This document from the American Academy of Pediatric Dentistry provides guidelines for managing dental patients with special health care needs (SHCN). It discusses that individuals with SHCN are at increased risk for oral diseases that can impact overall health. It recommends that dental practices establish a dental home for these patients to implement individualized preventive oral health practices. It also stresses the importance of effective communication, medical consultations, informed consent, and addressing barriers to care for patients with SHCN. Preventive strategies like dental sealants, fluorides, and addressing diet and medications are especially important for these patients.
02 classification and indications of rpdAmal Kaddah
This document discusses removable partial dentures. It begins by outlining the indications for removable partial dentures, including when the abutment teeth are not suitable for fixed bridges due to periodontal issues, extensive bone loss, or economic considerations. It then covers classifications for partially edentulous arches, including whether the denture is tooth-borne, tissue-borne, or a combination. Kennedy's classification system categorizes cases based on the location of edentulous spans. The document concludes with the component parts of removable partial dentures.
This document discusses oral habits such as thumb sucking. It defines oral habits as learned patterns of muscle contractions and classifies them in various ways, such as by pressure applied, psychological components, and whether they are useful or harmful. Common oral habits mentioned include thumb sucking, tongue thrusting and bruxism. Thumb sucking is explored in more depth, including its etiology, diagnosis, effects on teeth, and various treatment approaches like psychological therapy, reminder therapy, and intraoral appliances.
This document provides guidelines for managing dental patients with special health care needs (CSHCN). It defines CSHCN as children who have disabilities that affect daily activities and require modified dental care. The document outlines the history of caring for CSHCN and the establishment of special needs dentistry. It describes different types of special needs including intellectual, physical, medical, and psychiatric disabilities. Recommendations are provided for scheduling appointments, establishing a dental home, and thoroughly assessing patients to provide appropriate care for CSHCN.
Designing a Removable Partial Denture (Kennedy's Classification)Taseef Hasan Farook
This document discusses the design of removable partial dentures. It begins by classifying partially edentulous jaws using Kennedy's classification system. It then covers the basic considerations in design such as biomechanics, types of supports, and biological factors. The key steps in design are surveyed, including marking the path of insertion, height of contour, and undercuts. It describes the components of partial dentures including major connectors, minor connectors, rests, retainers, and the denture base. Specific clasp and retainer designs are covered for different clinical situations.
Serial extraction is an interceptive orthodontic procedure that involves the planned extraction of certain primary and permanent teeth in a sequence to guide the erupting permanent teeth into a favorable position. It was first described in 1929 as a way to address arch length deficiencies. The most common methods are Dewel's method, Tweed's method, and Nance method, all of which extract primary teeth first, followed by premolars and canines. Potential problems include anterior crossbites from residual spacing or skeletal discrepancies.
SETTING UP A PEDIATRIC DENTAL CLINIC.pptxDentalYoutube
1. Setting up an effective pediatric dental clinic requires considering factors like space provision, pleasant waiting areas, friendly staff attire and presentation, and use of distracting audiovisual aids.
2. The clinic environment should encourage parental involvement but also allow easy separation from children during procedures. Equipment and materials should be accessible for treating a high volume of young patients.
3. A team-based approach is important, with staff trained in positive communication skills to help relieve children's dental anxiety and promote cooperation during visits and treatments.
This document discusses the pediatric treatment triangle model in dentistry. The pediatric treatment triangle describes the relationship between the child patient, parents, and dentist. It was originally proposed by Dr. GZ Wright in 1975 and later modified by McDonald in 2004 to include societal influences. The success of pediatric dental treatment depends on effective communication and cooperation between all three parties in the triangle relationship. Parental attitudes and anxiety levels can significantly impact a child's behavior and response to dental procedures.
02 classification and indications of rpdAmal Kaddah
This document discusses removable partial dentures. It begins by outlining the indications for removable partial dentures, including when the abutment teeth are not suitable for fixed bridges due to periodontal issues, extensive bone loss, or economic considerations. It then covers classifications for partially edentulous arches, including whether the denture is tooth-borne, tissue-borne, or a combination. Kennedy's classification system categorizes cases based on the location of edentulous spans. The document concludes with the component parts of removable partial dentures.
This document discusses oral habits such as thumb sucking. It defines oral habits as learned patterns of muscle contractions and classifies them in various ways, such as by pressure applied, psychological components, and whether they are useful or harmful. Common oral habits mentioned include thumb sucking, tongue thrusting and bruxism. Thumb sucking is explored in more depth, including its etiology, diagnosis, effects on teeth, and various treatment approaches like psychological therapy, reminder therapy, and intraoral appliances.
This document provides guidelines for managing dental patients with special health care needs (CSHCN). It defines CSHCN as children who have disabilities that affect daily activities and require modified dental care. The document outlines the history of caring for CSHCN and the establishment of special needs dentistry. It describes different types of special needs including intellectual, physical, medical, and psychiatric disabilities. Recommendations are provided for scheduling appointments, establishing a dental home, and thoroughly assessing patients to provide appropriate care for CSHCN.
Designing a Removable Partial Denture (Kennedy's Classification)Taseef Hasan Farook
This document discusses the design of removable partial dentures. It begins by classifying partially edentulous jaws using Kennedy's classification system. It then covers the basic considerations in design such as biomechanics, types of supports, and biological factors. The key steps in design are surveyed, including marking the path of insertion, height of contour, and undercuts. It describes the components of partial dentures including major connectors, minor connectors, rests, retainers, and the denture base. Specific clasp and retainer designs are covered for different clinical situations.
Serial extraction is an interceptive orthodontic procedure that involves the planned extraction of certain primary and permanent teeth in a sequence to guide the erupting permanent teeth into a favorable position. It was first described in 1929 as a way to address arch length deficiencies. The most common methods are Dewel's method, Tweed's method, and Nance method, all of which extract primary teeth first, followed by premolars and canines. Potential problems include anterior crossbites from residual spacing or skeletal discrepancies.
SETTING UP A PEDIATRIC DENTAL CLINIC.pptxDentalYoutube
1. Setting up an effective pediatric dental clinic requires considering factors like space provision, pleasant waiting areas, friendly staff attire and presentation, and use of distracting audiovisual aids.
2. The clinic environment should encourage parental involvement but also allow easy separation from children during procedures. Equipment and materials should be accessible for treating a high volume of young patients.
3. A team-based approach is important, with staff trained in positive communication skills to help relieve children's dental anxiety and promote cooperation during visits and treatments.
