Management of People With Special Needs 2012

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1 of the lectures from Special Needs Dentistry Course - Management of People With Special Needs

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Management of People With Special Needs 2012

  1. 1. MANAGEMENT OF PEOPLE WITH SPECIAL NEEDS Dr Noor Rohana bt Kamaruddin Pegawai Pergigian Daerah Perak Tengah
  2. 2. PRINCIPLE OF MANAGEMENT ASSESSMENT  DENTAL NEEDS  URGENT/ ELECTIVE  BEHAVIORAL MANAGEMENT  ORAL SEDATION  N2O/ O2 INHALATION SEDATION  IM SEDATION  IV SEDATION  GA  CONSCIOUS SEDATION  DEEP SEDATION
  3. 3. PRINCIPLE OF MANAGEMENT  PREVENTIVE  TREATMENT  OPERATIVE  SURGICAL PROCEDURE  MAINTENANCE
  4. 4. PREVENTIVE PROGRAMME  OHI  DIETARY ADVICE  FLUORIDE APPLICATION  FISSURE SEALENT  REGULAR DENTAL VISITS
  5. 5. PROBLEMS WITH OH  PERIODONTAL D/S - COMMON  CANNOT MANAGE ORAL HYGIENE TECNIQUE  SUCCESS DEPEND ON PARENTS/ STAFF  NO PRIORITY GIVEN TO ORAL HEALTH
  6. 6. EFFECTIVE PLAQUE CONTROL Practice, skill, time, effort, preseverance  OH AIDS  Toothbrush modifications  Enlarged – Acrylic resin to increase bulk  Elongated  Angled  Superbrush/ Double headed brush  Finger brush  Finger props  Electric toothbrush
  7. 7. EFFECTIVE PLAQUE CONTROL  Chemical control of plaque  Chlorhexidine – Gel, Spray, Rinse  Eg Orodex  Topical fluoride application  Duraphat, Tooth mousse, Enamel Pro Varnish (  dental caries 40%)
  8. 8. DIETARY COUNSELING Given in wider context of context of general health  PROBLEMS  May retain infant feeding practices longer, sweetened comforters used as pacifiers  Use of sugared liquid medications  Feeding difficulties – liquidized food (high in sugar)  SECC (Severe Early Childhood Caries)
  9. 9. RESTORATIVE TREATMENT  Restorations do not cure caries  Requires simultaneous preventive measures  Treatment under GA  Limited restorative treatment  Drastic approach required eg full dental clearance  Advanced restorative treatment  Pulpotamy & Preformed crowns
  10. 10. LEARNING DISABILITIES/ MENTAL RETARDATION [MR]  Deficiency in theoretical intelligence & social functioning  Expressed as IQ  70 – 89 – Educationally subnormal  < 50 – Severe MR  Commonest cause of MR – Down Syndrome
  11. 11. DOWN SYNDROME  1 IN 700 live birth, Trisonomy 21, Translocation  Strong correlation betw maternal age & DS  Mother’s age < 25yrs – 1:2000  Mother’s age > 40yrs – 1:50
  12. 12. DOWN SYNDROME  FEATURES OF DOWN’S  Short stature, tendency to obesity  Midface hypoplasia  Specific co-morbid  Congenital cardiac abnormalities  Learning disability & behavioral problem  Frequent infection – URTI common
  13. 13. ORAL HEALTH CARE  3-TIER SYSTEM  PRIMARY CARE  Dental Nurses  SECONDARY CARE  Dental Officers  TERTIARY CARE  Specialist
  14. 14. ORAL HEALTH CARE  PRE-REFERRAL CHECK LIST  Ascertain severity  Medical history  Ability of parent/ guardian to attend  Ability to maintain oral hygiene  Compliance to preventive measures  Staying at home/ institution  Transport  Reasons for referral  Urgent or Elective

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