YDC Pediatric Symposium Part 5


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YDC Pediatric Symposium Part 5

  1. 1. The Bisphosphonate Challenge <ul><li>Bisphosphonates are experimental and may increase bone density and lessen pain </li></ul><ul><li>They reduce life of osteoclasts and let osteoblasts produce bone </li></ul><ul><li>Now used in osteogenesis imperfecta and other fibro-osseous conditions </li></ul><ul><li>Used for osteoporosis in children with profound disability and no mobility </li></ul><ul><li>No evidence of BRONJ in kids </li></ul><ul><li>Possible implications for tooth eruption, movement, avulsion, implants </li></ul>
  2. 2. The Bisphosphonate Challenge <ul><li>No evidence or guidelines exist for children </li></ul><ul><li>Consult with MD </li></ul><ul><li>IV BIS is worse than oral BIS for BRONJ </li></ul><ul><li>Consider discontinuation of BIS for three months prior to oral surgery </li></ul><ul><li>Allow tissues to fully heal before beginning BIS therapy if possible </li></ul>
  3. 3. Cancer or Sickle Cell Disease? <ul><li>Hydroxyurea is an antineoplastic now used to reduce frequency and severity of sickle cell crises </li></ul><ul><li>Antibiotics are not routinely requested for dental treatment of children with SCD </li></ul><ul><li>Consult MD about need for supplemental antibiotics if taking penicillin </li></ul><ul><li>Request blood studies if on hydroxyurea (Hydrea) and surgery needed </li></ul>
  4. 4. What Does Evidence Say About Care?
  5. 5. Pulp Therapy and Infection Risk <ul><li>Is there evidence to preclude pulp </li></ul><ul><li>therapy for children with heart disease? </li></ul><ul><li>Traditionally, pulp therapy was not recommended in congenital heart disease or cancer patients </li></ul><ul><li>Success rates have improved </li></ul><ul><li>Life span has improved requiring some sort of long-term consideration for tooth replacement </li></ul><ul><li>Space maintainers and removable appliances may present greater risk of infection </li></ul><ul><li>OK to do vital pulpotomies in some patients </li></ul>
  6. 6. Prematurity/Low Birthweight Do They Present Dental Challenges? Today, thousands of babies are saved in NICUs and grow up to become happy healthy children, but many bring with them a host of developmental problems that impact oral health
  7. 7. Premies and Behavioral Problems <ul><li>Klassen AF et al. Health status and health-related quality of life in a population-based sample of neonatal intensive care unity graduates. Pediatrics 2004;113:594-600. </li></ul><ul><li>Doyle LW et al. Outcome at 14 years of extremely low birthweight infants: a regional study. Arch Dis Child Fetal Neonatal Ed 2001;85:F159-64. </li></ul><ul><li>Hack M et al. Outcomes in young adulthood for very-low birthweight infants. N Engl J Med 2002;346:149-57. </li></ul><ul><li>These children grow up to have lower IQs, learning problems, and more general health problems, but they don’t get into trouble typical for many teens! </li></ul>
  8. 8. Not All MDs Agree on AB Coverage For Dialysis Patients <ul><li>Tong RC et al. Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment. Nephrology 2004;9:167-70. </li></ul><ul><li>Give ABs if artificially created shunt </li></ul><ul><li>No ABs if peritoneal dialysis </li></ul><ul><li>No ABs for hemodialysis </li></ul><ul><li>Always check with MD </li></ul>
  9. 9. What About Periodontal Disease in These Obese DM2 Kids? <ul><li>We’re not sure yet; too soon to tell </li></ul><ul><li>Aren G et al. Periodontal health, salivary status, and metabolic control in children with type 1 diabetes mellitus. J Periodontol 2003;74:1789-95. </li></ul><ul><li>Compared 16 children with newly diagnosed DM, 16 long-term DM (4 yrs) and 16 healthy controls </li></ul><ul><li>Perio Index: HC<ND<LT </li></ul><ul><li>Pocket depth same for HC and ND but deeper for LT </li></ul><ul><li>LT had > bleeding on probing than other two groups </li></ul>