This document discusses the pediatric treatment triangle model in dentistry. The pediatric treatment triangle describes the relationship between the child patient, parents, and dentist. It was originally proposed by Dr. GZ Wright in 1975 and later modified by McDonald in 2004 to include societal influences. The success of pediatric dental treatment depends on effective communication and cooperation between all three parties in the triangle relationship. Parental attitudes and anxiety levels can significantly impact a child's behavior and response to dental procedures.
School dental health programs aim to improve children's oral health through education, prevention, and treatment services directly in schools. The key aspects of such programs include conducting dental inspections and health education, providing preventive interventions like fluoride varnish and sealants, and making referrals for treatment when needed. Evaluations show such programs can reduce dental caries by 20-30% through approaches like water fluoridation, fluoride tablets, and toothbrushing programs in schools. The community benefits from improving children's oral health as it helps establish healthy habits that can last a lifetime.
Transient malocclusions are self-correcting developmental variations that occur during dental development. In the pre-dentate period, infants have a retrognathic mandible that corrects over time. In the primary dentition, children commonly have an anterior open bite, deep anterior bite, spacing between teeth, and an edge-to-edge anterior bite that self-correct. In the mixed dentition, a deep bite and crowding are common but resolve with time. The permanent dentition may show increased overjet and overbite during transition that lessen without treatment.
This document discusses food impaction, including its causes, types, mechanisms, signs and symptoms, detection, and management. Food impaction occurs when food becomes forcefully wedged between teeth or in the gingiva. It is often caused by factors like uneven tooth wear, missing teeth, or poor restorations. Left untreated, food impaction can lead to inflammation, bone loss, and tooth mobility. Detection involves examining contacts, using dental floss or casts. Management includes nonsurgical treatments like cleaning and occlusal adjustment, as well as restoring proper contacts and replacing missing teeth.
The lingual arch space maintainer is a passive bilateral mandibular appliance used to control tooth movement and arch perimeter after the loss of lower primary molars. It consists of bands on the first molars connected by a stainless steel wire. The wire is positioned to contact the lower incisors and rest on the gingiva of the molared and molar bands. It maintains the arch shape and leeway space until the permanent teeth erupt. Advantages include allowing eruption of permanents without interference and maintaining oral hygiene, while disadvantages include not preventing opposing tooth extrusion and potential for distortion.
The document defines a dental home as an ongoing relationship between a dentist and patient that provides comprehensive, accessible, and family-centered oral healthcare from infancy through adolescence. A dental home has characteristics like being accessible in the community, family-centered, providing unbiased information continuously, and being comprehensive, coordinated, and compassionate. When a parent or caregiver approaches a dental home, the dentist will take a history, do an examination, and do a risk assessment to enhance the dentist's ability to assist the child and family with optimal oral healthcare.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
This document outlines a treatment plan for periodontal disease. It includes 5 phases: emergency, etiotropic (non-surgical), surgical, restorative, and maintenance. The etiotropic phase involves nonsurgical therapies like scaling, root planing, and oral hygiene instruction. The surgical phase uses various periodontal surgeries to further treat pockets and furcations. The restorative phase focuses on final restorations. Lastly, the maintenance phase provides periodic recall visits to monitor the patient's condition. The overall goal is to resolve inflammation and reduce pocket depths through a coordinated approach involving multiple dental specialists.
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document discusses the potential for a dental caries vaccine. It begins by defining dental caries and explaining why it is a major public health problem. It then covers how the immune system works and classifications of immunity. Key aspects of the microbiology of dental caries are explained, focusing on Streptococcus mutans and its antigenic determinants. The document discusses the need for a caries vaccine, potential routes of administration including mucosal and systemic routes, and advantages and disadvantages of passive immunization approaches. It concludes by considering the public health perspective on a potential caries vaccine and analyzing whether it could help reduce the global burden of dental caries.
This document discusses caring for children with autism and their oral health needs. It begins with an overview of autism, noting it is a neurodevelopmental disorder characterized by difficulties with social communication and interaction. For dental care, it recommends preparation strategies like social stories and visual supports to help children with autism understand and feel comfortable with visits. It also outlines common oral health problems experienced by those with autism, such as damaging oral habits, cavities, and drooling, as well as prevention techniques including xylitol, specialized toothbrushes, and herbal lollipops.
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
This document discusses various classifications and causes of malocclusion. It begins by introducing Moyer's classification which categorizes etiology into heredity, development defects, trauma, physical agents, habits, diseases, and malnutrition. White and Gardiner's classification separates causes into dental base abnormalities, pre-eruption abnormalities, and post-eruption abnormalities. Graber's classification divides factors into general factors like heredity, environment, and local factors like anomalies in tooth number. The document then examines specific causes in greater detail such as heredity, congenital defects, environment, anomalies in tooth number including supernumerary teeth and missing teeth.
Behavioural Management in Pediatric DentistrySwalihaAlthaf
This document provides information on behavioral management techniques used in pediatric dentistry. It defines key terms like behavior, behavior management, behavior shaping, and behavior modification. It then categorizes and describes various non-pharmacological behavior management techniques including communication, use of second language, tell-show-do, desensitization, modeling, behavior shaping, contingency management, distraction, assimilation and coping techniques.
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
Early childhood caries (ECC) is a major public health problem affecting young children worldwide. ECC can develop soon after teeth erupt and involves colonization of the oral cavity by cariogenic bacteria like Streptococcus mutans. Clinical features include rapid progression of decay affecting maxillary anterior teeth first in a rampant pattern. Multiple factors contribute to ECC risk including prolonged bottle feeding with sugary liquids, genetic and socioeconomic factors. Management focuses on prevention through education and early intervention to arrest non-cavitated lesions.
American Academy of Pediatrics Holds Its 2015 National Conference Dr Jay Schwartz
Since 2007, experienced pediatrician Dr. Jay Schwartz has treated young patients as the owner of Collin County Pediatrics in Frisco, Texas. An involved medical professional, Dr. Jay Schwartz maintains membership in the American Academy of Pediatrics, which oversees various programs and activities to promote the health and well-being of all children.
School dental health programs aim to improve children's oral health through education, prevention, and treatment services directly in schools. The key aspects of such programs include conducting dental inspections and health education, providing preventive interventions like fluoride varnish and sealants, and making referrals for treatment when needed. Evaluations show such programs can reduce dental caries by 20-30% through approaches like water fluoridation, fluoride tablets, and toothbrushing programs in schools. The community benefits from improving children's oral health as it helps establish healthy habits that can last a lifetime.
