Dental Management of Handicapped Children

Dr. Amal Abdulkader

Disabled childe or Handicapped child includes all the children that have:

* Mental conditions.* Physical conditions.* Medical conditions.* Social conditions.

Interferes with normal functioning.

Handicapped patients in dental clinic

First Dental Visit:- Initial dental examination.- Establish an excellent

relationship with the parents, guardian and the patient.

- Through medical & dental history.

- You must be prepared to discuss the patient health status & possible planned dental treatments with the physicians.

- Poor oral hygiene plaque.- Gingivitis & periodontitis.- Caries lesions:

* soft diets sugar.

* Psycho drugs salivation .- Malocclusion.- Dental abrasions.- Para functional habits (Bruxism)

Common oral & dental problems

At the time of treatment we must consider factors such as :

• The level of dependency • Type of disability. • Associated systemic disease. • Effects of medications.• Level of oral hygiene.• Malocclusion.• Para functional problems related to mastication.

Presence of frequent dental traumas.• Behavior during treatment.• Patient's diet:

(Type, texture, frequency and the quantity of carbohydrates consumed)

Classification of disabled patients There are several classification of disabled patients, we

grouping them by the following manner:

• Disabilities by specific dentistry problems. • Physical disabilities.• Sensorial disabilities.• Neuro-psychological disabilities.• Disabilities by renal diseases.• Disabilities by chronic diseases.• Disabilities by immunological diseases. We are only refer to Neuro-psychological disabilities and

Sensorial disabilities.

Neuro-psychological disabilities

Mental retardation. term used when an individual's intellectual development is significantly

lower than average and whose ability to adapt to their environment is consequently limited.

The WHO recommends the division of the mentally subnormal into three broad categories:

1-Mild Subnormal_ with IQ of 50 to 69 and a mental age in the adult of 8 to 12 years. 2-Moderate Subnormal_ with IQ of 20 to 49 and a mental age in adult of 3 to 7 years. 3-Sever Subnormal_ with IQ of 0 to 19 and a mental age in the adult of 0 to 2 years.

• There are many organic causes & syndromesthat can cause or accompany mental retardation.

Dental Problems Anomalies in the dento facial morphology and in

the dental eruptive pattern.

Enamel hypoplasia.

Delayed eruption.

High palatal vault with a hypoplastic maxilla.

Tendency for Class II malocclusion with an open bite.

Over retained primary dentition

Down's Syndromewe may found:= supernumerary teeth. = Microdontia.= Macroglosia. = A bifid, fissured or excrotal

tongue. There are specific facial

characteristics, ocular anomalies and premature fusion of the cranial sutures in these patients.

High incidence of rapid destructive periodontal disease

Dental treatment of a child with mental retardation1- Behavior management techniques can be used for patients with mild or

moderate retardation 2- Dental procedures must be explained slowly, simply and repetitively. 3- Give only one instruction at a time. Reward the patient with compliments after

each procedure. 4 - Actively listen to the patient. People with mental retardation often have trouble

with communication. 5- The visits should be short. Minimal new procedures should be introduced at

each appointment. 6- Gradually progress to more difficult procedures. 7- We must learn from the parents or guardians about the patient's habits,

comprehensive words or gestures to facilitate our work 8- Before using physical restriction on patients, suitability must be considered for

each case and with parental or guardian consent. 9- We must consider the patient's behavior, his age and the type of dental

treatment needed. 10- We may utilize elements of partial or total restriction, or the collaboration of 2

or 3 helpers. 11- Sedation techniques can also be used such as oral premeditation. 12- General anesthesia should be used only in cases where physical restriction,

behavior management and conscious sedation have all failed or were ineffective in providing the most efficient care.

With adequate preparation the Dentist and the staff can provide a valuable service. By thoroughly understanding the patient's degree of mental retardation and abilities and by exercising patience and understanding, the Dentist should have not significant problems in delivering dental care.

Cerebral Palsy Not a specific disease entity is a

collection of disabling disorders caused by insult and permanent damage to the brain in the prenatal and perinatal periods, during which time the central nervous system is still maturing. This disability might involve muscle tone with disruption of movement and posture, dysfunction and paralysis.

Three most common types of neoromuscular dysfunctions:

• Spasticity.• Athetosis.• Ataxic.

Classification according to affected area by this disorder:

• Monoplegia.

• Hemiplegia

• Paraplegia.

• Diplegia.

• Quadriplegia

Dental Problems

Dental treatment:• The chair should be recline and pillows

used to fasten and adapt to the body.

• Small children can sit on their parents’ shoulders.

• Consultation with the child physician for treatment with premedication

Patients with sensorial disabilities

• Visual Impairment.

• Hearing Loss.