MANAGEMENT OF PEOPLE WITH SPECIAL NEEDS

Dr Noor Rohana bt KamaruddinPegawai Pergigian Daerah Perak Tengah

PRINCIPLE OF MANAGEMENTASSESSMENT

DENTAL NEEDS URGENT/ ELECTIVE BEHAVIORAL MANAGEMENT ORAL SEDATION N2O/ O2 INHALATION SEDATION IM SEDATION IV SEDATION GA

CONSCIOUS SEDATION DEEP SEDATION

PRINCIPLE OF MANAGEMENT

PREVENTIVE TREATMENT

OPERATIVE SURGICAL PROCEDURE

MAINTENANCE

PREVENTIVE PROGRAMME

OHI DIETARY ADVICE FLUORIDE APPLICATION FISSURE SEALENT REGULAR DENTAL VISITS

PROBLEMS WITH OH

PERIODONTAL D/S - COMMON CANNOT MANAGE ORAL

HYGIENE TECNIQUE SUCCESS DEPEND ON

PARENTS/ STAFF NO PRIORITY GIVEN TO ORAL

HEALTH

EFFECTIVE PLAQUE CONTROLPractice, skill, time, effort, preseverance OH AIDS

Toothbrush modifications Enlarged – Acrylic resin to increase bulk Elongated Angled

Superbrush/ Double headed brush Finger brush Finger props Electric toothbrush

EFFECTIVE PLAQUE CONTROL

Chemical control of plaque Chlorhexidine – Gel, Spray, Rinse

Eg Orodex

Topical fluoride application Duraphat, Tooth mousse, Enamel Pro

Varnish ( dental caries 40%)

DIETARY COUNSELINGGiven in wider context of context of general health PROBLEMS

May retain infant feeding practices longer, sweetened comforters used as pacifiers

Use of sugared liquid medications Feeding difficulties – liquidized food

(high in sugar) SECC (Severe Early Childhood Caries)

RESTORATIVE TREATMENT Restorations do not cure caries Requires simultaneous preventive

measures Treatment under GA

Limited restorative treatment Drastic approach required eg full

dental clearance Advanced restorative treatment

Pulpotamy & Preformed crowns

LEARNING DISABILITIES/MENTAL RETARDATION [MR] Deficiency in

theoretical intelligence & social functioning

Expressed as IQ 70 – 89 – Educationally

subnormal < 50 – Severe MR

Commonest cause of MR – Down Syndrome

DOWN SYNDROME

1 IN 700 live birth, Trisonomy 21, Translocation

Strong correlation betw maternal age & DS Mother’s age < 25yrs – 1:2000 Mother’s age > 40yrs – 1:50

DOWN SYNDROME FEATURES OF DOWN’S

Short stature, tendency to obesity Midface hypoplasia Specific co-morbid

Congenital cardiac abnormalities Learning disability & behavioral

problem Frequent infection – URTI common

ORAL HEALTH CARE 3-TIER SYSTEM

PRIMARY CARE Dental Nurses

SECONDARY CARE Dental Officers

TERTIARY CARE Specialist

ORAL HEALTH CARE PRE-REFERRAL CHECK LIST

Ascertain severity Medical history Ability of parent/ guardian to attend Ability to maintain oral hygiene Compliance to preventive measures Staying at home/ institution Transport Reasons for referral Urgent or Elective