Transient malocclusions are self-correcting developmental variations that occur during dental development. In the pre-dentate period, infants have a retrognathic mandible that corrects over time. In the primary dentition, children commonly have an anterior open bite, deep anterior bite, spacing between teeth, and an edge-to-edge anterior bite that self-correct. In the mixed dentition, a deep bite and crowding are common but resolve with time. The permanent dentition may show increased overjet and overbite during transition that lessen without treatment.
This document discusses food impaction, including its causes, types, mechanisms, signs and symptoms, detection, and management. Food impaction occurs when food becomes forcefully wedged between teeth or in the gingiva. It is often caused by factors like uneven tooth wear, missing teeth, or poor restorations. Left untreated, food impaction can lead to inflammation, bone loss, and tooth mobility. Detection involves examining contacts, using dental floss or casts. Management includes nonsurgical treatments like cleaning and occlusal adjustment, as well as restoring proper contacts and replacing missing teeth.
The lingual arch space maintainer is a passive bilateral mandibular appliance used to control tooth movement and arch perimeter after the loss of lower primary molars. It consists of bands on the first molars connected by a stainless steel wire. The wire is positioned to contact the lower incisors and rest on the gingiva of the molared and molar bands. It maintains the arch shape and leeway space until the permanent teeth erupt. Advantages include allowing eruption of permanents without interference and maintaining oral hygiene, while disadvantages include not preventing opposing tooth extrusion and potential for distortion.
The document defines a dental home as an ongoing relationship between a dentist and patient that provides comprehensive, accessible, and family-centered oral healthcare from infancy through adolescence. A dental home has characteristics like being accessible in the community, family-centered, providing unbiased information continuously, and being comprehensive, coordinated, and compassionate. When a parent or caregiver approaches a dental home, the dentist will take a history, do an examination, and do a risk assessment to enhance the dentist's ability to assist the child and family with optimal oral healthcare.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
This document outlines a treatment plan for periodontal disease. It includes 5 phases: emergency, etiotropic (non-surgical), surgical, restorative, and maintenance. The etiotropic phase involves nonsurgical therapies like scaling, root planing, and oral hygiene instruction. The surgical phase uses various periodontal surgeries to further treat pockets and furcations. The restorative phase focuses on final restorations. Lastly, the maintenance phase provides periodic recall visits to monitor the patient's condition. The overall goal is to resolve inflammation and reduce pocket depths through a coordinated approach involving multiple dental specialists.
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document discusses the potential for a dental caries vaccine. It begins by defining dental caries and explaining why it is a major public health problem. It then covers how the immune system works and classifications of immunity. Key aspects of the microbiology of dental caries are explained, focusing on Streptococcus mutans and its antigenic determinants. The document discusses the need for a caries vaccine, potential routes of administration including mucosal and systemic routes, and advantages and disadvantages of passive immunization approaches. It concludes by considering the public health perspective on a potential caries vaccine and analyzing whether it could help reduce the global burden of dental caries.
This document discusses caring for children with autism and their oral health needs. It begins with an overview of autism, noting it is a neurodevelopmental disorder characterized by difficulties with social communication and interaction. For dental care, it recommends preparation strategies like social stories and visual supports to help children with autism understand and feel comfortable with visits. It also outlines common oral health problems experienced by those with autism, such as damaging oral habits, cavities, and drooling, as well as prevention techniques including xylitol, specialized toothbrushes, and herbal lollipops.
Electronic apex locator by dr.imran m.shaikhImran Shaikh
. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
This document discusses various classifications and causes of malocclusion. It begins by introducing Moyer's classification which categorizes etiology into heredity, development defects, trauma, physical agents, habits, diseases, and malnutrition. White and Gardiner's classification separates causes into dental base abnormalities, pre-eruption abnormalities, and post-eruption abnormalities. Graber's classification divides factors into general factors like heredity, environment, and local factors like anomalies in tooth number. The document then examines specific causes in greater detail such as heredity, congenital defects, environment, anomalies in tooth number including supernumerary teeth and missing teeth.
Behavioural Management in Pediatric DentistrySwalihaAlthaf
This document provides information on behavioral management techniques used in pediatric dentistry. It defines key terms like behavior, behavior management, behavior shaping, and behavior modification. It then categorizes and describes various non-pharmacological behavior management techniques including communication, use of second language, tell-show-do, desensitization, modeling, behavior shaping, contingency management, distraction, assimilation and coping techniques.
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
Early childhood caries (ECC) is a major public health problem affecting young children worldwide. ECC can develop soon after teeth erupt and involves colonization of the oral cavity by cariogenic bacteria like Streptococcus mutans. Clinical features include rapid progression of decay affecting maxillary anterior teeth first in a rampant pattern. Multiple factors contribute to ECC risk including prolonged bottle feeding with sugary liquids, genetic and socioeconomic factors. Management focuses on prevention through education and early intervention to arrest non-cavitated lesions.
American Academy of Pediatrics Holds Its 2015 National Conference Dr Jay Schwartz
Since 2007, experienced pediatrician Dr. Jay Schwartz has treated young patients as the owner of Collin County Pediatrics in Frisco, Texas. An involved medical professional, Dr. Jay Schwartz maintains membership in the American Academy of Pediatrics, which oversees various programs and activities to promote the health and well-being of all children.
Prosthetic management of cleft lip and palate patientsanjivbairwa7
This document discusses prosthodontic treatment for individuals with cleft lip and palate. It covers classification of clefts, impression materials used, impression techniques, feeding plates for infants, and options for tooth replacement including removable partial dentures, fixed partial dentures, and dental implants. The main goals of prosthodontic rehabilitation are to improve feeding, tongue function, and speech development for infants using feeding plates, and to provide natural-looking tooth replacement for older individuals.
Behavioral Management Technique For Patient With Special Needs DrGhadooRa
done by : ( ABCD'S &G )
alaa ba-jafar
abrar alshahranii
sahab filfilan
nada alharbi
shahd rajab
Ghadeer suwaimil
I hope that you enjoy and you benefit❤
This document provides an overview of periodontal considerations for restorative dentistry. It discusses the normal periodontium, biologic width, and factors that can irritate the periodontium during restorative procedures. Margin placement is an important consideration, as subgingival margins pose the greatest biologic risk. Contour, contacts, embrasures and overhangs can also impact the periodontium. Proper evaluation and correction of biologic width violations is discussed to minimize risks to periodontal health from restorative work.
