Special Care Client Report

By: Heather Atchley-Grey

My patients name is Jennifer and she 33 years of age. She suffers from Scoliosis, an
intellectual and physical disability, and previously seizures as an infant. Jenny is unable to live
on her own and requires a fulltime care taker, which is her mother, to complete all everyday
tasks.
Scoliosis is an abnormal curvature of the spine. The spine is typically straight when
viewed form the back but in persons with scoliosis the spine curves to the side. The spine can
present with one or more curves, occurring in the lumbar, thoracic and cervical portion of the
spine. There are four different types of scoliosis: idiopathic, congenital, neuromuscular and
degenerative scoliosis. Idiopathic is the most common form of scoliosis. It has no identifiable
cause; however, there is strong evidence concluding it may be inherited. Congenital scoliosis is
present at birth and is due to a bone abnormality. Neuromuscular scoliosis is the result of
abnormal muscles or nerves. It is generally seen in people with spina bifida or cerebral palsy.
Lastly, degenerative scoliosis is the result of traumatic bone collapse from an illness or injury,
previous major back surgery, or the thinning of bones due to osteoporosis. Other physical
identifying factors of scoliosis, other than curvature of the spine, consist of uneven shoulders or
protrusion of one shoulder blade, asymmetry of the waistline or having one hip higher than the
other. The diagnosis for scoliosis is completed by a physical exam with imaging such as X-rays,
CT scan or MRI; and the choice for treatment is based on the severity of the degree of curvature
and the chances of the curvature getting worse. The main options for treatment are
observation, bracing and surgery. If the curvature is less than 20 degrees, observation is

indicated and rarely is further treatment needed; whereas more than 20 degrees would require
bracing or surgical intervention to prevent further progression of the curve. Bracing is only
effective on those who are still growing, for the reason that the brace is intended to help slow
or stop the curving of the spine from getting worse, and is not recommended for those who
have finished growing. Surgical treatment involves correcting the curve of the spine to as close
to normal as possible, and a spinal fusion to hold the spine in place. A surgeon would place
screws and rods in the back, and places bone graft around the bones intended to be fused
together allowing the bones to grow together and become solid. Severe curvature can lead to
continued physical pain, difficulty breathing and significant disfigurement. Jenny has congenital
scoliosis. Her condition was present at birth and is due to a bone abnormality. She wore a brace
when she was younger but her mother reports it did little help. Currently there is no plan for
surgery or further treatment.
An intellectual disability, or previously called mental retardation, is a person having
below average intelligence or mental ability, lacking in skills necessary for day-to-day living.
There are varying degrees of intellectual disabilities, from mild to profound. Those with a mild
disability generally can live independently with the right support whereas with a profound
disability the individual will require a caretaker to assist in daily activities and cannot live
independently. Determining a persons intellectual functioning is based on their intelligence
quotient, or IQ, which refers to the persons ability to learn, reason, make decisions and solve
problems. A persons IQ is based on a test. The average IQ is 100, whereas the IQ of someone
with a mild intellectual disability is around 70 and less than 20 for those who have profound
intellectual disability. For individuals having a profound intellectual disability, such as Jenny,

they may have other health issues such as seizures, mood disorders, motor skill impairment,
hearing and vision problems as well. A person who has an intellectual disability not only has
limitations with intellectual functioning abilities but also in their behaviors to adapt. This means
they have limitations in skills necessary to complete day-to-day functions such as be able to
communicate effectively, interact with others, and take care of oneself.
Physically delayed development, or known as physical retardation, is the delay or
regression in physical development and motor skills. A person who presents with this condition
has decreased coordination and inability to complete fast body movements. Their coordination
is that of a six year old and they walk very slowly. During childhood, the individual would fail to
meet developmental milestones such as crawling and standing, and experience delays in the
development of motor skills. Additionally, they are typically shorter in height and lighter in
weight.
Currently, Jennys mental and physical developmental delays affect her everyday life.
She cannot achieve everyday tasks on her own and requires assistance around the clock. Her
physical and cognitive abnormalities are obvious and she will never be able to live
independently. Communicating her specific needs and wants are difficult for her.
Febrile seizures are seizures or convulsions experienced in young children, usually
between the ages of 6 months and 5 years of age, which are triggered by a fever. The fever may
be present with common illnesses such as the flu, cold or an ear infection. The seizure can
occur without the fever being present at the time of the seizure, but will develop within the
next couple hours. The clinical manifestations of a febrile seizure are loss of consciousness, and

uncontrollable shaking of the arms and legs. These are the more common signs, whereas the
less common are eye rolling, stiff limbs, and twitching on one side of the body. Most often
these are accompanied by a fever of 101 degrees and last less than 15 minutes. The sight and
thought of a seizure can be frightening but febrile seizures are common and do not cause longterm health problems. Febrile seizures are not the same as having epilepsy (a complex seizure
disorder requiring medications and treatment) for the reason that epilepsy is characterized by
reoccurring seizures not induced by a fever. Although, children who experience febrile seizures
are more likely to develop epilepsy than the general population especially those who have
seizures lasting longer than 10 minutes or have reoccurring seizures within 24 hours. Jenny
experienced febrile seizures as a child until the age of 2. She has not had a seizure since this
time and suffered no long-term health effects. No medications are taken currently or previously
for this condition.
There will be several modifications needed for Jennys treatment. Based on her
developmental delays, I will need to be sure to make the appointment as pleasant and
comfortable as possible. Since she cannot complete everyday tasks such as maintaining her oral
health, I will need to effectively communicate the importance of daily plaque removal and the
health implications, such as further progression of periodontal disease and potential risk for
cardiovascular disease, if daily plaque removal is not maintained. Individuals with poor motor
coordination lack the ability of natural cleansing of the mouth, so again enforcing the
importance of daily oral hygiene. Although, Jennys communication is limited it is still important
to direct questions toward her to build rapport. When explaining the procedure, I will need to
speak at a level where Jenny can understand, as well as speaking slowly and giving one

direction at a time. For Jennys comfort, having an assistant suction during the use of the ultrasonic will be the best option. No injections will be completed in the interest of not traumatizing
her. The treatment area will need to be clear of potential hazardous such as keeping the
instruments at a distance and giving myself adequate room to complete treatment. For Jenny,
lying back in the dental chair is uncomfortable. Her scoliosis causes discomfort in her upper
back for the reason that she had a large bump that protrudes out. She will need a pillow behind
her head/neck to help alleviate any discomfort as well as be kept sitting up in the dental chair
throughout treatment, and I will need to remain standing. Lastly, I will need to be extra
efficient with my use of time. This will be a long appointment for her, so utilizing my time well
will allow me to provide the most thorough care in the time she allows for treatment to be
completed.

Sources:
Gluck, S. (2014, May 21). Mild, Moderate, Severe Intellectual Disability Differences. Retrieved
November 30, 2015, from http://www.healthyplace.com/neurodevelopmentaldisorders/intellectual-disability/mild-moderate-severe-intellectual-disability-differences

Intellectual Disability. (n.d.). Retrieved November 30, 2015, from

http://www.webmd.com/parenting/baby/intellectual-disability-mental-retardation

What is Physical Retardation? (n.d.). Retrieved November 30, 2015, from

http://www.wisegeek.com/what-is-physical-retardation.htm

Febrile Seizures Fact Sheet. (n.d.). Retrieved November 30, 2015, from
http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

Jaccarino, CDA, RDH, MA, J. (2015, October 23). The Patient with Special Needs: General
Treatment Considerations. Retrieved November 30, 2015, from
http://www.dentalcare.com/media/en-US/education/ce384/ce384.pdf