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Dental health assessment and procedures for children with special needs

Dental health is a healthcare section often overlooked in India by health planners. In children with special needs, oral health is left out since their critical needs are a priority and met first. Dental hygiene in these individuals becomes necessary only when dental issues exacerbate. As a result, poor dental health is widely prevalent among children with special needs.

According to the American Academy of Pediatric Dentistry, special health care needs are defined as “any physical, developmental, mental, sensory, behavioural, emotional or cognitive impairment or limiting conditions that require medical management, healthcare intervention and/or use of specialised services or programs”. The estimated population of children under the age of 18 who fall under the special needs category is around 15-18% in developed nations. In the US, 13% percent of adolescent children under the age of 17 are included in the special needs category. 

MedPiper Technologies, Journomed and Daffodil Health had conducted a webinar on 4th September, 2021 where the speaker, Dr. Ridhi Taneja Chaudhary, spoke about the various aspects of dental care that is needed for children with special needs. Dr. Ridhi Taneja Chaudhary is a dentist and cosmetic surgeon who is also an active social speaker and advocate for children with special needs. She also spoke about the barriers that both the children and dental practitioners face in order to maintain and provide good oral health options. The webinar was moderated by Mr. Amal Kiran, Founder and CEO of Daffodil Health. 

Often underlying disorders in children with special needs result in the patient’s inability to maintain good oral hygiene either independently or with help,  thus leading to dental issues like caries (cavities), periodontitis (gum infection), etc. Moderate to severe gingivitis was observed to increase with age and degree of mental retardation. Some of the local factors that contribute to this severity are: 

  1. Tooth Morphology
  2. Malocclusion: An abnormal alignment of the upper and lower teeth that happen because of childhood habits like thumb sucking 
  3. Macroglossia tongue: A disorder (genetic in origin) where the tongue is larger in proportion to other structures in the mouth. Protrusion of the tongue from the mouth may interfere with the feeding of the infant and affects speech development
  4. Bruxism: Excessive grinding of teeth especially during the night leading to jaw pain and other dental problems 
  5. Lack of normal masticatory function

Other factors such as medication, physical trauma, oral motor habits like atypical swallowing, lip sucking can worsen these dental conditions in children. 

Children with special needs who suffer from dental issues tend to exhibit anxiety and lack of cooperation due to physical disabilities, mental limitations and behavioural management issues. Some patients who suffer from dementia or other cognitive setbacks find it difficult to pinpoint their issues. This can make it difficult to perform conventional dental procedures and oral examinations for dental practitioners. 

To this end, the American Dental Association has provided a set of guidelines for caries risk assessment and has outlined protocols called Caries Risk Management by Risk Assessment (CAMBRA). CAMBRA is an evidence-based approach that focuses on determining many factors causing the expression of disease and taking corrective action. 

Dr. Ridhi speaks about the use of General Anaesthesia to help combat these difficulties. General Anaesthesia (GA) can help to ease the anxiety of children with special needs and in turn help the practitioners to do the necessary procedures. It is also easier to extract teeth under GA rather than performing traditional endodontic methods. Under GA, multiple extractions can be done in one session which reduces the stress in patients and the transport and further operation costs. Parental satisfaction with GA has also increased over the years.  

GA is a safe route but it is still an expensive procedure and it requires a lot of pre-operative preparation time. There are even some harmful side effects associated with the long-term use of GA such as memory impairment and postoperative delirium which can exacerbate in children with special needs. Dr. Ridhi stated that the practitioners should only opt for GA only if it is absolutely necessary and the practitioner should inform the parents/guardian about the talk about the side effects.

Other methods of sedation and nitrous oxide are also used to help with performing dental procedures. Short-term interventions can be done by giving antibiotics. Dr. Ridhi also suggests using less operative techniques and more behavioral management techniques to reduce the stress of the special needs children. This includes using audiovisual distraction, giving stress balls to the patients, or playing soothing music in the clinic. 

Dental Treatment for Children with Special needs requires special care and attention. The dentist or the practitioner should be familiarised with the disorder that the child has and have to be extremely aware and mindful while providing the necessary care. 

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