Dental management of handicapped children

1. Dental Management of
Handicapped Children
Dr. Amal Abdulkader

2. Disabled childe or Handicapped child
includes all the children that have:
* Mental conditions.
* Physical conditions.
* Medical conditions.
* Social conditions.
Interferes with normal functioning.

3. 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.

4. Common oral & dental problems
- Poor oral hygiene plaque.
- Gingivitis & periodontitis.
- Caries lesions:
* soft diets  sugar.
* Psycho drugs  salivation .
- Malocclusion.
- Dental abrasions.
- Para functional habits (Bruxism)

5. 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)

6. 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.

7. 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 & syndromes
that can cause or accompany mental retardation.

8. 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

9. Down's Syndrome
we 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

11. Dental treatment of a child with mental
retardation
1- 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.

12. 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.

13. Three most common types of
:neoromuscular dysfunctions
• Spasticity.
• Athetosis.
• Ataxic.

14. Classification according to affected
:area by this disorder
• Monoplegia.
• Hemiplegia

15. • Paraplegia.
• Diplegia.

16. • Quadriplegia

17. Dental Problems

18. :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

19. Patients with sensorial disabilities
• Visual Impairment.
• Hearing Loss.