SPECIAL NEEDS FOR MANAGEMENT OF SPECIAL PATIENTSAmina Arain
This document discusses the management and dental care of patients with special needs. It outlines that special care dentistry aims to motivate patients to maintain oral health, prevent issues, and make appointments comfortable. Key aspects of care include creating an accessible environment, using protective stabilization techniques during procedures, obtaining informed consent, and desensitizing patients to dental treatment. Communication with caregivers is essential to understand the patient's needs and abilities.
Behaviour management is important for pediatric dentists treating cognitively, physically, mentally and emotionally developing children. The major difference between treating adults and children is that treating children involves a triad relationship between the child, dentist and parents. Dentists should counsel parents not to voice their own fears in front of children or use dentistry as a threat. Factors like the dentist's attitude, attire, and presence of parents can affect a child's behavior. Effective behavior management techniques for children include communication, modeling, desensitization, voice control, relaxation and hypnosis. Physical restraints should only be used as a last resort for uncooperative or handicapped patients.
This document discusses child behavior and behavior management techniques in dentistry. It defines concepts like fear, anxiety, and emotions commonly seen in children. It also describes various classification systems used to assess child behavior and factors that can influence it like parental attitudes. The document outlines non-pharmacological behavior management techniques including communication, modeling, desensitization and contingency management. It discusses practical considerations for behavior management in a dental clinic.
An Introduction to Special Needs DentistySyafiq Ali
Siti Zaleha Hamzah is a specialist in special needs dentistry based in Hospital Serdang in Malaysia. She provides clinical support for patients with intellectual, physical, medical, and psychiatric conditions. Special needs dentistry focuses on modifying dental treatment for patients with disabilities or medical complexities. It aims to improve oral health and well-being for those with conditions that make regular dental care difficult. Treatment is often provided using behavior management strategies and may involve specialists from other areas.
This document discusses behavior management techniques for treating children in a pediatric dental clinic. It describes how fear is one of the primary emotions acquired early in life that can influence a child's behavior. There are different types of fear like objective and subjective fear. It also classifies children's behaviors into categories like cooperative, lacking cooperative ability, potentially cooperative, controlled, uncontrolled, timid, tense cooperative, and whining. Behavior management can be achieved through non-pharmacological methods like preappointment modification, communication skills, behavior shaping techniques, and pharmacological methods like sedatives. Specific techniques discussed include tell-show-do, modeling, audioanalgesia, aversive conditioning, implosion therapy, and retraining.
This document provides guidelines for behavior guidance techniques used in pediatric dentistry. It discusses the importance of dental care for children and outlines a variety of behavior guidance methods. Predictors of child behavior, such as developmental level and past dental experiences, can help dentists choose the appropriate guidance techniques. Communication between the dentist, staff, child and parents is key. Informed consent is also important when using techniques beyond basic communication. The document provides a framework to help dentists safely and effectively deliver quality dental care to children.
INTRODUCTION
DEFINITIONS
CLASSIFICATIONS
COMMUNICATION WITH GERIATRIC PATIENT
Dr.MM HOUSE CLASSIFICATION
AGE & NUTRITION
FACTORS AFFECTING NUTRITION
This document reviews dentistry for children with special needs. It discusses common oral health problems for these children like dental caries, enamel issues, eruption abnormalities, and gingival enlargement. These problems are often due to conditions like cerebral palsy, medications, or poor oral hygiene. The management of oral diseases in special needs children is generally similar to other children but may require sedation. Preventive strategies include toothbrushing adaptations, fluorides, sealants, prophylaxis and oral exams by a pediatric dentist. Overall, both general and oral health are closely linked, so dental care is important for improving quality of life in special needs children.
Dr. Janet Bauer of Loma Linda University addresses the growing issue of dental neglect in seniors, particularly those in early to mid-stage dementia who can no longer practice good dental hygeine without assistance. The presentation was part of the June 7, 2013 Glenner Symposium on Elder Abuse and Neglect for San Diego County health care professionals.
The document discusses patient education, motivation, and oral hygiene instruction. It covers domains of learning, theories of motivation like the health belief model, and the process of behavioral change which involves factual education, practical demonstration, motivation, and reinforcement. Key aspects of patient education are discussed like the learning ladder, principles of learning, and changing a patient's attitude towards dental health. Methods of oral hygiene instruction like disclosing agents, toothbrushes, and interdental aids are also summarized.
This document discusses dental public health in India and compares practices in other countries. It finds that in India, dental public health/community dentistry is often misunderstood and seen merely as a way to increase patient numbers rather than prevent disease. National oral health policies in India also remain unimplemented. By contrast, countries like the UK, Nordic nations, and the Netherlands integrate public dental health practitioners and preventive services into their universal healthcare systems. The document calls for India to better define the role of public dental health to improve oral health outcomes.
1. Oral health education provided by dental professionals has faced criticism for being expert-led, prescriptive, and failing to acknowledge social factors influencing behavior change.
2. Reviews found little evidence that oral health education alone reduces cavities unless combined with fluoride, and that increases in patient knowledge did not necessarily translate to behavior changes.
3. Studies showed dental professionals provided inconsistent advice to patients and were more likely to advise middle-class patients perceived as more motivated, using a didactic teaching approach.
Jc: barriers to dental care for children with special health care needsDr. SHRUTI SUDARSANAN
The document summarizes a study that investigated barriers to providing dental care to children with special needs from the perspective of general dentists in Kerala, India. A survey of 149 dentists found the main barriers were lack of specialized training, inaccessible clinics, and unmotivated caregivers. While most dentists felt oral health disparities should be addressed and were interested in further training, many were unaware of disability rights laws. The study highlights the need for improved education and resources to increase access to dental care for children with special needs.
Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
Estimation of dental treatment need in special care . Mohamed Alkeshan
This document discusses dental treatment considerations for patients with special needs. It notes barriers to care for these patients and ways to improve access, including through hospital outpatient programs, university training programs, and mobile dental units. For treatment, protective stabilization, nitrous oxide, or general anesthesia may be used. Home dental care requires parental assistance. Preventive care like fluoride, sealants, and diet management is important. The document reviews managing specific conditions like intellectual disabilities, Down syndrome, and autism. Overall, it stresses the importance of preventive care and treating special needs patients in general practice when possible.
