Management

Of Children With Special

Health Care Needs
DEFINITION
The AAPD defines special health care needs as
“any physical, developmental, mental, sensory,
behavioral, cognitive, or emotional impairment
or limiting condition that requires medical
management, health care intervention, and/or
use of specialized services or programs.
PREVALENCE
• Over 1 billion people across the world have some form of
disability
• India:2.21% (26.8 million) of India’s population
CLASSIFICATION OF THE SPECIAL HEALTH CARE
NEEDS
NOWAK (1976)
1. Physically handicapped e.g., Poliomyelitis
2. Mentally handicapped e.g., Mental retarded
3. Congenital defects
4. Congenital disorders e.g., Cleft palate
5. Convulsive disorders e.g., Epilepsy
6. Communication disorders e.g., Deafness
7. Systemic disorders e.g., Juvenile diabetes
8. Osseous disorders e.g., Rickets, osteopetrosis
9. Malignant disorders e.g., Leukemia
 COMMON ORAL HEALTH PROBLEMS FOUND IN SHCN CHILDREN

DENTAL PERIODONTA ENAMEL

CARIES L PROBLEMS HYPOPLASIA

5
Norwood KW, Slayton RL. Oral health care for children with developmental disabilities. Pediatrics 2013;131(3):614-9.
 COMMON ORAL HEALTH PROBLEMS FOUND IN SHCN CHILDREN

MAL- BRUXISM POUCHIN TRAUMA

OCCLUSION G OF
FOOD

6
Norwood KW, Slayton RL. Oral health care for children with developmental disabilities. Pediatrics 2013;131(3):614-9.
Dental Management of the
children with special health
care needs

7
 UNDERSTANDING
PATIENTS CHILD WHO’S NOT ABLE
COGNITIVE LEVEL, TO COMMUNICATE
SCHEDULE TRIGGERS, PROPERLY SHOULDN’T BE
MORNING SENSITIVITIES
APPOINTMENTS ASSUMED TO BE
INTELLECTUALLY
DISABLED

COMMUNICATE
AT THE LEVEL OF Initial contact -
THE CHILD opportunity to address
the child’s primary oral
TAKING
health needs
DETAILED
HISTORY AND
MEDICAL Consideration for length
ARRANGE MEDICAL
RECORDS OF of appointment, type of
CONSULTATION IF
THE PATIENT the procedure that can
NECESSARY
be done
Estrella MRP, Boynton JR. General dentistry’s role in the care for children with special needs: A review. Gen Dent 2010
 MANAGEMENT during the
PROCEDURE

BEHAVIOR
MODIFICATION
PREVENTION
Non- pharmacological
1. Dental home Pharmacological
2. Preventive
strategies 1. Oral
2. Inhalational
3. General
anaesthesia

Sinha S, Praveen P, Prathibha Rani S, Anantharaj A. Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and
a Case Report.
DENTAL HOME

Dental home is simply the early

foundation of a healthy And
balanced pediatric dental
triangle

12
American Academy of Pediatric Dentistry. Policy on dental home. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:43-4.
 A Dental home should be established by 12 months of
age

Major goal - Prevention of ECC.

AIM – Give education to parents and creating a positive attitude

in parents and children toward dentistry

American Academy of Pediatric Dentistry. Policy on dental home. The Reference Manual of Pediatric Dentistry. Chicago,
13 Ill.:
PREVENTIVE STRATEGIES 14
Preventive
Anticipatory
strategies guidance
Home
about risk of dental
trauma, care
mouthguard
Non- fabrication
cariogeni
c diet

Dental Chlorhexidine
sealants, mouth rinse,
fluoride Floss and
varnishes, Electric Tooth
toothpastes, brush
SDF
American Academy of Pediatric Dentistry. Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry;
2021:287-94
 BEHAVIOR
MODIFICATION

16
 NON-PHARMACOLOGICAL
FAMILIARIZATION VOICE CONTROL RESTRAINTS

Al Mochamant, Iosif-Grigorios & Fotopoulos, Ioannis & Zouloumis, Lampros. (2015). Dental Management of Patients with SHCN. Balkan Journal of Dental Medicine.
19. 10.1515/bjdm-2015-0046.
 PHARMACOLOGICAL

Behavior shaping
Sedation
GA
medications
ORAL

Al Mochamant, Iosif-Grigorios & Fotopoulos, Ioannis & Zouloumis, Lampros. (2015). Dental Management of Patients withSHCN. Balkan Journal of Dental Medicine. 19.
10.1515/bjdm-2015-0046.
DENTAL Clinic design
19
 PARKING LOT WITH THE RAMP
CALL BELL FOR WHEELCHAIR

Doctor’s Assistant’s stool

chair

Papoose NITROUS OXIDE

board SEDATION UNIT
Wheelchair
Dental chair

NON
SLIPPIN ADDITIONAL SPACE
G FLOOR FOR WHEELCHAIR
INFRONT OF
STRAIGHT ENTRANCE
ACCESS
20
 RAMP IN MARKET
PLACE FACILITIES IN
SUBHARTI FOR
SHCN

