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 -3-
Dr. Hazem El Ajrami
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3. 5. Sensory handicapping conditions
A. Deafness and hearing impairments.
B. Blindness and visual impairments.
A. Dental management of patient with hearing
impairment:
 Oral manifestations:
Sometimes deafness is accompanied by:
 Bruxism.
 Poor oral hygiene due to inability to learn
adequately oral hygiene instructions.
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4.  Dental management:
1) In the first appointment determine how the
child desire to communicate e.g.:
 With lip reading.
 With sign language.
 Writing notes or combination of these.
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5. 2) Face the patient and maintain visual contact
with him.
3) Employ Show - Do approach and allow the
patient to use other sensations as taste or
touch to communicate.
4) If the child is wearing a hearing aid, it should
be turned off before dental procedure, as
those children are very sensitive to vibration
coming out of hand-piece.
5) Keep smile, calm and communicate kindly.
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6. B. Dental management of patient with visual
impairment (Blindness):
 Oral manifestations:
1. Poor oral hygiene due to visual impairment.
2. Hypoplastic teeth.
3. Traumatic injury shows an increased
incidence than normal child.
4. Early childhood caries due to prolonged
bottle-feeding.
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7.  Dental management:
1. Describe the dental office in details.
2. Sit close to the patient and maintain physical
contact with the child e.g. holding his hand.
3. Allow the patient to ask questions about the
treatment.
4. Utilize Tell - Do approach and allow the
patient to touch, taste and smell for
explaining the treatment.
5. Maintain a relaxed atmosphere and limit the
patient's dental care to one dentist.
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8. 6. Respiratory disorders
Asthma
 Definition:
It is a chronic inflammatory disease of the
airway and characterized by cough, wheezing,
chest tightness and shortness of breath.
 Oral manifestations:
1) High caries rate due to:
 Repeated administration of medicines
containing sugars.
 Also prolonged use of bronchodilators can
lead to decreased salivary flow rate.
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9. 2) Repeated use of corticosteroids can lead to:
 Dry mouth.
 Oral candidiasis and sometimes tongue
enlargement.
3) Gingivitis:
Patients with asthma show a high rate of
gingivitis due to:
 Frequent inhalation of steroids.
 Mouth breathing.
 Impaired immunological factors.
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10. 4) Oro-facial abnormalities due to:
 Impaired respiratory function.
 Mouth breathing.
Studies showed that there is an increase in
the facial height, high palatal vault, greater
overjet and high prevalence of posterior
cross- bite.
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11.  Dental management:
General consideration:
I. Oral hygiene instructions and fluoride
supplements.
II. Instruct the patient to rinse his mouth after
using the inhaler.
III. Prescribe antifungal drug for patients taking
corticosteroids nebulizer.
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12. In the dental office:
1) The major concern of the dentist is to prevent
the acute attack in the clinic. Therefore, the
patient should bring the inhaler
(bronchodilator) at each visit.
2) Antihistaminics could be taken to minimize
bronchoconstriction.
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13. 3) The dentist should avoid certain factors that
may predispose the attack during dental
treatment as:
 Improper positioning of suction tip, cotton
rolls and fluoride trays position.
 Prolonged supine position.
 Any material with a strong odor as
methylacrylate, enamel or dentin dust or
rubber dam sheets.
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14. If the attack occurs during dental treatment:
The dentist should immediately discontinue
the procedure and allow the patient to assume
more comfortable position.
Establish and maintain a patent airway.
Give oxygen via a facemask.
The dentist can give epinephrine 0.01 mg/kg
subcutaneously to a maximum dose 0.3 mg.
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15.  General anesthesia is not preferred as:
1) It may lead to hypoxia and pulmonary
edema.
2) There is a risk of postoperative lung
collapse.
Therefore, patients require bronchodilator
before general anesthesia.
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16. 7. Mental handicapping
• Down's syndrome: (Mongolism, Trisomy 21)
Down's syndrome is the leading cause of
mental retardation. It occurs in about 1 of
every 660 live births. It is associated with an
extra chromosome 21, so each cell contains
three number 21 chromosomes rather than
two. This syndrome is most common among
first born infants of women over 35 years of
age.
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17.  Clinical features which influence the dental
and oral health:
1) Mental retardation.
2) Abnormal immune system with high
incidence of periodontal diseases which
may be aggravated by some local factors
such as tooth morphology, bruxism,
malocclusion and poor oral hygiene.
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18. 3. Chronic upper respiratory tract infection due
to:
 Mouth breathing
 Xerostomia.
4. Hypotonia: decreased muscle tone of the lips
and cheeks which may lead to inefficient
chewing.
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19.  Oral manifestations:
1) Prognathic Class III relationship, which lead
to open bite.
2) Mouth breathing and xerostomia.
3) Protruded scrotal tongue.
4) Delayed teeth eruption and exfoliation.
5) Microdontia and partial anodontia.
6) The roots of the teeth tend to be small and
conical.
7) Rapid destructive periodontal diseases.
8) Lower caries index.
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20. Dental management:
Many children with Down's syndrome are
affectionate and cooperative, and dental
procedures can be provided without
compromise if the dentist works slightly slower
pace. Light sedation and immobilization may be
indicated in those children who are moderately
apprehensive. Severely resistant patients may
require general anesthesia.
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21. Thank You
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