Knowledge of Oral Health Issues Among Baltimore A Pilot Study.docxwrite4
This study examined the conceptual oral health knowledge of low-income adults in Baltimore through questions on oral health topics. The majority of respondents knew that sugar causes cavities and that brushing and flossing daily prevents tooth decay. However, knowledge about plaque, flossing frequency, and gum disease was more limited. The study concluded that practitioners should consider patients' limited knowledge when discussing oral health to ensure messages are understood and health promotion is effective.
This document discusses a panel convened by the Macy Foundation to examine issues related to the dental curriculum, specifically regarding diagnosis and primary health care. The panel consisted of 10 experts in dental education. They discussed how changes to the dental curriculum could expand the scope of dental practice to include more precise evaluation of oral diseases, diagnosis of systemic diseases, and primary health care screening in the dental office. This would help train dental practitioners to better promote oral and systemic health as part of an evolving healthcare system.
This document discusses opportunities for expanding the role of dentistry in diagnosis and primary health care. A panel of experts convened by the Macy Foundation examined issues related to the dental curriculum. The panel discussed how training dental students to more precisely evaluate oral, dental, and craniofacial diseases, as well as help diagnose systemic diseases, could begin changing the scope of dental practice. The dental profession must consider practice models relevant for the 21st century that emphasize diagnosis and the dentist's role as a full member of the healthcare team.
Treatment Planning in Paediatric Dentistry - a Structured Approach.pdfAinaBalqis8
This document summarizes the key steps in developing a structured treatment plan for pediatric dental patients. It discusses assessing caries risk, evaluating a child's coping ability, selecting appropriate behavior management strategies, and determining treatment options and sequencing. A thorough treatment plan considers the child's age, risk status, psychological factors, and available treatments to provide safe, effective, and evidence-based care tailored to each individual patient.
This document discusses the importance of dental and vision care, and challenges that homeless individuals face in accessing these services. It notes that dental problems can cause pain, infection, and negatively impact quality of life and employment prospects. Similarly, untreated vision issues affect daily functioning and long-term health. However, many homeless people lack insurance or ability to pay for these services. The document describes innovative programs that health care for the homeless clinics have implemented to improve access, such as on-site dental and vision clinics, mobile services, and partnerships with outside providers. It emphasizes the importance of preventive care and dedicated clinics that understand homeless patients' needs.
Saskatchewan oral health professions (sohp) seniors oral health and long ter...saskohc
The document discusses oral health among older adults living in long-term care facilities in Saskatchewan. It notes that seniors today are retaining more of their natural teeth compared to 20 years ago, putting them at greater risk for dental and oral diseases. Poor oral health can negatively impact overall health and quality of life. The document recommends establishing legislative oral health care policies for long-term care homes to ensure residents receive regular assessments, daily oral hygiene, and access to dental services. It also recommends employing oral health coordinators and providing initial and ongoing oral assessments and treatments for residents. The goal is to improve oral and overall health through better access to oral health care for long-term care residents in Saskatchewan.
Diabetic patients knowledge, attitude and practice toward oral healthAlexander Decker
This study assessed the knowledge, attitudes, and practices of 612 diabetic patients in Abha City, Saudi Arabia regarding their oral health. The results showed that over half of patients were unaware of their increased risk of oral diseases as diabetics. Less than half knew that diabetes can cause dental caries and gingivitis. While patients' oral hygiene practices were generally good, their knowledge about the oral health risks of diabetes was deficient. The study highlights the need for better patient education on maintaining oral health and the link between diabetes and oral diseases.
Improving Access to Oral Health Care for Vulnerable People living in Canadasaskohc
This document summarizes a report by a Canadian panel that evaluated access to oral healthcare for vulnerable groups. The panel found that vulnerable groups have the highest oral health issues but lowest access to care. The current public and private systems do not effectively provide reasonable access to care for all vulnerable Canadians. The panel recommends developing evidence-based standards of care, planning personnel and delivery systems to provide this care across diverse settings, financing necessary resources, and monitoring outcomes to improve access for all Canadians.
Powerpoint of continuing education program on mid-level providers in dentistry. Focus on the training of advanced skills hygienists both in terms of ADHP and prior projects in the United States for training dental hygienists to perform skills traditionally reserved for dentists
Similar to Guideline On Management Of Dental Patients With Special2171 (20)
Guideline On Management Of Dental Patients With Special2171
1. AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
Guideline on Management of Dental Patients With
Special Health Care Needs
Originating Council
Council on Clinical Affairs
Review Council
Council on Clinical Affairs
Adopted
2004
Revised
2008
Purpose health of those with certain systemic health problems or condi-
The American Academy of Pediatric Dentistry (AAPD) recog- tions. Patients with compromised immunity (eg, leukemia or
nizes that providing both primary and comprehensive preven- other malignancies, human immunodeficiency virus) or car-
tive and therapeutic oral health care to individuals with special diac conditions associated with endocarditis may be especially
health care needs (SHCN) is an integral part of the specialty of vulnerable to the effects of oral diseases. Patients with mental,
pediatric dentistry.1 The AAPD values the unique qualities of developmental, or physical disabilities who do not have the abil-
each person and the need to ensure maximal health attainment ity to understand and assume responsibility for or cooperate with
for all, regardless of developmental or other special health care preventive oral health practices are susceptible as well. Oral health
needs. This guideline is intended to educate health care provid- is an inseparable part of general health and well-being.4
ers, parents, and ancillary organizations about the management SHCN also includes disorders or conditions which manifest
of oral health care needs particular to individuals with SHCN only in the orofacial complex (eg, amelogenesis imperfecta,
rather than provide specific treatment recommendations for oral dentinogenesis imperfecta, cleft lip/palate, oral cancer). While
conditions. these patients may not exhibit the same physical or communica-
tive limitations of other SHCN patients, their needs are unique,
Methods impact their overall health, and require oral health care of a
This guideline is based on a review of the current dental and med- specialized nature.
ical literature related to individuals with SHCN. A MEDLINE Currently, 52 million Americans have some type of dis-
search was conducted using the terms “special needs”, “disabled abling condition and 25 million Americans have a severe disabil-
patients”, “handicapped patients”, “dentistry”, and “oral health”. ity.5 Due to improvements in medical care, SHCN patients will
Papers and workshop reports from the AAPD-sponsored sym- continue to grow in number; many of the formerly acute and
posium “Lifetime Oral Health Care for Patients with Special fatal conditions have become chronic and manageable problems.
