Paediatric Special Needs

Question 1

what are the classification of disabilities?

Answer 1

intellectual/behavioural (autism etc)

physical (cerebral palsy)

sensory (vision, hearing)

medically compromised (cardiac etc)

Question 2

what is autism spectrum disorder (ASD)?

Answer 2

used to describe a lifelong developmental disorder which affects with peoples interactions and communication

Question 3

what are some clinical implications with patients with disabilities?

Answer 3

difficulty with:

• social communication, verbal and non-verbal
• social interaction, expressing or recognising emotions/feelings
• changing routine to come to a dentist
• sensory difficulties like noises and bright lights

Question 4

what are some dental features of down syndrome?

Answer 4

Maxillary hypoplasia
class 3 occlusion
anterior open bite
hypodontia (born without some teeth)
predisposition to periodontal disease

Question 5

what are the 3 main types of cerebral palsy?

Answer 5

spastic (80% of them) [increased muscle tone]
ataxic (co-ordination/balance)
dyskinetic (uncontrollable movements)

Question 6

what are some dental considerations for a patient with cerebral palsy?

Answer 6

difficulty tolerating dental treatment
increased rate malocclusion
drooling
poor oral hygiene
periodontal disease
high prevalence of bruxism (clenching)
etc

Question 7

what is the most common childhood cancer?

Answer 7

leukaemia

Question 8

what is leukaemia

Answer 8

blood cancer of WBC

Question 9

what are the implications for dental care of a child with cancer?

Answer 9

Dental hygiene needs to be good before cancer therapy since it can be very damaging and taxing on the body

children with cancer are managed by the dental team in the children’s hospital

Question 10

what are the dental implications of a child with a congenital cardiac defect?

Answer 10

meds which increase bleeding tendency (warfarin/aspirin)
higher risk of GA
careful use of adrenaline containing LA
increased risk of enamel hypoplasia
risk of infective endocarditis from oral bacteria in blood stream

Question 11

what is infective endocarditis?

Answer 11

infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel

Question 12

why are patients with infective endocarditis at a greater risk if they have poor oral hygiene?

Answer 12

risk of bacteremia

they must have good oral hygiene to avoid any infection or requiring any major treatment that can expose blood stream like extractions etc

Question 13

what are some invasive dental procedures?

Answer 13

placing matrix bands
sub-gingival rubber dam clamps
PMPR subgingival
extractions
implants
preformed metal crowns
endo treament

Question 14

what are some non-invasive dental procedures?

Answer 14

infiltration/block of LA
BPE
supra gingival restoration/scaling
removing sutures
radiographs

Question 15

what are the name of some bleeding disorders?

Answer 15

von willebrand’s disease
haemophilia A & B

Question 16

what is von willibrand disease?

Answer 16

inherited deficiency of von willibrand factor. Affects platelet adhesion and aggregation

Question 17

what is haemophilia?

Answer 17

lack of clotting factors = increased bleeding tendency

haemophilia A = factor VIII
haemophilia B = factor IX

Question 18

what are the impacts of dental disease in children with disabilities?

Answer 18

• increased risk of caries
  delayed diagnosis
  delayed management
  need for multidisciplinary planning
  pain/infection can be difficult to manage
  health risk posed by dental infection
  risks posed by dental treatment

Question 19

what are some main dental findings in a special needs patient?

Answer 19

• anomalies of tooth number
  anomalies of tooth size
  dental trauma
  periodontal disease
  calculus accumulation
  grinding