Dental Management of Handicapped ChildrenDr. Amal Abdulkader
Disabled childe or Handicapped child includes all the children that have: * Mental conditions. * Physical conditions. * Medical conditions. * Social conditions.Interferes with normal functioning.
Handicapped patients in dental clinicFirst Dental Visit:- Initial dental examination.- Establish an excellent relationship with the parents, guardian and the patient.- Through medical & dental history.- You must be prepared to discuss the patient health status & possible planned dental treatments with the physicians.
At the time of treatment we must consider factors such as :• The level of dependency• Type of disability.• Associated systemic disease.• Effects of medications.• Level of oral hygiene.• Malocclusion.• Para functional problems related to mastication. Presence of frequent dental traumas.• Behavior during treatment.• Patients diet:(Type, texture, frequency and the quantity of carbohydrates consumed)
Classification of disabled patientsThere are several classification of disabled patients, we grouping them by the following manner:• Disabilities by specific dentistry problems.• Physical disabilities.• Sensorial disabilities.• Neuro-psychological disabilities.• Disabilities by renal diseases.• Disabilities by chronic diseases.• Disabilities by immunological diseases.We are only refer to Neuro-psychological disabilities and Sensorial disabilities.
Neuro-psychological disabilitiesMental retardation.term used when an individuals intellectual development is significantly lower than average and whose ability to adapt to their environment is consequently limited.The WHO recommends the division of the mentally subnormal into three broad categories:1-Mild Subnormal_ with IQ of 50 to 69 and a mental age in the adult of 8 to 12 years.2-Moderate Subnormal_ with IQ of 20to 49 and a mental age in adult of 3 to 7 years.3-Sever Subnormal_ with IQ of 0 to 19 and a mental age in the adult of 0 to 2 years.• There are many organic causes & syndromesthat can cause or accompany mental retardation.
Dental ProblemsAnomalies in the dento facial morphology and in the dental eruptive pattern.Enamel hypoplasia.Delayed eruption.High palatal vault with a hypoplastic maxilla.Tendency for Class II malocclusion with an open bite. Over retained primary dentition
Downs Syndromewe may found:= supernumerary teeth.= Microdontia.= Macroglosia.= A bifid, fissured or excrotal tongue.There are specific facial characteristics, ocular anomalies and premature fusion of the cranial sutures in these patients.High incidence of rapid destructive periodontal disease
Dental treatment of a child with mental retardation1- Behavior management techniques can be used for patients with mild or moderate retardation2- Dental procedures must be explained slowly, simply and repetitively.3- Give only one instruction at a time. Reward the patient with compliments after each procedure.4 - Actively listen to the patient. People with mental retardation often have trouble with communication.5- The visits should be short. Minimal new procedures should be introduced at each appointment.6- Gradually progress to more difficult procedures.7- We must learn from the parents or guardians about the patients habits, comprehensive words or gestures to facilitate our work8- Before using physical restriction on patients, suitability must be considered for each case and with parental or guardian consent.9- We must consider the patients behavior, his age and the type of dental treatment needed.10- We may utilize elements of partial or total restriction, or the collaboration of 2 or 3 helpers.11- Sedation techniques can also be used such as oral premeditation.12- General anesthesia should be used only in cases where physical restriction, behavior management and conscious sedation have all failed or were ineffective in providing the most efficient care.With adequate preparation the Dentist and the staff can provide a valuable service. By thoroughly understanding the patients degree of mental retardation and abilities and by exercising patience and understanding, the Dentist should have not significant problems in delivering dental care.
Cerebral PalsyNot a specific disease entity is a collection of disabling disorders caused by insult and permanent damage to the brain in the prenatal and perinatal periods, during which time the central nervous system is still maturing. This disability might involve muscle tone with disruption of movement and posture, dysfunction and paralysis.
Three most common types of :neoromuscular dysfunctions• Spasticity.• Athetosis.• Ataxic.
Classification according to affected :area by this disorder• Monoplegia.• Hemiplegia
:Dental treatment• The chair should be recline and pillows used to fasten and adapt to the body.• Small children can sit on their parents’ shoulders.• Consultation with the child physician for treatment with premedication
Patients with sensorial disabilities• Visual Impairment.• Hearing Loss.