Needs” (Chicago, IL: November, 2006) were reviewed.2 Historically, many of these patients received care in nursing
homes and state-operated institutions. Today, society’s trend is
Background to mainstream these individuals to traditional community-based
The AAPD defines special health care needs as “any physical, centers, with many seeking care from private dental practitio-
developmental, mental, sensory, behavioral, cognitive, or emo- ners. The Americans with Disabilities Act (AwDA) defines the
tional impairment or limiting condition that requires medical dental office as a place of public accommodation.6 Thus, dentists
management, health care intervention, and/or use of specialized are obligated to be familiar with these regulations and ensure
services or programs. The condition may be developmental or compliance. Failure to accommodate patients with SHCN could
acquired and may cause limitations in performing daily self- be considered discrimination and a violation of federal and/or
maintenance activities or substantial limitations in a major life state law.
activity. Health care for individuals with special needs requires Although regulations require practitioners to provide physi-
specialized knowledge, increased awareness and attention, adap- cal accessibility to an office (eg, wheelchair ramps, handicapped-
tation, and accommodative measures beyond what are consid- parking spaces), individuals with SHCN can face many other
ered routine.”3 barriers to obtaining oral health care. Financing and reimburse-
Individuals with SHCN are at increased risk for oral diseases.4 ment have been cited as common barriers for medically neces-
Oral diseases can have a direct and devastating impact on the sary oral health care.5 Families with SHCN children experience
CLINICAL GUIDELINES 107
2. REFERENCE MANUAL V 30 / NO 7 08 / 09
much higher expenditures than required for healthy children. well as customized services should be documented so the office
Most individuals with SHCN rely more on government funding staff is prepared to accommodate the patient’s unique circum-
to pay for medical and dental care and generally lack adequate stances at each subsequent visit.
access to private insurance for health care services.6,7 Insurance When scheduling patients with SHCN, it is imperative that
plays an important role for families with SHCN children, but the dentist be familiar and comply with Health Insurance
it still provides incomplete protection.8,9 Lack of preventive and Portability and Accountability Act (HIPAA) and AwDA regula-
timely therapeutic care may increase the need for costly episodic tions applicable to dental practices.19 HIPAA insures that the
care.10 Optimal health of children is more likely to be achieved patient’s privacy is protected and AwDA prevents discrimination
with access to comprehensive health care benefits.11 on the basis of a disability.
Nonfinancial barriers such as language and psychosocial,
structural, and cultural considerations may interfere with access Dental home
to oral health care.9 Effective communication is essential and, for Patients with SHCN who have a dental home20 are more likely
hearing impaired patients/parents, can be accomplished through to receive appropriate preventive and routine care. The dental
a variety of methods including interpreters, written materials, home provides an opportunity to implement individualized pre-
and lip-reading. Psychosocial factors associated with utilization ventive oral health practices and reduces the child’s risk of pre-
include oral health beliefs, norms of caregiver responsibility, and ventable dental/oral disease.
positive caregiver dental experience. Structural barriers include When SHCN patients reach adulthood, their oral health
transportation, school absence policies, discriminatory treat- care needs may go beyond the scope of the pediatric dentist’s
ment, and difficulty locating providers who accept Medicaid.12 training. It is important to educate and prepare the patient and
Community-based health services, with educational and social parent on the value of transitioning to a dentist who is know-
programs, may assist dentists and their patients with SHCN.13 ledgeable in adult oral health needs. At a time agreed upon by
Priorities and attitudes can serve as impediments to oral the patient, parent, and pediatric dentist, the patient should be
care. Parental and primary physician lack of awareness and transitioned to a dentist knowledgeable and comfortable with
knowledge may limit a SHCN patient from seeking preventive managing that patient’s specific health care needs. In cases where
dental care.14 Other health conditions may seem more impor- this is not possible or desired, the dental home can remain with
tant than dental health, especially when the relationship between the pediatric dentist and appropriate referrals for specialized
oral health and general health is not well understood.15 SHCN dental care should be recommended when needed.21
patients may express a greater level of anxiety about dental care
than those without a disability, which may adversely impact the Patient assessment
frequency of dental visits and, subsequently, oral health.16 Familiarity with the patient’s medical history is essential to de-
Pediatric dentists are concerned about decreased access to creasing the risk of aggravating a medical condition while ren-
oral health care for SHCN patients as they transition beyond dering dental care. An accurate, comprehensive, and up-to-date
the age of majority. Pediatric hospitals, by imposing age restric- medical history is necessary for correct diagnosis and effective
tions, can create another barrier to care for these patients. Transi- treatment planning. Information regarding the chief complaint,
tioning to a dentist who is knowledgeable and comfortable with history of present illness, medical conditions and/or illnesses,
adult oral health care needs often is difficult due to a lack of medical care providers, hospitalizations/surgeries, anesthetic expe-
trained providers willing to accept the responsibility of caring riences, current medications, allergies/sensitivities, immunization
for SHCN patients.17 Furthermore, as children with disabilities status, review of systems, family and social histories, and thorough
reach adulthood, health insurance coverage may be restricted.18 dental history should be obtained.22 If the patient/parent is unable
to provide accurate information, consultation with the caregiver
Recommendations or with the patient’s physician may be required. At each patient
Scheduling appointments visit, the history should be consulted and updated. Recent medical
The parent’s/patient’s initial contact with the dental practice attention for illness or injury, newly diagnosed medical conditions,
(usually via telephone) allows both parties an opportunity to ad- and changes in medications should be documented. A written
dress the child’s primary oral health needs and to confirm the update should be obtained at each recall visit. Significant medical
appropriateness of scheduling an appointment with that par- conditions should be identified in a conspicuous yet confidential
ticular practitioner. Along with the child’s name, age, and chief manner in the patient’s record.
complaint, the receptionist should determine the presence and Comprehensive head, neck, and oral examinations should
nature of any SHCN and, when appropriate, the name(s) of be completed on all patients. A caries-risk assessment should be
the child’s medical care provider(s). The office staff, under the performed.23 A caries-risk assessment tool (CAT) provides a means
guidance of the dentist, also should determine the need for an of classifying caries risk at a point in time and, therefore, should
increased length of appointment and/or additional auxiliary staff be applied periodically to assess changes in an individual’s risk
in order to accommodate the patient in an effective and efficient status. An individualized preventive program, including a dental
manner. The need for a higher level of dentist and team time as recall schedule, should be recommended after evaluation of the
patient’s caries risk, oral health needs, and abilities.
