Special Health Care Needs Flashcards
Definition of special health care needs
Special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.
The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.
6 “critical steps” to ensuring the successful transition from a pediatric-centered to an adult-centered dental home for individuals with SHCN
- All patients with SHCN have a health care provider that take responsibility of the transition
- Identify the core competencies required to provide care for SHCN patients
- To develop a portable, accessible, medical summary to facilitate the transition
- To develop an up-to-date detailed transition plan
- To ensure that the same standards for primary and preventive care are applied
- To ensure that affordable, comprehensive, continuous health insurance is available to patients with SHCN
There is agreement in the literature that specific transition planning should begin between what ages?
14 and 16 years
Barriers to care for SHCN
- Dentistry has been found to be the most common category of unmet health care for children with SHCN.
- Only 10% of surveyed general dentist reported that they treat patients with SHCN often, while 70% reported that they rarely or never treat patients with SHCN.
- 95% of pediatric dentist reported to a survey from the AAPD that they routinely provided care to patients with SHCN.
- There are approximately 10.2 million children with SHCN under 19 years of age (representing 14% of all U.S. children).
- When patients reach adulthood, their oral needs may go beyond the scope of pediatric dentist’s expertise.
- Oral health care for adults with SHCN is often difficult to access because lack of trained providers.
- A 2015 survey of senior dental students noted that the provision of oral health care to patients with SHCN was among the top 4 topics in which they were least prepared.
Preventive strategies
- Education of parents
- Dietary counseling
- Sealants and topical fluoride
- Interim therapeutic restorations
- Toothbrushes with modifications
Pathophysiology of Lesch-Nyhan syndrome
- Inherited as an x-linked trait that affects how the body builds and breaks down purines.
- Individuals affects with this syndrome are missing or are severely lacking an enzyme called hypoxanthine guanine phosphoribosyltransferase (HGP) –> without this enzyme high levels of uric acid build up in the body
- LNS is produced by the mutation in the HPRT1 gene that codes for the enzyme HGP
Clinical manifestation/evaluation of Lesch-Nyhan
- Intellectual disability (mild to severe)
- Speech articulation problems
- Extensor spasm of the trunk
- Self-mutilative behavior (begins with the eruption of teeth)
- Dramatic and extremely rapid loss of tissue –> hallmark
Dental findings for Lesch-Nyhan
- Self mutilating behavior usually involving the lips and fingers
- Tophi on pinna (due to high uric acid)
Epidemiology of Hunter and Hurler Syndrome
- Hurler syndrome, also known as mucopolysaccharidosis type I (MPS I), is a genetic disorder that results in the buildup of glycosaminoglycans due to a deficiency of alpha-L iduronidase (this enzyme is responsible for the degradation of mucopolysaccharides in lysosomes).
- MPS II –> Hunter syndrome
- The overall frequency is 1 per 100,000 births, the MPS as a whole have a frequency of 1 in every 25,000 births.
Clinical evaluation/manifestations for Hurler Syndrome (MPS I)
- Abnormal bones in the spine
- Claw hand **
- Cloudy corneas
- Deafness
- Halted growth
- Heart valve problems
- Joint disease, including stiffness
- Mental cognitive delay that gets worse over time
- Thick, coarse facial features with low nasal bridge
Dental findings for Hunter/Hurler
- Progressive coarsening of facial features
- Papular skin lesions
- Macrocephaly
- Short necks
- Widely spaced teeth and enlarged tongue
Clinical evaluation/manifestation for Sturge-Weber syndrome
- Manifested at birth by seizures accompanied by a large port-wine stain birthmark on the forehead and upper eyelid of one side of the face. **
- The birthmark can vary in color from light pink to deep purple and is caused by an overabundance of capillaries around the ophthalmic branch of the trigeminal nerve, just under the surface of the face.
- There is also malformation of blood vessels in the pia mater overlying the brain on the same side of the head as the birthmark.
- This causes calcification f tissue and loss of nerve cells in the cerebral cortex. - Neurological symptoms include seizures that begin in infancy and may worsen with age. There may be muscle weakness on the same side. **
- Some children will have developmental delays and mental retardation; about 50% will have glaucoma.
Dental findings for Sturge-Weber Syndrome
- Oral manifestations occur in about 40% of patients.
- Bluish-red lesion that blanches on pressure.
- Mostly on the buccal mucosa and lips, less on maxillary gingiva and palate.
- Floor of the mouth, tongue and mandibular gingiva are rarely involved.
