MS2 - Medically Compromised Children Flashcards
What should you consider when making definitive treatment plans for medically compromised children?
-History / condition
-risk assessment
-Diagnosis
-prevention
-conjunction with specialist and child’s doctor
-is hospital admission required for dental tx?
How many children with Down Syndrome have a congenital heart defect (CHD)?
70%
what is the most common type of heart condition in paediatric pts?
CHDs
(80% of heart conditions in paeds pts, 10% of these are part of other syndromes/chromosomal abnormalities)
*what may be some medical implications to consider in a child with CHD?
-risk of bacterial endocarditis (especially with any valve defects)
-anticoagulant therapy -> bleeding tendency
- other medical conditions / syndromes
- possibility of oxygenation issues
- possibility of blood pressure issues
What are the clinical features of a cardiac conditons?
-Dyspnoea - SOB
-Cyanosis
-Clubbing of fingers
-Heart murmurs, clicks or thrills
-Heart rate affected
what possible oral features can present in children with CHDs? (2)
-enamel developmental defects
-Increased risk of caries (medications, compliance, diet)
What oral feature in primary dentition would lead you believe there may be an underlying genetic issue?
Generalised enamel hypoplasia
If a child with cardiac conditions presents with any pulpal infection in a primary tooth, how should you treat this and why?
Extraction
Avoid pulp therapy in primary teeth in pts with cardiac conditions - reduce risk of bacterial endocarditis
Can you use LA with adrenaline in a child with cardiac conditions?
Yes, provided it is administered carefully (aspirate)
What are the indications for Antibiotic Prophylaxis?
-Prosthetic heart valve
-History of IE
-RHD in low socio-economic group
-Congenital heart disease with unrepaired cyanotic defect
-congenital heart disease with residual defects at/adjacent to a prosthetic device
-uncontrolled Immunodepression (eg. transplant, HIV, etc)
Explain the 3 basic steps of clotting cascade after there is injury to a blood vessel
- vascular spasm
- Platelet plug formation
- coagulation
Is a pt is taking NSAIDs/aspirin, what would it tell you about the management of that pt?
-would cause an acquired qualitative platelet disorder
-> may have failure of initial clot formation
If a patient has platelet disorders, how should you manage the patient?
-Management of platelet levels - refer to GP for blood test
-Avoid nerve blocks (avoid injury to blood vessel in case excessive bleeding occurs)
-Avoid extractions - consult GP
-good surgical technique and local haemostatic measures
What are some examples of acquired coagulation disorders?
-Haemophilia A, B and C
-Vik K deficiency
-Renal failure
-Liver disease
-Bone marrow suppression
When considering an invasive dental procedure in a patient with haemophilia, what should you warm them of?
In haemophiliac pts, bleeding can be delayed by several hours (as primary haemostasis is not impaired)
*What are dental management strategies / consideration for pts with coagulation disorders?
-Liaise with haematologist
-Avoid oral surgery / invasive procedures in the general dental setting
-Avoid prescription of drugs that exacerbate bleeding (eg. NSAIDs)
-For LA
* Use vasoconstrictor
* Nerve blocks require haematological prophylaxis
-appropriate local haemorrhage control
Is it safe to use LA in pts with anaemia?
Yes
*What are the oral manifestations of anaemia?
-*soreness of the tongue and oral mucosa
-recurrent ulcerations
-angular cheilitis
-atrophic glossitis
What should you consider when treating a pt with haemolytic anaemia?
Consult doctor whether abx prohylaxis is required
what are some oral features of pts with immunodeficiencies?
-candidiasis
-recurrent aphthous ulcers
-recurrent herpetic infections
-gingival and periodontal disease
-premature primary tooth exfoliation
how should you manage pulpally involved teeth in a pt with immunodeficiency?
primary tooth -> always extract
Permanent tooth -> weigh risks and benefits of treatment and condition
How should you treat oral candidiases in Newborns and children younger than 2? (2)
either
1. Nystatin liquid (100,000 units/mL) - 1mL topically at the tip of the tongue then swallow - 4x daily after feeding for 7-10 days (continue 2-3 days after symptoms resolve)
or
2. Miconazole 2% gel - 1.25mL topically then swallowed - 4x daily after feeding for 7-10 days, continue for 10 days after feeding
How do you treat oral candidiasis for children over 2 years old? (3)
- Nystatin liquid (100,000 units/mL) - 1mL topically (then swallowed) - 4x daily after food, continue for 2-3 days after symptoms resolve
or - Miconazole 2% gel - 2.5mL topically then swallowed - 4x daily after food, continue for 2-3 days after symptoms relieve
or - Amphotericin B - 10mg lozenge sucked then swallowed - 4x dialy after food for 7-10 days, continue 2-3 days after symptoms resolve
*Oral signs / symptoms of cancer?
-non-healing ulcer >2 weeks
-unexplained pain in the mouth
-displacement of teeth
-bony expansion
-trismus
-numbness
-lymph node involvement
-change in voice/sore throat
What drugs should you NOT prescribe a pt with renal conditions?
Nephrotoxic drugs - eg. Paracetamol, Penicillin, Tetracyclines
What are important considerations when treating a pt with liver disease? (2)
-Altered coagulation (Vit K deficiency)
-Immunodepression -> consult specialist about abx prophylaxis
What should be done prior to tx in a pt with endocrine disorders?
- Liase with endocrinologist about appropriateness of steroid prophylaxis
What is a dental manifestation of Hypothyroidism?
- delayed eruption of teeth -> primary teeth may be over-retained
What is a dental manifestation of hyperthyroidism?
Premature eruption of teeth
If you see a premolar tooth in a 5 year old pt, what may you suspect?
May be Hyperthyroidism -> refer to GP/ specilaist
What considerations should you take when treating a pt with respiratory conditions eg. asthma?
- Avoid NSAIDs
- Avoid rubber dam to avoid triggers
- avoid long appts
- avoid potential alergens - eg. strong odours, stress
What is the dose of epinephrine for children in case of anaphylaxis and where to inject?
300ug into antero-lateral aspect of thigh
what is the epinephrine dose for adults undergoing anaphylaxis?
500ug
Can you do pulp therapy in pts with down syndrome who have cardiac conditions?
NO
*what are the dental and orofacial features of a pt with Down Syndrome?
- macgroglossia
- Class III - concave look
- AOB
- Underdeloped mis 1/3 of face
- periodontal disease
- Supernumerary or missing teeth
- Delayed eruption
- high palatal arch
- bifid uvula
- Low set ears
- short neck
- depressed nasal septum
What do you need to consider when treating a pt with down syndrome for invasive treatment?
Abx prophylaxis - especially if they have CHD