108 CLINICAL GUIDELINES
3. AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
A summary of the oral findings and specific treatment Preventive strategies
recommendations should be provided to the patient and parent/ Individuals with SHCN are at increased risk for oral diseases;
caregiver. When appropriate, the patient’s other health care pro- these diseases further jeopardize the patient’s health.3 Education
viders should be informed. of parents/caregivers is critical for ensuring appropriate and regu-
lar supervision of daily oral hygiene. Dental professionals should
Medical consultations demonstrate oral hygiene techniques, including the proper po-
The dentist should coordinate care via consultation with the sitioning of the person with a disability. They also should stress
patient’s other care providers including physicians, nurses, and the need to brush with a fluoridated dentifrice twice daily to help
social workers. When appropriate, the physician should be con- prevent caries and to brush and floss daily to prevent gingivitis.
sulted regarding medications, sedation, general anesthesia, and Toothbrushes can be modified to enable individuals with physi-
special restrictions or preparations that may be required to en- cal disabilities to brush their own teeth. Electric toothbrushes
sure the safe delivery of oral health care. The dentist and staff may improve patient compliance. Floss holders may be benefi-
always should be prepared to manage a medical emergency. cial when it is difficult to place hands into the mouth. Caregiv-
ers should provide the appropriate oral care when the patient is
Patient communication unable to do so adequately.
When treating patients with SHCN, an assessment of the Dietary counseling should be discussed for long term
patient’s mental status or degree of intellectual functioning is prevention of dental disease. Dentists should encourage a non-
critical in establishing good communication. Often, informa- cariogenic diet and advise patients/parents about the high
tion provided by a parent or caregiver prior to the patient’s visit cariogenic potential of oral pediatric medications rich in sucrose
can assist greatly in preparation for the appointment.24 An effort and dietary supplements rich in carbohydrates.27 As well, other
should be made to communicate directly with the patient during oral side effects (eg, xerostomia, gingival overgrowth) of medica-
the provision of dental care. A patient who does not communi- tions should be reviewed.
cate verbally may communicate in a variety of non-traditional Patients with SHCN may benefit from sealants. Sealants re-
ways. At times, a parent, family member, or caretaker may need duce the risk of caries in susceptible pits and fissures of primary
to be present to facilitate communication and/or provide infor- and permanent teeth.28 Topical fluorides (eg, brush-on gel, mouth
mation that the patient cannot. According to the requirements rinse, varnish, professional application during prophylaxis) may
of the AwDA, if attempts to communicate with the SHCN be indicated when caries risk is increased.29 Interim therapeutic
patient/ parent are unsuccessful because of a disability such as restoration (ITR),30 using materials such as glass ionomers that
impaired hearing, the dentist must work with those individuals release fluoride, may be useful as both preventive and therapeutic
to establish an effective means of communications.6 approaches in patients with SHCN.28 In cases of gingivitis and
periodontal disease, chlorhexidine mouth rinse may be useful. For
Informed consent patients who might swallow a rinse, a toothbrush can be used to
All patients must be able to provide appropriate signed informed apply the chlorhexidine. Patients having severe dental disease may
consent for dental treatment or have someone who legally can need to be seen every 2 to 3 months or more often if indicated.
provide it for them. Informed consent/assent must comply with Those patients with progressive periodontal disease should be
state laws and, when applicable, institutional requirements. In- referred to a periodontist for evaluation and treatment.
formed consent should be well documented in the dental record
through a signed and witnessed form.25 Barriers
Dentists should be familiar with community-based resources
Behavior guidance for patients with SHCN and encourage such assistance when
Behavior guidance of the patient with SHCN can be challenging. appropriate. While local hospitals, public health facilities, re-
Demanding and resistant behaviors may be seen in the person habilitation services, or groups that advocate for those with
with mental retardation and even in those with purely physical SHCN can be valuable contacts to help the dentist/patient
disabilities and normal mental function. These behaviors can address language and cultural barriers, other community-based
interfere with the safe delivery of dental treatment. With the resources may offer support with financial or transportation
parent/caregiver’s assistance, most patients with physical and considerations that prevent access to care.
mental disabilities can be managed in the dental office. Protec-
tive stabilization can be helpful in patients for whom traditional Patients with developmental or acquired orofacial conditions
behavior guidance techniques are not adequate.26 When protec- The oral health care needs of patients with developmental or
tive stabilization is not feasible or effective, sedation or general acquired orofacial conditions necessitate special considerations.
anesthesia is the behavioral guidance armamentarium of choice. While these individuals usually do not require longer appoint-
When in-office behavior guidance including sedation/general ments or advanced behavior guidance techniques commonly
anesthesia is not feasible or effective, a hospital or outpatient associated with SHCN patients, management of their oral condi-
surgical care facility is necessary to provide treatment. tions presents other unique challenges.31 Developmental defects
CLINICAL GUIDELINES 109
4. REFERENCE MANUAL V 30 / NO 7 08 / 09
such as hereditary ectodermal dysplasia, where most teeth are 5. University of Florida College of Dentistry. Oral health care
missing or malformed, cause lifetime problems that can be dev- for persons with disabilities. Available at: “http://www.
astating to children and adults.4 From the first contact with the dental.ufl.edu/Faculty/Pburtner/disabilities/introduction.
child and family, every effort must be made to assist the family in htm”. Accessed March 23, 2008.
adjusting to the anomaly and the related oral needs.32 The dental 6. Americans with Disabilities Act (AwDA). Available at:
practitioner must be sensitive to the psychosocial well-being of the “http://www.usdoj.gov/crt/ada/adahom1.htm”. Accessed
patient, as well as the effects of the condition on growth, function, March 23, 2008.
and appearance. Congenital oral conditions may entail therapeutic 7. Crall JJ. Improving oral health for individuals with special
intervention of a protracted nature, timed to coincide with devel- health care needs. Pediatr Dent 2007;29(2):98-104.
opmental milestones. Patients with conditions such as ectodermal 8. Newacheck PW, Kim SE. A national profile of health care
dysplasia, epidermolysis bullosa, cleft lip/palate, and oral cancer utilization and expenditures for children with special health
frequently require an interdisciplinary team approach to their care needs. Arch Pediatr Adolesc Med 2005;159(1):10-7.
care. Coordinating delivery of services by the various health care 9. Chen AY, Newacheck PW. Insurance coverage and financial
providers can be crucial to successful treatment outcomes. burden for families of children with special health care needs.
