Pedodontics III Al Azhar University Palestine Gaza Upload By: Lama El Banna lama1997bana@gmail.com Faculty of oral and dental medicine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic III
Dental Management of Handicapped
Children
Dr. Hazem El Ajrami
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3. • Dental Management of Handicapped
Children [Children with Special Health
Care Needs (CSHCN)]
Definitions:
Handicapped children are those having
certain physical, mental, social and dental
conditions that prevent them from achieving
full potential when compared with other
children.
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4. The term Special Health Care Needs (CSHCN)
could replace some terminologies given to
those children as: handicapped, disabled,
exceptional and special needs.
A great challenge faces the dentist when
communicating with those children, thus
requiring specific management and certain
modifications of the offered dental services.
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5. • Classification:
(CSHCN) could be classified into three
main categories according to the type of
handicapping condition into:
I. Dental handicapping conditions.
II. Medical (physical) handicapping
conditions.
III. Mental handicapping conditions.
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6. • Management of (CSHCN):
1. General considerations should be followed
with all disabled children.
2. Specific management for each condition.
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7. 1. General considerations:
 First dental visit: It usually runs and follows
the same guidelines of the first dental visit of
a normal child.
 Objectives of the first dental visit:
A. To establish good communication with the
child and his parents.
B. To obtain background information about
the child regarding social, dental and
medical history. Data should be collected
and updated on regular bases.
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8. C. Examination of the child:
 Extra-oral examination to evaluate general
appearance, weight, gait and facial
symmetry.
 Intra-oral examination to detect any
abnormality in the teeth number, anatomy.
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9. D. Taking radiographs:
 To detect any abnormalities in the
developing dentition.
 To detect specific problems.
 To detect dental caries.
 Taking radiographs could be delayed to the
second visit until more trust will be built
between the child and dentist.9

10. Stabilization of the film should be done.
Reverse bitewing technique: Some disabled
children cannot control gagging reflex.
Therefore, bitewing film could be put in the
vestibule rather than the floor of the mouth,
and the x-ray tube is put below the lower
border of mandible on the opposite side.
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11. E. Introduce the child to a simple treatment
procedure e.g. fluoride application.
F. Explain the treatment objectives to the child
(if possible) and his parents. E.g.:
 Length and number of treatment visits.
 Importance of oral hygiene measures and
disease prevention.
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12. G. Preventive measures:
All (CSHCN) are at high risk to develop
oral and dental diseases, so the dentist should
design a preventive dental program for them
and to follow its implementation with the
parents.
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13. • Among these preventive measures:
1. Home dental care:
It is the prime responsibility of the parents to
establish good oral hygiene to their disabled
child .
Home dental care should be performed for:
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14.  Infants, the dentist should instruct the parents to
clean the child's teeth with a piece of soft cloth.
 For an older child, the parents should brush the
child's teeth using the simple techniques
(scrubbing) as well as the proper position of the
child to permit maximum control and support
during tooth brushing. Certain modifications are
found in the toothbrushes used to help children
with poor motor and neuromuscular skills.
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16. 2. Diet counseling:
Proper diet is considered a corner stone for
any preventive dental program, especially for
disabled child. So diet history analysis
should be evaluated by the dentist, and diet
modifications should be listed and given to
the parents as:
 Nursing bottle or breast-feeding should be
discontinued at the age of 12 months, (After
starting eruption of primary teeth) to
decrease the incidence of ECC.
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17. Certain drugs as sedatives, hypnotic and
anticonvulsants not only contain sugars, but
also reduce salivary flow rate and thereby
reduce the protective effect of saliva against
dental caries.
With certain neuromuscular disorders the
masticatory function of the child is so
compromised and they fed soft diet, which is
highly cariogenic.
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18. 3. Fluoride application:
The level of fluoride in drinking water
should be evaluated at first.
 If between 0.7 -1 ppm → no need for
fluoride supplements.
 If less than that → fluoride supplements are
needed either systemically or topically
applied.
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19. 4. Preventive restorations:
 Fissure sealants are highly indicated for
those children who at high risk.
 Stainless steel crowns are highly indicated
for patients with severe bruxism.
 ART (Atraumatic Restorative Treatment)
is also indicated.
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20. 5. Regular professional supervision:
Recall dental visits every 3 months are very
important for those children to re-examine,
re-evaluate the oral and dental conditions and
to apply fluoride if needed.
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21. H. Physical (body) restraints:
Among the general considerations which
are kept in mind and applied by the dentist
when communicating a handicapped child
are the body restraints or immobilization (to
prevent the involuntary or risky movement of
the child).
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22. Indications:
Lack of the child's cooperation due to lack
of maturity or due to physical or mental
disability.
Lack of the child's cooperation and failure
of all behaviour shaping techniques
performed by the dentist
If the safety of the child or the dentist is at
high risk without the use of body restraints.
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23.  Contraindications:
1) With cooperative child.
2) If there is an underlying medical or
systemic problems.
3) Shouldn't be used as a punishment.
4) Shouldn't be used in the first visit.
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24. Intra-oral restraining devices:
Open- wrapped mouth probe.
Rubber bite blocks.
Extra-oral (body control) restraining
devices:
Safety belt.
Pedi-wrap restraints.
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26. Head stabilizing devices:
Fore arm body support.
Head positioner.
Disposable plastic bowl.
Extra assistants.
 N.B.: The choice of G.A. (treatment under
general anesthesia) for disabled child should be
kept in mind if the dentist fails to treat him
under local anesthesia.
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27. Thank You
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