- The lesions resemble a vascular hyperplasia or large tumor-like mass.
- Early eruption of teeth reported from increased vascularity.
- Dilantin hyperplasia is common (not any more!)
- Oral hygiene problems in cognitive delay patients.
Special considerations for Sturge-Weber Syndrome
- Major problem is hemorrhage from the angiomas **
- Hospitalization with complete workup is recommended
- For GA, oral intubation may be safer
- Special hygiene aids for patients with intellectual disability
Pathophysiology of neurofibromatosis
- The neurofibromatoses are genetic disorders that cause tumors to grow in the nervous system.
- The tumors begin in the supporting cells that make up the nerves and the myelin sheath.
- Although many affected persons inherit the disorder, between 30 and 50 percent of new cases arise spontaneously through mutation (change) in an individual’s genes. Once this change has taken place, the mutant gene can be passed on to succeeding generations.
Classification of neurofibromatosis
- The disorders is classified as neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis, a type that was once considered to be a variation of NF2. ***
- NF1 is the more common type of the neurofibromatoses. ***
- NF2 is less common and is characterized by slow-growing tumors on the eighth cranial nerves. The tumors cause pressure damage to neighboring nerves.
- The distinctive feature of schwannomatosis is the development of multiple schwannomas (except on the vestibular branch of the 8th cranial nerve). The dominant symptom is pain.
Dental findings for neurofibromatosis
- Enlarged fungiform papilla
- Oral neurofibromas
- Hyperplasia of soft and oral tissues associated with bony hypoplasia
- Malpositioned teeth
- Intrabony lesions
- Wide inferior alveolar canal
Clinical evaluation/findings of Rubenstein-Taybi
- Broadening of the thumbs and big toes
- Constipation
- Excess hair on body (hirsutism)
- Heart defects possibly requiring surgery ***
- Intellectual disability
- Seizures
- Short stature that is noticeable after birth
- Slow development of cognitive skills
- Slow development of motor skills accompanied by low muscle tone
Dental findings for Rubenstein-Taybi
- Small mouth
- Thin upper lip
- Retrognathia
- High arched narrow palate
- Malpositioned crowded teeth
- Talon cusp **
- High caries rate
Clinical evaluation/findings for Treacher Collins Syndrome
(OMENS)
- Orbit - abnormal orbital size and position (O0-O3)
- Mandible - small mandible and short ramus; ramus abnormally short and abnormally shaped; complete absence of the ramus, glenoid fossa and TMJ (M0-M3) ***
- Ear - malposition of the lobule with absent auricle (E0-E3)
- Facial nerve - All branches of the facial nerve are affected (N0-N3)
- Soft tissue - Severe tissue or muscle deficiency (S0-S3)
Dental findings for Treacher Collins Syndrome
- Hypoplasia of the facial bones (underdevelopment of the mandible and zygomatic arch)
- Small mandible —> malocclusion ***
- Cleft palate
- Dental anomalies (60% of patients): tooth agenesis, enamel malformation, ectopic eruption of the first molars
- High arch palate
- Lip incompetency (small mandible)
Clinical finding/evaluation for Pierre Robin Sequence
- Airway obstruction —> if not appropriate treatment: hypoxia, cor pulmonale, failure to thrive, and cerebral impairment
- The most important medical problems are difficulties in breathing and feeding ***
Dental findings for Pierre Robin Sequence
- Micrognathia and retrognathia
- Cleft palate
- Glossoptosis (often associated with airway obstruction): in many cases the tongue is not larger than normal, but because of the small mandible, the tongue is large for the airway ***
Clinical evaluation/findings for Rett Syndrome
• An infant with Rett syndrome usually has normal development for the first 6-18 months
• Symptoms can range from mild to severe.
• Symptoms may include:
- Floppy arms and legs — frequently the first sign **
- Apraxia: a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked even though:
• The request or command is understood
• They are willing to perform the task
• The muscles needed to perform the task work properly
• The task may have already been learned
- Breathing problems — tend to worsen with stress
- Excessive saliva and drooling **
- Intellectual disabilities and learning difficulties **
• Assessing cognitive skills in those with Rett syndrome, however, is difficult because of the speech and hand motion abnormalities
- Scoliosis
- Shaky, unsteady or stiff gait, toe walking; about 50% are not ambulatory
- Seizures (up to 80%)
- Loss of purposeful hand movements; for example- the grasp used to pick up small objects is replaced by repetitive hand motions like hand wringing or constant placement of hands in mouth
- Loss of social engagement ***
- Ongoing, sever constipation and gastro-esophageal reflux (GERD)
- Poor circulation
- Severe language development problems
Most frequent oral habits associated with Rett Syndrome
- Digit/hand sucking and/or biting
- Bruxism
- Mouth breathing
- Drooling
- Tongue thrusting
Additional dental findings for Rett Syndrome
- Gingivitis is the most common alteration of soft tissues.
