anti-histamin, anti-diuretik dll)
 Menghidap penyakit sistemik (kencing manis, hiperkolesterol, buah
pinggang dll)

82. PENYEBAB
 Sebelum Kelahiran
 Baka
 Pengambilan dadah, alkohol
 Toksemia
 Jangkitan penyakit
 Tidak diketahui
 Semasa Kelahiran
 Tidak cukup bulan
 Kelahiran yg terlalu lama
 Sawan
 Selepas Kelahiran
 Penyakit berjangkit
disebabkan bakteria dan
virus
 Kecederaan telinga
 Pengambilan ubat
berlebihan ototoksik
(streptomycin)
 Demam campak, beguk
 Jaundis
 Berat badan kurang dari
1500g
 Jangkitan kuman telinga
tengah
 Tidak diketahui

83. PENGURUSAN
Langkah awal perlulah diambil dalam mengatasi
masalah pendengaran terutama di kalangan kanak-
kanak. Ia boleh mendatangkan kesan buruk terhadap
perkembangan bahasa dan pertuturan kanak-kanak
tersebut. Ini seterusnya akan merencat
perkembangan sosial, komunikasi, psikologi dan
vokasional individu berkenaan. Masalah pendengaran
perlu dikesan sejak kecil (umur < 3 bulan) agar
pemasangan alat bantu dengar yang bersesuaian
serta program rawatan seterusnya dapat dilakukan.
Ini adalah bertujuan untuk mengurangkan kesan
masalah pendengaran yang dihadapi oleh kanak-
kanak berkenaan:

84.  HEARING LOSS and DEAFNESS can also be accommodated
with careful planning. Patients with a hearing problem may
appear to be stubborn because of their seeming lack of response
to a request.
 Patients may want to adjust their hearing aids or turn them off,
since the sound of some instruments may cause auditory
discomfort.
 If your patient reads lips, speak in a normal cadence and tone. If
your patient uses a form of sign language, ask the interpreter to
come to the appointment. Speak with this person in advance to
discuss dental terms and your patient's needs.
 Visual feedback is helpful. Maintain eye contact with your patient.
Before talking, eliminate background noise (turn off the radio and
the suction). Sometimes people with a hearing loss simply need
you to speak clearly in a slightly louder voice than normal.
Remember to remove your facemask first or wear a clear face
shield.

85. KURANG UPAYA PENGLIHATAN
 Tidak dapat melihat atau mengalami penglihatan terhad di
kedua-dua belah mata walaupun dengan menggunakan alat
bantu penglihatan seperti cermin mata atau kanta sentuh.
Terdapat dua (2) tahap OKU Penglihatan, iaitu :
 Buta (Blind)
 Penglihatan kurang daripada 3/60 atau medan penglihatan
kurang dari 10 darjah dari fixation.
 Terhad (Low Vision / Partially Sighted)
 Penglihatan lebih teruk dari 6/18 tetapi sama dengan atau
lebih baik daripada 3/60 walaupun dengan menggunakan
alat bantuan penglihatan atau medan penglihatan kurang
dari 20 darjah dari fixation.

87. KURANG UPAYA PENGLIHATAN
Globally the major causes of visual impairment
are:
 uncorrected refractive errors (myopia,
hyperopia or astigmatism), 43 %
 cataract, 33%
 glaucoma, 2%.

88. Siapakah yg berisiko
People aged 50 and over
 About 65 % of all people who are visually
impaired are aged 50 and older.
Children below age 15
 An estimated 19 million children are visually
impaired. Of these, 12 million children are
visually impaired due to refractive errors, a
condition that could be easily diagnosed and
corrected. 1.4 million are irreversibly blind for
the rest of their lives.

89. REFRACTIVE ERROR
 A refractive error, or refraction error, is an
error in the focusing of light by the eye and a
frequent reason for reduced visual acuity.
 Causes: Family history
Genetic disorder-Marfan syndrome
Down syndrome

90. ANATOMI MATA

91.  Myopia: When the optics are too powerful for the length of
the eyeball one has myopia or nearsightedness. This can arise
from a cornea with too much curvature (refractive myopia) or
an eyeball that is too long (axial myopia). Myopia can easily
be corrected with a concave lens which causes the divergence
of light rays before they reach the retina.(Rabun jauh)
 Hyperopia: When the optics are too weak for the length of
the eyeball, one has hyperopia or farsightedness. This can
arise from a cornea with not enough curvature (refractive
hyperopia) or an eyeball that is too short (axial
hyperopia).This can be corrected with convex lenses which
cause light rays to converge prior to hitting the retina.(Rabun
dekat)

92. Myopia –Rabun jauh

93. Hyperopia –Rabun dekat

94. Astigmatism is a condition in
which an abnormal curvature
of the cornea can cause two
focal points to fall in two
different locations, making
objects up close and at a
distance appear blurry.

