GOOD MORNING

MANAGEMENT OF MEDICALLY COMPROMISED CHILDREN

INTRODUCTION

DEFINATION

INCREASED RISK FOR ORAL DISEASES IN CHILDREN WITH CHRONIC HEALTH CONDITIONS
Asthmatic Conditions Increased Caries Risk Gingivitis Calculus, Dental Erosion Decreased Salivary Secretion Rate Renal Disorders Calculus Disturbances In Dental Development

Childhood Malignancies Viral And Fungal Infections Mucositis Disturbances In Dental Development

CARDIOVASCULAR DISORDERS

Diagnosis 1. Imaging: echocardiography is commonly used to support a clinical diagnosis of heart failure. This modality uses ultrasound to determine the stroke volume. 2. Chest X rays are frequently used to aid in the diagnosis of congestive heart failure on X rays are : vascular redistribution peribronchial cuffing kerley b line consolidation of lower lung fields cardiomegaly 3. Electrocardiogram : it is used to identify arrhythmias, ishemic heart disease, right and left ventricular hypertrophy and presence of conduction delay or abnormalities. 4. Blood tests: it is routinely performed include electrolytes, measures of renal function, liver function tests, thyroid function tests, a complete blood count and often C reactive protein if infection is suspected. An elevated B type natriuretic peptide is a specific test indicative of heart failure. 5. Angiography: heart failure may be the result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium .

Dental management of patient with chf 1. Evaluate patient 2. Identify underlying causative factors 3. Considered drug usage 4. Use semisupine position or upright chair position as per patient comforts 5. Watch for orthostatic hypotension, make position or chair changes slowly and assist in and out of chair 6. Watch for sign of digitalis toxicity 7. Schedule short, stress free appointments.

DENTAL MANAGEMENT: Essential principles: Eliminate oral infection Reduce the risk of bacterial endocarditis Maintain good oral health Liaise with the patient s Cardiologist Vigilant preventive regimen Pre-surgical 0.2% chlorhexidine mouth wash Determine coagulation status (INR) Reduce stress with sedation or GA Reduce stress with profound anaesthesia Monitor for respiratory distress

DENTAL MANAGEMENT: Pulp therapy Extraction of pulpally involved primary teeth Vital and non-vital pulp therapy of the primary dention is contraindicated in children at risk of bacterial endocardits. This is due to the fact that cleansing, shaping and obturaCon is problemaCc in primary teeth, resulCng in the potenCal for recurrent and/or sub-clinical bacterial infecCon of the primary root canal system. EndodonCc treatment of the permanent denCCon is not contraindicated in cardiac paCents, even those at risk of bacterial endocardiCs; provided canal cleansing, shaping and obturaCon is effecCve, and technique is employed to avoid transportaCon of debris through the apex.

Several important principles need to be followed when manging children with cardiac disease. Tranient bacteraemia can occur following invasive dental procedures and potentially