Mental Disorders
Developmental Disorders:
Mental Retardation
Mental retardation (MR) is defined as significant subaverage general
intellectual functioning existing in conjunction with deficits in adaptive
behavior and is manifested during the developmental period prior to age
18. It is not an illness but an impairment in intellectual and adaptive
functioning. The cause is not always known; rarely can a single cause be
identified. In 75 percent of cases the cause is unknown.
Some of the known causes are:
-
chromosomal abnormalities
-
prenatal conditions (rubella, alcohol use, drug use)
-
perinatal (anoxia)
-
postnatal (meningitis, encephalitis, trauma, cultural deprivation, severe
malnutrition)
Mental retardation is defined by Intelligence Quotient (IQ) scores or by
categories such as:"educable," "trainable," "total care":
-
normal intellectual functioning, IQ = 100
-
mild mental retardation, IQ = 55-70 (educable)
-
moderate mental retardation, IQ = 40-55 (trainable)
-
severe mental retardation, IQ = 25-40 (some training possible)
- profound mental retardation, IQ <25 (total care is required)
(Note: Due to variability in testing, these classificatrions
are not always appropriate and an individualized approach is always indicated.)
3 to 5 individuals in 100 are classified as mentally retarded. 85 percent
are mildly mentally retarded (IQ > 55) and can function in the community
environment. Mental retardation may be the most common disabling condition
the dentist will encounter in private practice.
Mental retardation can be associated with other disorders, e.g.:
- seizure disorders
- cardiac anomalies
-
emotional disorders
Consultation with the physician, family and care givers is essential for:
- obtaining an accurate medical history
-
providing appropriate oral health care
- obtaining informed consent
-
managing behavior
-
insuring that daily oral hygiene is performed
 Oral findings
may include:
- poor oral hygiene
- malocclusion
- enamel deficits
- gingival hyperplasia
- tongue thrusting habits
- clenching and bruxism
- drooling
-
self-injurious behavior
-
pica (ingestion of inedible objects)
Communicating with the patient who has mild mental retardation:
- minimize distractions
- use short explanations
- use simple language
-
take more time to present information
- avoid explanation of causes
-
focus on effects of lack of oral hygiene
- teach activities rather than concepts
-
encourage consistency
- use "tell-show-do"
- use positive reinforcement
-
use verbal praise
 Communicating
with the patient who has severe mental retardation:
- use shorter simpler explanations,
- greater repetition of instructions and
- use more practice of oral hygiene procedures
-
more extensive use of positive reinforcement
Accommodating the behavior of these individuals may present a challenge.
Behavioral difficulties are often related to cognitive functioning. Behavior
management may require:
-
"tender loving care"
-
"gentle firmness" (verbal control)
- desensitization
-
restraints
- sedation
-
general anesthesia
-
a combination of the above strategies
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