- Dental attrition is frequently present in these children.
- Palatal shelving could be seen, probably related to the digit/hand sucking and/or biting habits.
- A high prevalence of anterior open bite.
- No associations with anomalies of tooth number, size, form, structure, or eruption.
What is Beckwith-Wiedemann Syndrome?
Congenital growth disorder that causes large body size, large organs, and other symptoms
Signs of Beckwith-Wiedemann Syndrome
• A ridge on the forehead caused by premature closure of the bones (metopic ridge) *** • Enlarged fontanelle (soft spot) • Enlarged kidneys, liver, and spleen • Large size (90th percentile) • Low blood sugar (hypoglycemia) • Macroglossia *** • Midline abdominal wall defects - Omphalocele - Umbilical hernia - Diastasis recti • External ear (pinna) abnormalities and low-set ears
Beckwith-Wiedemann Syndrome and Cancer
- While most children with BWS do not develop cancer, these individuals do have a significantly increased risk of certain childhood cancers, particularly Wilms’ tumor (nephroblastoma) and hepatoblastoma
- Children with BWS are most at risk during early childhood and should receive cancer screening during this time
Dental findings for Beckwith-Wiedemann Syndrome
• Macroglossia is very common (>90%) and a prominent feature of BWS
• Infants with BWS and macroglossia typically cannot fully close their mouth in front of their large tongue, causing it to protrude out
• Macroglossia in BWS becomes less noticeable with age and often requires no treatment; bit it does cause problems for some children
• In severe cases, macroglossia should be evaluated by a craniofacial team for surgical intervention
• The best time to perform the surgery for a large tongue is not known.
- Some surgeons recommend performing the surgery between 3 and 6 months of age.
What is Crouzon Syndrome (Craniofacial Dysostosis)?
- Crouzon syndrome is characterized by the premature fusion of certain skull bones (craniosynostosis) ***
- This early fusion prevents the skull from growing normally and affects the shape of the head and face
Characteristics of Crouzon Syndrome
• Brachycephaly, which results in the appearance of a short and broad head.
• Exophthalmos (bulging eyes due to shallow eye sockets after early fusion of surrounding bones)
• Hypertelorism (greater than normal distance between the eyes)
• External strabismus
• Psittichorhina (beak-like nose)
• Hypoplasia maxilla (insufficient growth of the mid face)
• Crouzon syndrome is also associated with PDA (patent ductus arteriosus) and aortic coarctation
• Relative mandibular prognathism (chin appears to protrude despite normal growth of mandible)
• Cleft lip and palate
• Low-set ears
- Ear canal malformations are extremely common, generally resulting in some hearing loss
• People with Crouzon syndrome are usually of normal intelligence ***
Dental findings for Crouzon Syndrome
- Possible cleft lip and palate
- Narrow/high-arched palate
- Posterior bilateral crossbite
- Hypodontia
- Crowding of teeth
- Due to maxillary hypoplasia, Crouzon patients generally have a considerable negative OJ and subsequently cannot chew using their incisors
What is Ellis-Van Creveld Syndrome (Chondroectodermal dysplasia)?
Ellis-van Creveld syndrome is a rare genetic disorder that affects bone growth.