RAMP FOR EASY ACCESS OF

WHEELCHAIR

RESERVATION FOR SPECIAL LIFT FOR EASY ACCESS TO

SPECIAL PROVISION FOR DIFFERENTLY
INDIVIDUALS IN WAITING AREA CLINICS ON DIFFERENT
ABLED ON RECEPTION
FLOORS 21
COURTESY : SUBHARTI DENTAL COLLEGE AND HOSPITAL, SVSU, MEERUT
 DENTAL OPERATORY IN
ACCORDANCE WITH THE
GUIDELINES

CLINIC FOR DIFFERENTLY ABLED

CITIZENS

CLINIC DESIGN FOR SHCN IN

SUBHARTI DENTAL COLLEGE
22
Picture courtesy : Subharti Dental College and Hospital , SVSU, Meerut
 DOWN’S
SYNDROM
E
ADITI IS HAVING DOWNS SYNDROME AND IS
A PROUD CAFÉ OWNER IN MUMBAI 23
 Down syndrome, referred to as mongolism, is the
chromosomal disorder and is caused by the presence of an
extra copy of chromosome 21(trisomy 21).

3 TYPES
TRISOMY 21 : 95%
TRANSLOCATION : 4.8%
MOSAICISM : 3%

24
 In India, every 1
child in 830
children has
Downs syndrome

Approx 3000-5000
children born per
year GLOBALLY

25
CLINICAL features OF DOWN’S SYNDROME 26
CHARACTERISTIC PHYSICAL FEATURES
• SKULL IS BRACHYCEPHALIC

• FLATTENING OF THE NOSE BRIDGE

• SMALL,SHORT SNUB NOSE

• EYE DEFECTS AND IN MOST CASES,THE PALPEBRAL FISSURES SLANT

DOWNWARDS AT THE MIDLINE
• LOP EARS,NORMAL/LOW SET EARS,EARS WITH A FLAT OR ABSENT HELIX

• HYPOTONIA OF LOWER LIP,TOUNGE PROTUDING ABOVE IT

• NECK IS BROAD AND SHORT

• FINGERS ARE SHORT AND FLABBY ,SINGLE PALMER CREASE

28
ORAL FINDINGS INCLUDE
• Mouth breathing
• Open bite
• Appearance of macroglossia
• Fissured lips and tongue
• Angular cheilitis DELAYED ERUPITON

• Delayed eruption
• Oligodontia
• Small roots
• Microdontia
• Crowding
MISSING AND MALFORMED TEETH
• Low level of caries
ORAL FINDINGS INCLUDE

Destructive periodontal disease due to:

 Local factors such as tooth morphology, bruxism,
malocclusion, and poor oral hygiene.
 Certain systemic factors :Poor circulation, decreased humoral
response, general physical deterioration at an early age, and
genetic influences.

Tooth wear (both attrition and erosion) significantly greater in children

with Down syndrome
 DENTAL MANAGEMENT OF PATIENTS WITH DOWNS
SYNDROME

MINIMIZE STABILISE
WAITING AFFECTIONATE AND HEAD
TIME FOR COOPERATIVE (ATLANTO-
DENTAL PROCEDURES CAN AXIAL
THESE BE PROVIDED WITHOUT INSTABILITY)
PATIENTS COMPROMISE IF THE
DENTIST WORKS AT A
SLIGHTLY SLOWER PACE

• Light sedation and immobilization may be indicated in those children who are
moderately apprehensive.
• Severely resistive patients may require general anesthesia 31
 CHILDREN WITH DOWNS
SYNDROME OFTENLY PRESENT
WITH CARDIAC ILLNESS
HISTORY

SO, WE NEED TO GIVE ANTIBIOTIC

PROPHYLAXIS IN SUCH CASES TO
PREVENT THE RISK OF BACTERIAL
ENDOCARDITIS

32
33
 WHAT IS AUTISM ?
Autism spectrum disorder ( ASD) is
a neurodevelopmental disorder
that impairs the ability to
communicate, interact socially
with others, and respond to
certain stimuli in their
surroundings.
34
WHAT ONCE WAS
RARE….

GLOBAL
PREVALENCE- 7.6
PER 100 CASES

INDIA- 1 IN
500 CHILDREN
OR 0.20% IN
121 CR
POPULATION

Krishnamurthy V. A clinical experience of autism in India. J Dev Behav Pediatr 2008;29:331-3

 GENDER
PREDILICTION
S

More commonly found

in males, it is more
severe in females.

