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.