Anomalies associated with Ellis-van Creveld syndrome
• Post-axial polydactyly (extra fingers) • Congenital heart defects - Most commonly an atrial septal defect producing a common atrium, occurring in 60% of affected individuals • Short-limbed dwarfism • Short ribs • Cleft lip and palate • Various dental abnormalities • Pre-natal tooth eruption • Fingernail dysplasia • Malformation of the wrist bones - Fusion of the hamate and capitate bones
Dental findings for Ellis-van Creveld Syndrome (Chondroectodermal dysplasia)
- Cleft lip and palate
- Natal teeth
- Presence of multiple frenulum and abnormal attachments ***
- Abnormally shaped teeth
- Microdontia
- Congenitally missing teeth
Prominent characteristics of Fragile X (Martin Bell Syndrome)
- Elongated face (vertical maxillary excess) ***
- High-arched palate (related to above)
- Large or protruding ears
- Flat feet
- Larger testes (macroorchidism)
- Low muscle tone and flexible joints
Behavior problems associated with Fragile X Syndrome
• Delay in crawling, walking, or twisting • Hand clapping or hand biting • Hyperactive or impulsive behavior • Intellectual disability • Seizure disorder • Speech and language delay • Atypical social development - Shyness - Limited eye contact - Memory problems - Difficulty with facial recognition
Dental findings for Fragile X (Martin Bell Syndrome)
- Study compared the oral findings in fragile X syndrome individuals to those of normal age-matched patients
- Low caries rate (decayed, missing and filled = 12.3) and minimal intraoral soft tissue disease
- Rate of malocclusion, as determined by the first permanent molar classification, was not significantly different from that of matched subjects
- Fragile X subjects had a significantly higher occurrence of malocclusion as compared to matched subjects using cross-bite and open-bite as criteria
- The fragile X subjects also demonstrated significantly more severe occlusal wear of their teeth than the matched sample
What is Marfan syndrome?
A connective tissue disorder that affects the following:
• Skeletal system:
- Tall with long, thin arms and legs
- Arachnodactyly- “Spider-like” fingers
- Wingspan is much greater than their height
- A chest that sinks in or sticks out—funnel chest (pectus excavatum) or pigeon breast (pectus carinatum)
- Hypermobile joints
- Spine that curves to one side (scoliosis)
- Thin, narrow face
- Cardiovascular system:
- Mitral valve prolapse
- The aorta may stretch or become weak (aortic dilation or aortic aneurysm)
Dental findings in Marfan Syndrome
- High, arched palates ***
- Narrow jaws ***
- Crowding ***
- Small lower jaw (micrognathia) ***
There is limited research regarding specific management of the orthodontic problems commonly seen in people with Marfan Syndrome
Prader-Willi Syndrome symptoms
• PWS is present from birth
• Newborns are small for gestational age
• Have problems sucking and swallowing and often do not gain weight well
• May seem floppy and feel like a “rag doll” when held
• Often have a weak cry
• Obesity:
- Affected children have an intense craving for food and will do almost anything to get it
- This results in uncontrollable weight gain and morbid obesity
- Morbid obesity may lead to lung failure, which includes low blood oxygen levels, right sided heart failure and even death
• Facial features:
- “Almond-shaped” eyes
- Small, downturned mouth
• Irregular areas of skin that look like bands, stripes, or lines
• Limb (skeletal) abnormalities:
- Very small hands and feet compared to the body
Dental findings for Prader-Willi Syndrome
- Soft tooth enamel
- Thick, sticky saliva
- Poor oral hygiene
- Bruxism
Clinical findings/evaluation for tuberous sclerosis (a neurocutaneous syndrome)
- Hypomelanotic macules
- Facial angiofibromas
- Subungal fibromas
Dental findings for tuberous sclerosis (a neurocutaneous syndrome)
- Enamel hypoplasia/pitted enamel — seen in 90%
- Gingival fibromas
- Gingival hyperplasia secondary to seizure meds
What is Sotos Syndrome?
Also known as “Cerebral Gigantism”
Features of Sotos Syndrome
1) Characteristic facial features:
• Long, narrow face
• Unusually large head (height and/or head circumference >=2 SD above the mean)
• High forehead
• Flushed cheeks
• Small, pointed chin
• Down-slanting palpebral fissures
• This facial appearance is most notable in early childhood. Affected infants and children tend to grow quickly; they are significantly taller than their peers. Adult height is usually in the normal range, however.
• The cardinal features for this condition are characteristic facial features, learning disability, and overgrowth. ***
2) Intellectual delay and behavioral issues (ADHD, compulsive behaviors, phobias, obsessions). Learning disabilities can range from mild to very severe (requiring lifelong care).
3) Problems with speech and language
4) Hypotonia [may delay development of motor skills such as sitting and crawlng]
5) May have scholiosis, seizures, heart or kidney defects, hearing loss, and problems with vision
6) Neonatal jaundice
Dental findings for Sotos Syndrome
- Premature eruption of teeth ***
- Second premolar hypodontia
- Enamel defects and excessive tooth wear
- Mandibular prognathism
- High, vaulted palate
- Note: in many cases, fingernails were brittle and thin and patients had sparse frontoparietal hair in early childhood.
