DEPARTMENT OF PEDIATRIC AND PREVENTIVE CHILDREN DENTISTRY

MANAGEMENT OF PHYSICALLY HANDICAPPED CHILDREN

GUIDED BY- PRESENTED BY-DR. NITIN KHUSHBU JASOTANI

CONTENTSIntroductionDefinitionsClassification of handicapped childrenManagement of blind children Management of deaf childrenManagement of cleft lip & palate childrenWheelchair transfer

INTRODUCTION

The term special child or disabled child are often reserved for those who are having impairment that restricts or limits daily activity in some manner. Thereby these handicapped children can be broadly divided into medically compromised children and developmentally disabled children.

In recent years, the dental profession have shown increasing concern toward these disabled children.

DEFINITION OF HANDICAPPED CHILD

WHO DEFINITION- One who over an appreciable period of time is

prevented by physical or mental conditions from full participation in normal activities of their age group including those of social, educational, recreational and vocational nature.

AMERICAN ACADEMY OF PEDIATRIC DENTISTRY (1996)-

A person should be considered dentally handicapped if pain, infection or lack of functional dentition which affects the following-

1. Restricts consumption of diet adequate to support normal growth and developmental needs.

2. Delays or alters growth and development.3. Inhibits performance of any major life activity

including work, learning communication & recreation.

CLASSIFICATION OF HANDICAPPED CHILD-A. Frank & Winter (1974), have classified handicap

as-1. Blind or partially sighted.2. Deaf or partially deaf.3. Educationally subnormal.4. Epileptic.5. Maladjusted.

6. Physically handicapped.7. Defective of speech.8. Senile.

B. NOWAK(1976) Has classified handicapping conditions into nine categories as follows-

1. Physically handicapped. Eg- poliomyelitis.2. Mentally handicapped. Eg- mental retardation.3. Congenital defects. Eg- Congenital heart disease.

4. Convulsive disorders. Eg- epilepsy.5. Communication disorders. Eg- blindness, deafness.6. Systemic disorders. Eg- haemophilia.7. Metabolic disorders. Eg- juevenile diabetes.8. Osseous disorders. Eg- rickets.9. Malignant disorders. Eg- leukaemia.

Management Of Blind Children- Blindness is not an all or none phenomenon,

a person is considerded to be affected by

blindness if the visual acuity does not exceed 20/200 in the

better eyes, with correcting lenses.Etiology Of Blindness- Prenatal causes;-- Optic atrophy.- Micropthalmus.- Cataract.

- Toxoplasmosis.- Syphilis.- Rubella.- Developmental abnormalities of the orbit.- Dermoid & other tumours.Postnatal causes;-- Trauma.- Hypertension.- Premature birth.- Haemorrhagic disorders.- Glaucoma.- Diabetes mellitus.

MANAGEMENT- Take complete medical history.- Determine the degree of visual impairment.- Offer verbal & physical assurance.- Avoid expression of pity of refernces to visual

impairment as an affliction.- Do not grab, move or stop the patient without

verbal warning.- Paint a picture in the mind of visually

impaired child, describing the office setting, treatment & office personnel.

- Always give the patient adequate description before performing treatment procedures.

- Always maintain a relaxed atmosphere.

- Invite the pt. to touch, taste or smell, recognizing that these senses are acute.

- Explain the procedures of oral hygiene and then place the pt. hand over yours as you slowly but deliberately guide the toothbrush.

- Use audiocassettes tapes and braille dental pamphlets explaining specific dental procedures to supplement informations and decrease chair time.

MANAGEMENT OF DEAF CHILD - This includes individuals who have total

deafness as well as the hearing impaired making them suffer from varying degrees of deafness.

- Their speech is also affected as sounds have to be heard to be imitated.

ETIOLOGY OF DEAFNESS Prenatal causes- Viral infections such as rubella. - Ototoxic drugs.- Congenital syphilis.- Heredity.

Perinatal causes- Toxaemia late in pregnancy- Birth injury- Anoxia

Postnatal causes- Viral infections such as mumps,poliomyelitis.- Ototoxic drugs.

MANAGEMENT- During the preappointment interview, the

manner of communication should be elicited (i.e. lip reading, sign language, interpreter, writing notes or combination of these) along with a detailed medical history.

- Face the pt. and speak slowly at a natural pace without shouting.

- Reassure the pt., hold the patients hand initially or place a hand reassuringly on the pt. shoulder while the pt. maintains visual contact.

- Use visual aids and allow the pt. to see the instruments & demonstrate how they work.

- Display confidence; proceed slowly in a warm & reassuring manner, using facial expressions, smiles, gestures, physical contact and praise.

- Adjust the hearing aid before hand piece is in operation, since a hearing aid will amplify all sounds.

MANAGEMENT OF CHILDREN WITH CLEFT LIP & CLEFT PALATE

CLEFT LIP- Congenital deformity of the upper lips that

varies from a notching to a complete division of the lip.

CLEFT PALATE- A Congenital split of the palate that may

extend through the uvula, soft palate & into the hard palate; the lip may or may not be involved in the cleft of the palate.

Etiology of the cleft lip and palate- Heredity.- Environment:- teratogens like rubella virus.- Increased maternal age.- Decreased blood supply in nasomaxillary region.

Clinical features- Facial deformity.- Nasal regurgitation of milk.- Middle ear infection.- Inability to suck mother’s milk.- Speech defects.

Tooth defects in cleft lip and palate children

- Supernumerary teeth.- Congenitally missing teeth.- Peg – shaped teeth.- Thick curved hypoplastic incisors.- Gemination, fused supernumerary teeth is

frequently present.- Micro & macrodontia.- Enamel hypoplasia.- Crowding or spacing of teeth.

Protocol for dental care of cleft lip & palate in children

At birth -Predental treatment is provided which comprises

feeding palate, pre-surgical orthopedics and help surgeon in repair by stimulating palatal bone growth.

- Make study records by photographs, models.3-5 months - Introduce the parents to dental care for the

primary teeth. - Alignment of the primary teeth & palatal

expansion to be started using a simple fixed appliance like W-arch.

- Plastic surgeon to repair the lip.

12 months- Pedodontic review. Palatal prosthetic speech

appliance may be required.- Explain possible eruption abnormalities.2-6 years- Preventive measures for caries like fissure

sealing, fluoride application.- Restorative care if needed.6-8 years- Preventive or early orthodontic intervention

which involve procedures like removal of super numerary teeth.

- Dental bone assessment(OPG,wrist radio graph)- Suitability about bone grafting.

9-12 years- Pedodontist to plan future treatment.- Orthodontic consultation.- Bone graft of alveolar cleft.

12-15 years- Orthodontic treatment.- Oral surgeon to assist if the orthodontist

requires.- Review by plastic surgeon.

Wheelchair Transfer Severely physically disabled pt. who come

to the office may employ wheelchair as their princial means of mobility.

PROCESS:-1. Wheelchair should be positioned beside the

dental chair with its wheel locker.2. The person who has to do the major part of

the lifting stands behind the pt.3. Places his arms underneath the pt. arms &

grasps the pt.left forearm with his right hand and the right forearm with his left hand.

4. The dental assistant will be facing the pt. with her hands under the pt. knees.

5. The height of the dental chair should be adjusted so that the pt. will not have to be lifted too high to clear the arms of the chair.

6. At a pre-arranged signal, the pt. is lifted from the wheelchair into the dental chair.