Dentistry 123: Pediatric Dentistry

MANAGEMENT OF DENTAL PATIENTS WITH SPECIAL HEALTH CARE NEEDS

DR. AARON PUNZALAN

SPECIAL HEALTH CARE NEEDS

Providing both primary and comprehensive and

therapeutic oral health care to individuals with special
health care needs (SHCN) is an integral part of the
specialty of pediatric dentistry.
Patients included in this category are those who have
disabilities in the following:

Physical

Developmental

Mental

Sensory

Behavioral

Cognitive

Emotional
Health care for individuals with special needs requires
specialized knowledge, increased awareness and
attention, adaptation, and accommodative measures
beyond what are considered routine.

AUTISM AND AUTISM SPECTRUM DISORDER

Spectrum disorder (marami siyang subcategories)

Autism

Asperger syndrome- significant difficulties in social

interaction and nonverbal communication, alongside
restricted and repetitive patterns of behavior and
interests; blunted emotional capacity, difficulty in
sharing happiness
Examples: Communitys Abed Nadir, The Big
Bang Theorys Sheldon Cooper and Bobs
Burgers Tina Belcher

PDD (Pervasive Developmental Disorders) typical

autism

CDD (Childhood Disintegrative Disorders) - late onset

of developmental delays in language, social function,
and motor skills

Rett disorder - neurodevelopmental disorder of the

grey matter of the brain that almost exclusively affects
females but has also been found in male patients.
The clinical features include small hands and feet and
a deceleration of the rate of head growth (including
microcephaly in some).
Abnormal brain development
Brain may be 10-15% larger than normal in all areas
No specific dental anomalies
Dental conditions related to behavioral patterns
Normal morphology
Occlusal attrition due to persistent bruxism
Diet modifications which may be cariogenic such as
behavior modification programs and taste
Sensitivities
May develop seizures
Some have insensitivity to pain
Oral hygiene may be poor due to childs inability to brush
and accept assistance
Dental treatment

Desensitization

Positive reinforcement

JAVIER

Protective stabilization

Sedation

General anesthesia

Keep sentences short and simple

Music as aid

Use parent/caregiver as helper in communication

Keep environment familiar

Rehearsal of tx at home

Keep visits short and repetitive

End visit on a positive note

Autism is an incapacitating disturbance of mental and
emotional development that causes problems in learning,
communicating, and relating to others
lifelong developmental disability manifests itself during the
first 3 years of life, is difficult to diagnose, and has no cure
Children with autism have multiple medical and behavioral
problems that make dental treatment difficult.
These children often have poor muscle tone, poor
coordination, drooling, a hyperactive knee jerk, and
strabismus (condition of having a squint), and 30%
eventually develop epilepsy.
Children with autism may have strict routines and prefer
soft foods and sweetened foods. Because of poor tongue
coordination, children with autism tend to pouch food
instead of swallowing. This habit, combined with the desire
for sweetened foods, leads to increased susceptibility to
caries.
ATTENTION DEFICIT HYPERACTIVITY DISORDER

Characterized by:

Inattention

Hyperactivity (restlessness in adults)

Impulsivity
Subtypes:

Inattentive

Hyperactive

Combined
Discussion with parent/guardian and physician regarding
patients treatment for ADHD
Avoid treatment, if possible, on days when patient has not
taken medications because these would be the days that
they would really feel agitated
Positive reinforcement
Most patients are boys
MENTAL RETARDATION

A disability characterized by significant limitations both in

intellectual functioning and in adaptive behavior
Etiology: can be organic, chromosomal (Down Syndrome),
genetic metabolic disorders, prenatal and post natal
conditions
No difference versus normal population (except Down
Syndrome)
Higher incidence of periodontal disease
Altered eruption and malocclusion
Anomalies in tooth morphology
Drooling
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Dentistry 123: Pediatric Dentistry

MANAGEMENT OF DENTAL PATIENTS WITH SPECIAL HEALTH CARE NEEDS
DR. AARON PUNZALAN

Macroglossia
Clenching and bruxism
High vaulted palate
Dental considerations

Wide variation in behavior and level of understanding

Management of difficulty proportional with level of

cognitive functioning

Informed consent

Thorough medical history

Accurate and ever changing treatment plan

Good communication

Behavior modification similar to other patients who

are mentally challenged

Oral and IV sedation

Protective stabilization

General anesthesia

Strict preventive dentistry program

DEAFNESS

Dental considerations

Maintain eye contact when using sign language

Speak slowly but do not change your lip movements

so that the deaf person can read your lips

Use head and eye movement for communication

Intelligence is normal to superior

Other senses take over for those lost by hearing

impairment
REFERENCES:

Guidelines on Management of Dental Patients with SHCN.

American Academy of Pediatric Dentistry
Handbook of Pediatric Dentistry, 3rd edition
Dentistry for the Child and Adolescent, 8th edition
Hi! Kung ano lang yung kasama sa powerpoint ni sir, yun
lang yung mga dinagdagan ko ng konting info na galing sa
book/ net. Hehe. Please take time to read the article sent
by Sir about this topic. Last trans na to for Pedo. Good
luck and God bless us all!

JAVIER

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