Clinical evaluation/findings for hemihyperplasia (hemihypertrophy)
- Cases with hemihypertrophy not fulfilling criteria of complicated hemihypertrophies are grouped under isolated hemihypertrophy or hemihyperplasia (so this excludes Beckwith-Weidemann syndrome, etc.)
- Usually non-progressive and the body disproportion does not change. Bone age may or may not be increased on the hypertrophied side.
- Some cases have other features like nevi, capillary haemangiomas, and hypertrichosis.
- Intellectual disability may be present.
- No specific laboratory abnormalities.
- Viscera (kidney) on the hypertrophied side may be enlarged)
- Risk for neoplasm is about 5% (most common is Wilms tumor — nephroblastoma)
Dental findings for hemihyperplasia (hemihypertrophy)
- Dental issues seen in hemifacial hyperplasia
- Hemimandibular hypertrophy: excessive unilateral growth of the mandible occurs in individuals who seem metabolically normal. Unknown etiology. Usually between ages 15-20 yo. Formerly called condylar hyperplasia. **
Pathophysiology of Oculo-auriculo-vertebral syndrome (Goldenhar; hemifacial microsomia)
- Now believed that Goldenhar and HFM part of spectrum of issues, now referred to as the Oculo-auriculo-vertebral Spectrum.
- Seems to occur around day 30-45 of gestation; may be caused by an early bleed in utero — hemorrhage in the area of the 1st and 2nd branchial arches
- Most cases are sporadic and not familial
Clinical evaluation/findings for oculo-auriculo-vertebral spectrum
- Can be as mild as microtia of one ear or be very severe and include renal, cardiac, and skeletal issues. If bilateral, can resemble Treacher Collins.
- Facial asymmetry.
- Hypoplasia of the facial musculature.
- Frontal bossing.
- Ear - microtia, pinna displaced anteriorly and inferiority, preauricular tags and/or pits, middle ear anomaly with variable deafness.
- Eye - palpebral fissure is somewhat lowered on the affected side; epibulbar dermoids (growth on sclera)
- May have normal intelligence (esp with Goldenhar), but one study found that infants with OAV were at increased risk for neurodevelopmental problems.
- Spinal: hemivertebrae or hypoplasia of vertebrae, usually cervical.
Dental findings for oculo-auriculo-vertebral syndrome
- Oral- diminished to absent parotid secretion, anomalies in function or structure of the tongue ***
- Hypoplasia of malar, maxillary, and/or mandibular region
- Cleft palate with or without cleft lip often seen
Dental findings for fetal alcohol syndrome
- Smooth philtrum, thin upper lip
- Mild micrognathia, hypoplasia mandible
- Flat mid-face
- Minor ear abnormalities
- Cleft palate often
Clinical findings/evaluation for Cornelia De Lange Syndrome
- Low birth weight
- Intellectual disability and growth delay
- Hirutism
- Microcephaly
- Intellectual delay (range from mild to severe) and learning disabilities
- GERD (85% of patients)
- Behavioral issues (self-injury, compulsive repetition, autistic-like behaviors)***
- Prominent facial features: thin eyebrows that often meet at the midline (synophrys), long eyelashes, short upturned nose, thin downturned lips, low-set ears, coloboma of eyes, short neck, high forehead.
- High palate or cleft palate.
- Limb differences: small hands and feet, in curved fifth fingers (clinodactyly), partial joining of the second and third toes, proximally placed thumbs, and upper limb abnormalities, including missing fingers, hands or forearms.
Dental findings for Cornelia De Lange Syndrome
- Micrognathia
- Delayed eruption
- Prognathic maxilla with protruded maxillary anterior teeth
- Class II div I
- Cleft palate
Clinical evaluation/findings for Apert Syndrome
- Craniosynostosis
- Syndactyly (of hard and soft tissues)
- Mid-face hypoplasia
- Cervical spine fusion
Dental findings for Apert Syndrome
- Tooth agenesis (esp of canines)
- Cleft palate/bifid uvula; often see “Byzantine cleft”, which is not a true cleft, but a deep crevice.
