Classification of handicapped

conditions
Definition :
• W.H.O in 1980 defined a handicapped person as one
who over an appreciable period is prevented by physical or
mental conditions from full participation in the normal
activities of their age groups including those of a social ,
educational , recreational and vocational nature.
• American Association of Pediatric Dentistry , states that
a person should be considered dentally handicapped if there
is pain , infection or lack of functional dentition that affects
him/her as follows :
Restricts consumption of a diet adequate to support growth
and energy needs.
Delays or alters growth and development.
Inhibits performance of any major life activity.
 Various Classifications

Frank and Winter in 1974 have classified handicap

conditions as:
Blind or partially sighted
Deaf or partially deaf
Educationally subnormal
Epileptic
Maladjusted
Physically handicap
Defective in speech
Senile
Agerholm 1975 classified handicapping conditions
as :
Intrinsic category
Extrinsic category
For convenience of management they are classified
as :
Developmentally disabled child
Medically compromised patients
Nowak in 1976 classified handicapping conditions into nine
categories :
Physically handicapped
Mentally handicapped
Congenital defects
Convulsive disorders
Communication disorders
Systemic disorders
Metabolic disorders
Osseous disorders
Malignant disorders
The most common techniques employed to manage a
handicapped child in the operatory are :
Tender loving care
Local anesthesia
Premedication and sedation
Nitrous oxide analgesia
Physical restraints/ Protective stabilization
Behaviour modification
Hypnosis
General anaesthesia
MENTALLY CHALLENGED CHILDREN
Mental sub normality can be defined by American association
of Mental Deficiency as , subaverage general intellectual
functioning which originates during the developmental period
and is associated with impairment in adaptive behaviour.
Associated Dental problems
Multiple anomalies of facial structures , eruption time ,
sequence , number , presence of malocclusion and
enamel hypoplasia.
Higher prevalence of dental caries and periodontal disease.
Management :
Familiarize the patient to the office and dental personnel to
reduce his/her fear of unknown.
speech must be slow and simple.
Only one instruction at a time should be given.
TSD and TLD in mild cases whereas sedation in moderate cases.
Carefully listen to patient .
Appointments should be short and scheduled in early part of the
day.
GA indicated in cases where extensive rehabilitation is required.
DOWN’S SYNDROME
It is a malformation syndrome which occurs due to trisomy of
chromosome 21 (95%) , translocation (3%) , or due to mosaicism (2%) .
Oral manifestations :
Mouth
- small drooping mouth
- open mouth posture
Tongue
- Protrusive , fissured (scrotal) tongue.
- Circumvallate papillae may be enlarged , but filiform papillae may
be absent.
- Macroglossia
Lips -
Thick , dry , fissured.
Occlusion -
Anterior open bite and crossbite , class III tendency.
Small maxilla.
Palate -
Often appears high with horizontal palatal shelves (omega
palate) .
Bifid uvula , cleft lip and palate.
Eruption of teeth –
Retarded
Early shedding of deciduous teeth
Teeth -
Hypodontia
Microdontia
Hypocalcification and hypoplastic defects
Low incidence of caries
Periodontium -
Severe , early onset periodontal disease.
Management :
 Congenital defects – Cleft lip and cleft palate

Classification of cleft and cleft palate :

• Morphological classification
Put forward by Davies and Ritchie (1922) and Veau (1931)
Based on site and extent of the cleft
The Veau classification is as follows :
Group I: Cleft of the soft palate only
Group II: Cleft of the hard and soft palate till the incisive foramen
Group III: Complete unilateral cleft of soft palate , hard palate ,
alveolar ridge and the lip on one side.
Group IV: Complete cleft of the soft palate , hard palate , alveolar
ridge and the lip on both the sides .
• Embryological classification
Kernahan and Stark in 1958 and Spina in 1974 have classified
cleft lip and palate based on embryological principles.
Kernahan and Stark classification
Group I : Cleft of the primary palate
▫ Unilateral - Total , Subtotal
▫ Bilateral - Total , Subtotal
Group II : Cleft of the secondary palate
▫ Total
▫ Subtotal
▫ Submucous
 Group III :Cleft of both primary and secondary palate
▫ Unilateral - Total , Subtotal
▫ Median - Total , Subtotal
▫ Bilateral - Total , Subtotal
Spina classification
Group I : Pre incisive foramen clefts
▫ Unilateral
▫ Bilateral
▫ Median - cleft of the lip with or without an alveolar cleft
Group II : Trans incisive foramen clefts ( cleft of the lip , alveolus and palate)
▫ Unilateral
▫ Bilateral
Group III : Post incisive foramen clefts
▫ Total
▫ Partial
Group IV : Rare facial clefts