GOVERNMENT COLLEGE OF DENTISTRY

Dept.of Pedodontics

Presented By-Sonam Gehi

Vidhya Bhikonde

TREATMENT OF SPECIAL CHILD

Definition-American Association Of Pediatric Dentistry (1996) states , a person should be considered dentally handicapped if there is pain , infection, or lack of functional dentition that affects him/her as follows :Restricts consumption of a diet adequate to support growth and energy needs.Delays or otherwise alters growth and development.Inhibits performance of any major life activity including work , learning , communication , and recreation.

CLASSIFICATION-• Blind Or Partially blind• Deaf Or Partially deaf• Educationally Subnormal• Epileptic• Maladjusted• Defective In Speech• Senile

Frank and Winter (1974)

• Intrinsic• Extrinsic

Agerholm (1975)

• Developmentally disabled child• Medically compromised child

Convenience Of Management

Physically Handicapped

Mentally Handicapped

Congenital Defects

Convulsive Disorders

Communication Disorders

Systemic Disorders

Metabolic , Osseous , Malignant Disorders

NOWAK (1976)-

PHARMACOLOGICAL METHODS- PremedicationSedative and hypnoticsAnti-anxiety drugsAntihistamines

Conscious sedationGeneral anesthesia

Dental Treatment Of A Child

With Mental Retardation Behavior management techniques.

Dental procedures must be explained slowly, simply and repetitively.

Give only one instruction at a time.

Actively listen to the patient.

The visits should be short.

Gradually progress to more difficult procedures.

We must learn from the parents or guardians about the patients habits, comprehensive words or gestures to facilitate our work.

Use of physical restrictions on patients.

Consideration of patient behavior, age and type of treatment needed.

Need of helpers.

Sedation techniques.

Use of general aneasthesia.

GENERAL MANIFESTATIONS

ORAL MANIFESTATIONS

SPECIAL CONSIDERATIONS-

Incidence of cardiac disease.

Incidence of leukemia and acute and chronic infections.

Role of nitrous oxide analgesia, TSD , general anesthesia.

PREVENTIVE MEASURES.

Pulp treatment.

PHYSICALLY HANDICAPPED

CLASSIFICATION-Based on anatomical involvement-

Based on neuromuscular involvement-

DENTAL PROBLEMS DENTAL CARIES-

PERIODONTAL DISEASE-

MALOCCLUSION-

BRUXISM-

TRAUMA-

TONGUE THRUSTING-

MOUTH BREATHING-

TREATMENT- Thorough medical and dental history should be taken, maintain calm atmosphere , be empathetic.

Modification of regular toothbrushes to cope with grip or arm extension problems are usually easily done.

Correction of malocclusion.

Patients preference to be treated in the wheelchair.

Patient’s head stabilization.

Physical restraints.

Minimize startle reflex.

Use of local anesthesia.

Use of rubber dam ,gauze shields.

Premedication.

Use of general anesthesia.

Use of sealants and stainless steel crown on permanent posterior tooth..

COMMUNICATION DISORDERS

BLINDNESS•About 10 % of children below 20 yrs of age have visual defects.

•A person is considered affected by blindness if visual acuity does not exceed 20/200 in the better eye ,with the correcting lenses, or if the visual acuity is greater than 20/200 but accompanied by a visual field of no greater than 20 degrees.

•A dentist providing treatment for these patients first determine the degree of sight present , overall personality defects and speech disorders are most frequently observed along with blindness.

SNELLEN’S TEST TYPE TEST FOR VISUAL ACUITY

DENTAL PROBLEMSProlonged immature swallowing pattern due to reluctance to consume solid foods.

Poor oral hygiene related to learning disabilities as well as hypoplastic teeth.

Trauma to anterior teeth also occurs with a higher frequency.

Increased gingival inflammation due to inability to visualize and remove the plaque.

TREATMENT Complete medical history along with the degree of visual impairment is ascertained prior to treatment.

Paint a picture in the mind of your patient describing office settings , office personnel, and treatment procedures before starting anything.

Make physical contact reassuringly and do not suddenly grab or move patient without prior notice.

The dentist can make use of TTS rather than TSD

Many visually impaired child are photophobic.

Avoid using any signs, expressions of pity and references to blindness as an affliction.

Oral hygiene education.

THANK YOU!!