RATIO- 4:1
36
CLINICAL
FEATURES
OF AUTISM

37
38
 WHY SHOULD
DENTISTS BE
CONCERNED ?
INCREASED
PREVALENCE OF
DENTAL CARIES

39
 DENTAL
MANAGEMENT
OF CHILDREN
WITH AUTISM

40
 KEEP LANGUAGE AND
SENTENCES SIMPLE

ALLOW EXTRA TIME TO

PROCESS INFORMATION

REPETITION OF ORDERS

CHECK FOR DRUG HISTORY

EG. SSRI, ANTIEPILEPTICS 41
Chandrashekhar S, S Bommangoudar J. Management of Autistic Patients in Dental Office: A Clinical Update. Int J Clin Pediatr Dent.
 ADOPT PREVENTIVE
STRATEGIES

GIVE FLOURIDE BASED

42
TREATMENT WHEN ABSOLUTELY
NECESSARY

Chandrashekhar S, S Bommangoudar J. Management of Autistic Patients in Dental Office: A Clinical Update. Int J Clin Pediatr Dent.
 2nd VISIT
1ST VISIT
 3rd visit

CONSENT
• Dental diagnosis:

PRE OPERATIVE
POST OPERATIVE

PRE OPERATIVE POST OPERATIVE

 SIDDHANT , 6Y/M

DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY, SDC&H, MEERUT

SIDDHANT WAS TREATED
SUCCESSFULLY WITH
BEHAVIOR MODIFICATION
AND DESIRABLE
TREATMENT OUTCOMES
WERE ACHIEVED

DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY, SDC&H, MEERUT

CEREBRAL PALSY
49
CEREBRAL PALSY is a group
of non progressive disorders
resulting from malfunctioning
of the motor centres and
pathways of brain in foetal or
infantile stage.

50
CLASSIFICATION OF CEREBRAL
PALSY ON THE BASIS OF
TOPOGRAPHY

52
 ON THE
BASIS OF
MOTOR
FUNCTION

53
CLINICAL FEATURES
OF CEREBRAL PALSY

54
55
ASSOCIATED FEATURES

56
ORAL MANIFESTATIONS
 PERIODONTAL DISEASE:POOR ORAL
HYGIENE AND EATIND SOFT FOOD HIGH IN
CARBOHYDRATES
 GINGIVAL HYPERPLASIA DUE TO PHENYTOIN
 DENTAL CARIES
 MALOCCLUSION:PROCLINED MAXILLARY
TEETH ,EXCESSIVE OVERBITE AND OVERJET
OPEN BITES, UNILATERAL CROSSBITES
 BRUXISM
 TAUMATIC INJURIES
57
 DENTAL
MANAGEMENT
OF PATIENTS
WITH
CEREBRAL 58
1. Consider treating a 2. Try to stabilize 3. Use finger guards to
patient who uses a the patient’s head protect fingers during
wheelchair in the and keep back sudden muscle spasm
wheelchair. slightly elevated.

59
Dean JA, editor. McDonald and Avery's dentistry for the child and adolescent-E-book. Elsevier Health Sciences; 2021 Feb 2 .
4. Consider the use of 5. For control of 6.Introduce intraoral
pillows, towels etc for involuntary jaw stimuli (instruments
trunk and limb support. movements, use with smooth edges)
mouth props. slowly to avoid
eliciting gag reflex

60
Dean JA, editor. McDonald and Avery's dentistry for the child and adolescent-E-book. Elsevier Health Sciences; 2021 Feb 2.
WHEELCHAIR
TO DENTAL
CHAIR

TRANSFER
RULES
61
Determine Determine the patient’s need

Prepare Prepare the dental operatory

Prepare Prepare the wheelchair

Perform Perform the two-person transfer

Transfer Transfer from dental chair to wheelchair

Position Position the patient after the transfer

DIACO DENTAL CHAIR

63
http://www.diaco.co.uk/
 DISABILITY AIDED DENTAL (DAD) CHAIR

Krishnan, Lakshmi & Madankumar, Parangimalai. (2020). Development of modified dental chair to accomodate 64both
wheelchair bound patients and general population. Disability and Rehabilitation: Assistive Technology. 15. 1-4.
 SURYAKANT, 6Y/M

DIFFICULT TO TREAT
HIM INSPITE OF
HEAD
STABILISATION AND
BEHAVIOR
MODIFICATION SO
PATIENT WAS
TREATED UNDER GA

DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY, SDC&H, MEERUT

PREOPERATIVE POST OPERATIVE
PICTURE PICTURE

DEPARTMENT OF PEDIATRIC AND PREVENTIVE DENTISTRY, SDC&H, MEERUT

CONGENITAL HEART DEFECT
MORE CONSUMPTION
OF CARBOHYDRATE TO
GAIN WEIGHT FOR
SURGERY
TREATMENT PLAN
ANTIBIOTIC REGIMEN
SENSORY ADAPTED DENTAL ENVIORNMENT
SNOEZELEN
PHYSICAL RESTRAINING
Quick Recall
• Definition

• Classification

• Prevalent oral conditions

• Preventive strategies

• Clinic design

• How to write a consent

• Autism Spectrum Disorder

• Down Syndrome

• Cerebral Palsy

• Congenital Heart Defect