Notes

Outline

Special Patient Care Theory and Practice of Pediatric Dentistry

Lecture Overview Medically compromised Types Medical History and Consults Medications Multidisciplinary Approach Office Designs Dealing w/ Parents Dental Implications Restraints

Introduction Children w/ serious medical and developmental problems often survive for prolonged periods of time. Medically compromised includes - Congenital diseases Acquired diseases Developmental diseases Know all aspects of the disease, including medications. Important for the safety of the patient.

Types of Special Patients Cardiovascular Diseases Coagulation Disorders Respiratory Disorders Renal and Hepatic Disorders Convulsive Disorders Endocrine Disorders Chemotherapy and Radiation Immune Deficiency Disorders Developmentally Compromised Psychobehavioral Disorders Deafness Blindness

Medical History Obtain a good medical history. Get in touch with the child pediatrician and any other specialist. Assess need for premedication. Assess need to alter the current medication prior to dental Tx.

Medical Consults Whenever planning on treating a medically compromised child, always get a medical consult prior to treating the child. Keep a copy of the returned medical consult in the patient’s chart. Ask and Inform - Any concerns, contraindications and premedications required? What you are planning on doing and what type of anesthesia you plan on using Ask for clearance in writing

Medications Always be aware of all medications the child is taking. Know the medications ADR and interactions especially with local anesthesia. Keep an updated PDR or similar book in your office. Keep a copy of the information in the chart for future reference.

Multidisciplinary Approach Best form of management for Special Care patients. Sometimes the dentist can help evaluate the extra-oral and intra-oral findings in the identification of syndromes.

Dental Office modification Barrier free facilities to accommodate wheel chairs etc. Accessible dental operatory floor plans and movable equipment. Handicapped entrances and bathrooms.

Dealing with Parents of Special Care Patients Flexibility w/ scheduling etc. Compassion Over-protectiveness Rejection and Guilt Overindulgence Education

Dental Implications Dental visit Don’t hesitate to develop a rapport w/ the child May require the parent to assist taking radiographs May need to improvise!

Dental Implications Preventive Dentistry Most desirable way of ensuring good dental health especially in the medically compromised child. Formulate an individual program and educate the parent and patient if possible. May need to customize the handles etc for the patient. Constantly reinforce the proper brushing technique, use of restraints and positioning of the child.

Dental Implications Diet and Nutrition Proper diet Make recommendations on an individual basis after consulting with the child’s dietician or MD

Dental Implications Fluoride Exposure Judicious use of topical and systemic if necessary Weigh pros and cons of caries versus mild enamel mottling Preventive Restorations Sealants whenever indicated Placing Amalgams/filled resins in certain cases SSC in some cases

Dental Implications Recall Visits May need to recall every 2,3,4 or 6 months depending on the child’s needs. Management during dental treatment Additional time w/ child and parent May need to use restraints May need sedation or GA

Restraints Partial or complete immobilization Consent You must obtain consent from the parent in writing that you have their permission to use the restraints Types - Mouth Body Extremities Head

Mouth Restraints Molt’s mouth prop rubber bite blocks padded and wrapped tongue blades Caution  Lip and palate lacerations Tooth luxations

Body Restraints Papoose Board Triangular sheet Pedi-wrap Beanbag dental chair inserts Safety belts Extra assistant Parent Caution - interferences with medical devices

Extremity Restraints Posey straps Velcro straps Towel and tape Parent Extra assistant Caution - watch for deformed bones etc.

Head Restraints Forearm-body support Head positioner Plastic bowl Extra assistant Parent

Summary Treating the Special Care patient requires complete familiarity not only with the child’s condition, the medications the child in on and their interactions as well. A medical consults should be obtained if necessary. The parents of these children can show varying emotions and you need to be aware of them when dealing with them. Use of restraints may be necessary, caution must be exercised in their use after getting the necessary consent from the parent.