Patients with oral involvement of conditions such as osteo- Ambul Pediatr 2006;6(4):204-9.
genesis imperfecta, ectodermal dysplasia, and epidermolysis 10. Newacheck PW, McManus M, Fox HB, Hung YY, Halfon
bullosa often present with unique financial barriers. Although N. Access to health care for children with special health care
the oral manifestations are intrinsic to the genetic and congenital needs. Pediatrics 2000;105(4Pt1):760-6.
disorders, medical health benefits often do not provide for related 11. American Academy of Pediatrics, Committee on Child
professional oral health care. The distinction made by third party Health Financing. Scope of health care benefits for children
payors between congenital anomalies involving the orofacial com- from birth through age 21. Pediatrics 2006;117(3):979-82.
plex and those involving other parts of the body is often arbitrary 12. Kelly SE, Binkley CJ, Neace WP, Gale BS. Barriers to care-
and unfair.33 For children with hereditary hypodontia, removable seeking for children’s oral health among low-income care-
or fixed prostheses (including complete dentures or overdentures) givers. Am J Public Health 2005;95(8):1345-51.
and/or implants may be indicated.34 Dentists should work with 13. Halfon N, Inkelas M, Wood D. Nonfinancial barriers to
the insurance industry to recognize the medical indication and care for children and youth. Ann Rev Public Health 1995;
justification for such treatment in these cases. 16:447-72.
14. Shenkin JD, Davis MJ, Corbin SB. The oral health of special
Referrals needs children: Dentistry’s challenge to provide care. J Dent
A patient may suffer progression of his/her oral disease if treatment Child 2001;86(3):201-5.
is not provided because of age, behavior, inability to cooperate, 15. Barnett ML. The oral-systemic disease connection. An update
disability, or medical status. Postponement or denial of care can for the practicing dentist. J Am Dent Assoc 2006;137(suppl
result in unnecessary pain, discomfort, increased treatment needs 10):5S-6S.
and costs, unfavorable treatment experiences, and diminished 16. Gordon SM, Dionne RA, Synder J. Dental fear and anxiety
oral health outcomes. Dentists have an obligation to act in an as a barrier to accessing oral health care among patients
ethical manner in the care of patients.35 When the patient’s needs with special health care needs. Spec Care Dentist 1998;18:
are beyond the skills of the practitioner, the dentist should make (2)88-92.
appropriate referrals in order to ensure the overall health of the 17. Woldorf JW. Transitioning adolescents with special health
patient. care needs: Potential barriers and ethical conflicts. J Spec
Pediatr Nurs 2007;12(1):53-5.
18. Callahan ST, Cooper WO. Continuity of health insurance
References
coverage among young adults with disabilities. Pediatrics
1. American Academy of Pediatric Dentistry. Reference Man-
2007;119(6):1175-80.
ual. Overview: Definition and scope of Pediatric Dentistry.
19. US Dept of Health and Human Services Health Insurance
Pediatr Dent 2008;30(suppl):1.
Portability and Accountability Act (HIPAA). Available at:
2. American Academy of Pediatric Dentistry. Symposium
“http://:aspe.hhs.gov/admnsimp/pl104191.htm”. Accessed
on lifetime oral health care for patients with special needs.
March 23, 2008.
Pediatr Dent 2007;29(2):92-152.
20. American Academy of Pediatric Dentistry. Policy on dental
3. American Academy of Pediatric Dentistry. Definition of
home. Pediatr Dent 2007;29(suppl):22-3.
special health care needs. Pediatr Dent 2008;30(suppl):15.
21. Nowak AJ. Patients with special health care needs in pedi-
4. US Dept of Health and Human Services. Oral health in
atric dental practices. Pediatr Dent 2002;24(3):227-8.
America: A report of the Surgeon General. Rockville, Md:
22. American Academy of Pediatric Dentistry. Guideline on
US Dept of Health and Human Services, National Institute
record-keeping. Pediatr Dent 2007;29(suppl):29-33.
of Dental and Craniofacial Research, Nations Institutes of
Health; 2000.
110 CLINICAL GUIDELINES
5. AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
23. American Academy of Pediatric Dentistry. Policy on use of 32. American Cleft Palate-Craniofacial Association. Parameters
a caries-risk assessment tool (CAT) for infants, children and for evaluation and treatment of patients with cleft lip/palate
adolescents. Pediatr Dent 2007;29(suppl):29-33. or other craniofacial anomalies. Chapel Hill, NC: The Ma-
24. Klein U, Nowak AJ. Autistic disorder: A review for the ternal and Child Health Bureau, Title V, Social Security Act,
pediatric dentist. Pediatr Dent 1998;20(5):312-7. Health Resources and Services Administration, US Public
25. American Academy of Pediatric Dentistry. Guideline on Health Service, DHHS; Revised ed November 2007. Grant
informed consent. Pediatr Dent 2007;29(suppl):219-20. #MCJ-425074.
26. American Academy of Pediatric Dentistry. Guideline on 33. American Academy of Pediatric Dentistry. Policy on third
behavior guidance for the pediatric dental patient. Pediatr party reimbursement for oral health care services related
Dent 2008;30(suppl):125-33. to congenital orofacial anomalies. Pediatr Dent 2007;29
27. American Academy of Pediatric Dentistry. Policy on dietary (suppl):71-2.
recommendations for infants, children, and adolescents. 34. National Foundation for Ectodermal Dysplasias. Parameters
Pediatr Dent 2008;30(suppl):47-8. of oral health care for individuals affected by ectodermal
28. American Academy of Pediatric Dentistry. Guideline dysplasias. National Foundation for Ectodermal Dysplasias.
on pediatric restorative dentistry. Pediatr Dent 2008;30 Mascoutah, Ill. 2003.
(suppl):163-9. 35. American Academy of Pediatric Dentistry. Policy on the
29. American Academy of Pediatric Dentistry. Guideline on ethical responsibility to treat or refer. Pediatr Dent 2008;
fluoride therapy. Pediatr Dent 2008; 30(suppl):121-4. 30(suppl):83.
30. American Academy of Pediatric Dentistry. Policy on in-
terim therapeutic restorations (ITR). Pediatr Dent 2008;30
(suppl):38-9.
31. American Academy of Pediatric Dentistry. Guideline on
oral health care/dental management of heritable dental
developmental anomalies. Pediatr Dent 2008;30(suppl):
196-201.
CLINICAL GUIDELINES 111