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1
The Bisphosphonate Challenge● Bisphosphonates are experimental
and may increase bone density and lessen pain
● They reduce life of osteoclasts and let osteoblasts produce bone
● Now used in osteogenesis imperfecta and other fibro-osseous conditions
● Used for osteoporosis in children with profound disability and no mobility
• No evidence of BRONJ in kids• Possible implications for tooth
eruption, movement, avulsion, implants
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The Bisphosphonate Challenge
● No evidence or guidelines exist for children• Consult with MD● IV BIS is worse than oral BIS for BRONJ• Consider discontinuation of BIS for three months
prior to oral surgery• Allow tissues to fully heal before beginning BIS
therapy if possible
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Cancer or Sickle Cell Disease?● Hydroxyurea is an antineoplastic
now used to reduce frequency and severity of sickle cell crises
● Antibiotics are not routinely requested for dental treatment of children with SCD
• Consult MD about need for supplemental antibiotics if taking penicillin
• Request blood studies if on hydroxyurea (Hydrea) and surgery needed
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What Does Evidence Say About Care?
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Pulp Therapy and Infection RiskIs there evidence to preclude pulptherapy for children with heart disease?● Traditionally, pulp therapy was not
recommended in congenital heart disease or cancer patients
● Success rates have improved● Life span has improved requiring
some sort of long-term consideration for tooth replacement
● Space maintainers and removable appliances may present greater risk of infection
• OK to do vital pulpotomies in some patients
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Prematurity/Low BirthweightDo They Present Dental
Challenges?Today, thousands of
babies are saved in
NICUs and grow up to
become happy
healthy children, but
many bring with them a
host of developmental
problems that impact
oral health
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Premies and Behavioral Problems • Klassen AF et al. Health status and health-related quality of
life in a population-based sample of neonatal intensive care unity graduates. Pediatrics 2004;113:594-600.
• Doyle LW et al. Outcome at 14 years of extremely low birthweight infants: a regional study. Arch Dis Child Fetal Neonatal Ed 2001;85:F159-64.
• Hack M et al. Outcomes in young adulthood for very-low birthweight infants. N Engl J Med 2002;346:149-57.
● These children grow up to have lower IQs, learning problems, and more general health problems, but they don’t get into trouble typical for many teens!
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Not All MDs Agree on AB CoverageFor Dialysis Patients
• Tong RC et al. Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment. Nephrology 2004;9:167-70.
● Give ABs if artificially created shunt
● No ABs if peritoneal dialysis● No ABs for hemodialysis● Always check with MD
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What About Periodontal Disease in These Obese DM2 Kids?
● We’re not sure yet; too soon to tell• Aren G et al. Periodontal health, salivary status, and
metabolic control in children with type 1 diabetes mellitus. J Periodontol 2003;74:1789-95.
● Compared 16 children with newly diagnosed DM, 16 long-term DM (4 yrs) and 16 healthy controls
● Perio Index: HC<ND<LT ● Pocket depth same for HC and ND but deeper for LT● LT had > bleeding on probing than other two
groups