95. Treatment
 Glasses
 Contact lenses
 Refractive surgery

96. TREATMENT-DENTAL RELATED
 Determine the level of assistance your patient requires to move safely through the dental office.
 Use your patients' other senses to connect with them, establish trust, and make treatment a good
experience. Tactile feedback, such as a warm handshake, can make your patients feel comfortable.
 Face your patients when you speak and keep them apprised of each upcoming step, especially when
water will be used. Rely on clear, descriptive language to explain procedures and demonstrate how
equipment might feel and sound. Provide written instructions in large print
 Encourage independence in daily oral hygiene. Ask patients to show you how they brush, and follow
up with specific recommendations on brushing methods or toothbrush adaptations. Involve your
patients in hands-on demonstrations of brushing and flossing.
 Some patients cannot brush and floss independently due to impaired physical coordination or
cognitive skills. Talk to their caregivers about daily oral hygiene. Do not assume that all caregivers
know the basics; demonstrate proper brushing and flossing techniques. A power toothbrush or a
floss holder can simplify oral care. Also, use your experiences with each patient to demonstrate
sitting or standing positions for the caregiver. Emphasize that a consistent approach to oral hygiene
is important--caregivers should try to use the same location, timing, and positioning.
 Some patients benefit from the daily use of an antimicrobial agent such as chlorhexidine.
Recommend an appropriate delivery method based on your patient's abilities. Rinsing, for example,
may not work for a patient who has swallowing difficulties or one who cannot expectorate.
Chlorhexidine applied using a spray bottle or toothbrush is equally efficacious.
 If use of particular medications has led to gingival hyperplasia, emphasize the importance of daily
oral hygiene and frequent professional cleanings.
 Tips for caregivers are available in the booklet Dental Care Every Day: A Caregiver's Guide, also part
of this series.
 Back to Top

97. KETIDAKUPAYAAN MENTAL
 Keadaan penyakit mental yang teruk yang telah diberi
rawatan atau telah diberi diagnosis selama sekurang-
kurangnya dua (2) tahun oleh Pakar Psikiatri. Akibat
daripada penyakit yang dialami dan telah menjalani
rawatan psikiatri, mereka masih tidak berupaya untuk
berfungsi sama ada sebahagian atau sepenuhnya
dalam hal berkaitan dirinya atau perhubungan dalam
masyarakat. Di antara jenis-jenis penyakit mental
tersebut ialah Organic Mental Disorder yang serius dan
kronik, Skizofrenia, Paranoid, Mood Disorder
(depression, bipolar) dan Psychotic Disorder seperti
Schizoaffective Disorder dan Persistent Delusional
Disorders.

98. Apakah penyakit
skizofrenia? Major psychiatric disorder
 Mengubah cara persepsi,pemikiran dan
tingkahlaku
 Mengganggu otak dlm proses penerimaan dan
penafsiran maklumat

99. FAKTOR RISIKO
 Sejarah keluarga skizofrenia
-Parents-6%
-Siblings-9%
-Children-13%
-Dizygotic twin (Kembar tak seiras)-17%
-Children with 2 affected parents-46%
-Monozygotic twin-48%

100. FAKTOR RISIKO
 Sejarah komplikasi obstetrik
 Cannabis abusers
 Offspring of older fathers
 Unmarried mothers
 Childhood CNS infection

101. GEJALA-GEJALA POSITIF
 Delusi
 Halusinasi
 Pertuturan/pemikiran yang tidak teratur
 Tingkahlaku tidak teratur
 Tingkahlaku katatonik

102. GEJALA-GEJALA NEGATIF
Kekurangan motivasi dan tenaga
 Affective flattening
-kurang ekspresi emosi-ekspresi muka,ton suara,sentuhan
mata dan bahasa badan
 Alogia (poverty of speech)
-kurang kelancaran pertuturan (pemikiran tersangkut)
 Avolition
-tidak berminat utk keluar bersiar-siar,tidak berminat pada
perkara yg sebelum ini diminati,duduk didalam rumah tanpa

103. GEJALA KOGNITIF
 Masalah dalam proses pemikiran-masalah
pembelajaran dan daya penumpuan
 Pemikiran tidak teratur/bercelaru
 Pemikiran lembap
 Susah utk faham
 Kurang daya penumpuan
 Kurang daya ingatan
 Sukar utk mengeluarkan idea
 Sukar utk sepadukan pemikiran,perasaan
dan tingkahlaku

104. RAWATAN
 Ubat-ubatan
 Pendidikan
(Psychoeducation)
 Kaunseling dan psikoterapi
 Rehabilitasi (pemulihan)
 Kumpulan sokongan
 Perawatan dalam komuniti

105. MASALAH DENTAL IN MENTAL
CHALLENGE
People with intellectual disability have
poorer oral health and oral hygiene than
those without this condition. Data indicate
that people who have intellectual disability
have more untreated caries and a higher
prevalence of gingivitis and other
periodontal diseases than the general
population.

106. PENGURUSAN MASALAH DENTAL
 Set the stage for a successful visit by involving the entire dental team--
from the receptionist's friendly greeting to the caring attitude of the
dental assistant in the operatory. All should be aware of your patient's
mental challenges.
 Reduce distractions in the operatory, such as unnecessary sights, sounds,
or other stimuli, to compensate for the short attention spans commonly
observed in people with intellectual disability.
 Talk with the parent or caregiver to determine your patient's intellectual
and functional abilities, then explain each procedure at a level the patient
can understand. Allow extra time to explain oral health issues or
instructions and demonstrate the instruments you will use.
 Address your patient directly and with respect to establish a rapport.
Even if the caregiver is in the room, direct all questions and comments to
your patient.

107. PENGURUSAN MASALAH DENTAL
 Use simple, concrete instructions and repeat them often to
compensate for any short-term memory problems. Speak slowly
and give only one direction at a time. Be consistent in all aspects
of oral care, since long-term memory is usually unaffected.
 Use the same staff and dental operatory each time to help
sustain familiarity. The more consistency you provide for your
patients, the more likely they will cooperate.
 Listen actively, since communicating clearly is often difficult for
people with intellectual disability. Show your patient whether
you understand. Be sensitive to the methods he or she uses to
communicate, including gestures and verbal or nonverbal
requests.

108. TERIMA KASIH