W5 - Mgmt of the "Special" Child - Mani Flashcards
Describe the behaviour of retarded children (3)
- Short attention span
- Restlessness / Hyperactivity
- Erratic Emotional behaviour
Secondary dental consideration of retarded kids
- High dental caries
- Periodontal problems
- Enamel hypoplasia
- not directly caused by mental deficit*
- these pts are probably cared for by parents/caretakers → they have bigger problems than dental care*
How to manage mentally retarded pts (5)
- Familiarize pt to clinic
- Slow and simple speech
- One instruction at a time
- Short, morning appointments
- Listen to them carefully
Physical features of downs’ heads (not oral feats) (4)
Flat nasal bridge
Flattened face
Round skull
Small maxilla
IQ retarded
Features of Downs’ eyes (3)
Oblique palpebral fissures (upward slanted)
Scanty eyelashes
Epicanthic folds
Feats of Downs’ neck, muscles and joints
Short neck
Hypotonic muscles
Hyper extensive joints
Associated medical conditions with Downs (4)
Congenital heart problems (ASD, VSD) → consider AB
Acute lymphoplastic leukemia
Duodenal atresia
Umbilical Hernia
Oral manifestations of Downs (8)
KNOW ALL
Relative macroglossia
Thickened lips
anterior open bite
High arched palate
Bifid uvula
Delayed eruption
Perio
Hypo and microdontia
Dental tx of Downs pts
AB prophylaxis
Normal preventive regimen
Tell show do / sedation / GA
Pulp therapy contradicated if they are cardiac pt
Pt comes in
Has downs, cardiac condition, pulpally involved primary tooth.
Tx?
Extract
Pulp therapy contraindicated in cardiac conditions
Pt comes in
Has downs, no cardiac condition, pulpally involved primary tooth.
Tx?
Pulp therapy as needed
Treat as normal
Must confirm they do not have any cardiac condition
What is CP
Cerebral palsy
Nonprogressive lesion which occurs in developing brain
/ Damage to CNS
Etiology of CP (4)
Meningitis
Toxemia
Jaundice
Metal poisoning
Describe how CP affects movement (5)
Spastic and Dyskinetic
Increased motor tone → difficulty in moving limbs
Limited control of neck muscles
Lack of coordination of intraoral, perioral and masticatory musculature
Involuntary movements (slow writhing, quick jerking)
Facial grimacing
Are removable appliances (ex. space maintainers) appropriate for CP?
Depends on the severity of the spastic, uncontrolled movements
- not directly contraindicated
Feature of ataxic CP
Poor uncoordinated movements
Difficulty in grasping objects
What is asymmetric tonic neck reflex
Seen in CP pts
when pts head is turned to one side, the arm and leg on that side will extend and stiffen
The opposite side will flex
What is the tonic labyrinthine relex
Seen in CP pts
IF pts head falls backwards, back will arch and arms and legs will straighten out (postural extension)
3 reflexes seen in CP
Startle reflex
Tonic labyrinthine reflex
Asymmetic tonic neck reflex
Dental problems of CP pts (5)
Dental caries
Perio
Overjet & Openbite
Bruxism, TMJ
Trauma
Mgmt of CP pts (5)
Consider treating in wheelchair itself
Avoid abrupt mvmts, light, noises
Rubber dam to avoid hyperactive tongue and aspiration
GA if necessary
LA admin needs stabilisation to protect against sudden movements
Nondental features of ectodermal dysplasia (5)
Fine sparse hair
Dry skin
Dysplastic nails
Protuberant lips
Frontal bossing
Oral feats of ectodermal dysplasia
Oligodontia
Developmental defects of enamel
Conical teeth
Reduced alveolar growth
Maxillary hypoplasia
Reduced VDO
Types of epillepsy / seizures (4)
Primary generalised seizures
- Tonic-clonic / grandmal
- Petit mal
- Tonic
- Atypical
Partial / focal seizures
Status epilepticus
Recurrens
Oral manifestations of epillepsy (5)
Gingival overgrowth (from phenytoin)
Prone to facial injuries
Ulcerations / trauma
Secondary infections
cervical lymph adenopathy
How to manage pts with epillepsy
pts very sensitive to lights and loud noises
Avoid sudden movements
Slow introduction of dental chair light
Short Appts
Reduce stress
No removable appliances
Avoid seizure promoting drugs
How to manage deaf patients
DONT speak louder
Speak directly facing patient
Tell show do
Non-verbal (smile, facial expression, physical contact)
How to manage blind patient (5)
Describe the office setting and procedure
Physical contact → dont suddenly move pt
Touch / Taste / Smell
Keep instruments away
Caution when administering LA
What to say if you are unsure about AB prophylaxis
ex. articial prosthesis in other parts of the body such as hip replacement
“Generally not required, however the decision would be at the discretion of the treating physician”
Does a general examination warrant AB prophylaxis
No - even selective CPITN 6 teeth