- Enamel hypocalcification/hypoplasia
- Supernumerary teeth
- Ectopic eruption of maxillary 1st molars
- Maxillary/mid-face hypoplasia
- Class III malocclusion
- Lateral palatal swellings
- Delayed eruption
- Shovel-shaped incisors
Clinical evaluation/findings for Turner Syndrome
- Swollen hands and feet
- Wide and webbed neck
- Absent or incomplete development at puberty, including sparse pubic hair and small breasts***
- Broad, flat chest shaped like a shield
- Drooping eyelids
- Dry eyes
- Infertility
- Absent menstruation
- Short height
Dental findings for Turner Syndrome
- Micrognathia
- Premature eruption of permanent molars
- High arched palate
- Malocclusion
Clinical evaluation/findings for Noonan syndrome
- Delayed puberty
- Down-slanting or wide-set eyes
- Hearing loss
- Low-set or abnormally shaped ears
- Mild intellectual disability (only in about 25% of cases)
- Sagging eyelids (ptosis)
- Small penis
- Short stature
- Undescended testicles
- Unusal chest shape (usually a sunken chest called pectus excavatum)
- Webbed and short-appearing neck
- Pulmonary stenosis
- Other possible heart defects are hypertrophic cardiomyopathy, atrial septum defect, ventricular septum defect, septal hypertrophy or a combination of all of these defects.**
Dental findings for Noonan syndrome
- 1/3 of children with Noonan syndrome have malpositioned teeth.
- Delayed eruption and atypical eruption sequence.
Dental findings for Lowe Syndrome (Oculo-cerebro-renal syndrome)
- Periodontal disease with severe bone loss (due to defective inositol phosphate metabolism)***
- Impaction of permanent teeth
- Taurodontism***
- Underdevelopment of the maxilla and mandible
Clinical evaluation/findings for Klinefelters
- Only in males***
- Many men who have Klinefelter syndrome do not have obvious symptoms.
- Weak muscles
- Slow motor development
- Sparse body hair
- Enlarged breasts
- Wide hips
- Small testicles
- Penis may not reach adult size
- Voice may not be as deep
- Infertility, but can have normal sex life
- Some have language and learning problems
Dental findings in Klinefelters
- Maxillary and mandibular prognathism
- Permanent tooth crowns larger than usual
- Taurodontism***
- No recognizable features apparent at birth
Pathophysiology of Down Syndrome
A chromosomal condition characterized by the presence of an extra copy of genetic material on chromosome 21 (trisomy 21); 47 chromosomes instead of the usual 46
Common characteristics and physical signs of Down Syndrome
- Intellectual disability
- Stunted growth
- Atypical fingertips
- Flexible ligaments
- Decreased muscle tone at birth
- Brachycephaly
- Shortened extremities
- Oval palate
- Small teeth
- Macroglossia
- Low set and rounded ears
- Flattened nose
- Short neck
- Congenital heart disease***
- Separated joints between the bones of the skull (sutures)
- Single crease in the palm of the hand
- Upward slanting eyes
- Wide, short hands with short fingers
- White spots on the colored part of the eye (Brushfield spots)
Dental findings for Down Syndrome
- Microgenia (small chin)
- Macroglossia
- Microdontia (small teeth)
- Delayed eruption of teeth
- Small conical roots
- Hypodontia or partial anodontia
- Oval palate
- Hypoplasia of mid-facial region
Dental findings for Cri-du-chat (French term “Cat-cry” or “Call of the cat”)
- Micrognathia
- High palate
- Variable malocclusion (more commonly anterior open-bite)
- Cleft lip and palate
- Most patients also present with perioral muscle relaxation with labial incompetence and short philtrum
- These patients suffer dental erosions provoked by gastro-esophageal reflux and attritions because of intense day-and-night bruxism
Clinical evaluation/findings for achondroplasia
- Abnormal hand appearance with persistent space between the long and ring fingers
- Bowed legs
- Decreased muscle tone
- Disproportionately large head-to-body size difference
- Prominent forehead (frontal bossing)
- Shortened arms and legs (especially the upper arm and thigh)
- Short stature (significantly below the average height for a person of the same age and sex)
- Spinal stenosis
- Spine curvatures called hypnosis and lordosis
Dental findings for achondroplasia
- Depressed nasal bridge
- Maxillary hypoplasia
- Disturbed genesis of the teeth
- Disturbed development (partially formed)
- Disturbed eruption
- Shape abnormalities
What is attention deficit hyperactivity disorder (ADHD)?
- A neurobehavioral disease that is defined by persistent and maladaptive symptoms of hyperactivity/impulsivity and inattention.
- Also associated with several comorbid conditions and disorders such as mood disorders, disruptive behavior, and learning disabilities.
- Although diagnosed as a categorical disorder, ADHD may actually represent the extreme end of a normal continuum for traits of attention, inhibition, and the regulation of motor activity.
- Current advances in cognitive neuroscience and behavioral and molecular genetics have provide evidence that ADHD is a complex neurobiological disorder.
