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Abstracts in Developmental Dentistry

in H. Barry Waldman DDS MPH PhD, Articles

Glassman P. A review of guidelines for sedation, anesthesia, and alternative interventions for people with special needs. Special Care in Dentistry 2009;29(1):9-16.

The number and percentage of individuals with special needs are growing. Many of these individuals need special support in order to receive dental treatment. Modalities that can be used to provide dental treatment include pharmacological approaches to produce various levels of sedation or anesthesia. In addition to the use of medications, there are also techniques that employ behavioral or psychological interventions. In some circumstances, physical support or protective stabilization is used. This review of the numerous guidelines, which have been published for the use of sedation and anesthesia to facilitate the delivery of dental treatment, indicates that there are fewer guidelines for the inclusion of behavioral or psychological interventions or for the incorporation of social supports or prevention strategies. In addition, most published guidelines do not include considerations for people with special needs. There is a need for increased research and documentation of combined treatment modalities, and these combined approaches need to be incorporated into guidelines for patient care for people with special needs. There is also a need to advocate for reimbursement systems that support all appropriate treatment options so that practitioners can be free to recommend treatment options based on the efficacy and safety of each option.

Charles, JM. Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and autism. Journal of Dentistry for Children 2010;77(2):84-91.

The Federal government reports that 13% of Americans between birth and 18 years of old meet the definition of a child with special health care needs. These children and young adults present unique challenges for both pediatric and general dentists to provide access to the oral health care system-establishing a treatment plan for those with unique medical, behavioral and dental needs and maintaining oral health over the lifetime. The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.

Waldman HB, Perlman SP, Rader R. Hardships of raising children with special health care needs: a commentary. Social Work in Health Care 2010;49:618-629.

Providing health care services for youngsters with special health care needs (SHCN) requires understanding of the medical circumstances which impact on the particular youngster, as well as an increased awareness and sensitivity to their particular family setting, and the issues which impact on the child, his/her parents and siblings. To this end a review was carried out regarding the variable affects on these youngsters, such as poverty, parental and family issues, as well as considerations of who is at risk for SHCN and demographics of individuals with SHCN who have unmet health needs. The particular need for dental services, the health service most commonly reported as needed, but not received, is highlighted

Waldman HB, Perlman SP. Generally speaking, dentists can’t/will not treat patients with disabilities? Dental Hypotheses 2010;1(2):437-444.

There are more than a half of a billion people in the world who are disabled as a consequence of mental, physical and sensory impairments. The issues related to the care of individuals with disabilities increasingly will impact on the economic and social realities throughout the world as increased numbers of individuals with disabilities continue to survive; in particular, individuals with developmental disabilities and the burgeoning geriatric populations. The question considered is whether dentists are able and willing to provide needed services for patients with disabilities? The issues faced in the United States are used as examples in a commentary which reviews the barriers faced by dentists who would consider providing care to individuals with disabilities. Despite formidable obstacles, the fact is that many do provide needed care to many of these patients. The need is to expand the preparation of future dentists and augment the abilities of current practitioners.

Watson EK, Moles DR, Kumar N, Porter SR. The oral health status of adults with a visual impairment, their dental care and oral health information needs. British Dental Journal 2010;208(8):E15.

The study sought to identify the oral health and experiences of adults with a visual impairment together with the nature, source and access to oral health information. In addition the study evaluated the oral health status of a group of individuals with a visual impairment with respect to oral health markers, treatment choice and attendance patterns in comparison to a reference group from the general population in the United Kingdom. METHOD One hundred adults with a visual impairment were examined and completed a questionnaire concerning their experience of oral health care and available information sources. The information collected was directly compared with data from the Adult Dental Health Survey 1998 for the south region of England. RESULTS The present group of individuals with a visual impairment had better oral hygiene practices, and similar levels of oral hygiene and hard tissue disease to those of a comparable group of the Adult Dental Health Survey 1998 (ADHS 1998). However 24% of those with a visual impairment were not registered with a dentist and 26% of the patients wished for appropriate information concerning oral health care. CONCLUSIONS There is a need to develop oral health promotion that ensures patients with a visual impairment have appropriate information regarding oral health care and its provision

de Morais Gallarreta FW, Bernardotti FP, de Freitas AC, de Queiroz AM, Faria G. Characteristics of individuals with hydrocephalus and their dental care needs. Special Care in Dentistry 2010;30(2):72-6.

Hydrocephalus is considered a congenital disease affecting the central nervous system, and is characterized by accumulation of cerebrospinal fluid in the lateral ventricles of the brain causing progressive ventricular dilatation. This review paper reports on the oral characteristics of persons with hydrocephalus and discusses their dental care needs. It has been reported that patients with hydrocephalus can present chronological changes in the eruption of their teeth, changes in the occlusion, greater accumulation of plaque, and have a higher caries prevalence. Regular dental visits are needed to control caries as well as to educate the caretakers about oral hygiene for children with hydrocephalus. In addition, the dental practitioner should be careful not to put pressure on the ventricular-peritoneal drainage tube during dental treatment. Special devices are available to support the patient's head if they have macrocephally.

Lee PY, Chou MY, Chen YL, Chen LP, Wang CJ, Huang WH. Comprehensive dental treatment under general anesthesia in healthy and disabled children. Chang Gung Medical Journal 2009;32(6):636-42.

BACKGROUND: Differences in dental treatment under general anesthesia (GA) in healthy and disabled children are rarely reported. This retrospective study evaluated the characteristics and treatment modalities performed under general anesthesia in pediatric dental patients at Taipei Chang Gung Memorial Hospital between 2004 and 2005, and compared the different treatment patterns performed in healthy children and children with special health care needs.

METHODS: The data were reviewed in pediatric patients from 1 to 18 years old who underwent dental treatment performed under general anesthesia from January 2004 to December 2005. Patients with special health care needs who had at least one type of mental or physical disability were assigned to the disabled group; and the other healthy patients were assigned to the healthy group. The treatment modalities of operative restoration, crowns, pulp therapy, sealant and extracted teeth were compared in the two groups.

CONCLUSIONS: For very young children or those with special health care needs, dental treatment performed under general anesthesia is beneficial and efficient. The findings of this study suggest that underlying medical or mental conditions may influence the dental condition and treatment modality provided.

Ferguson FS, Cinotti D. Home oral health practice: the foundation for desensitization and dental care for special needs. Dental Clinics of North America 2009;53(2):375-87, xi.

As oral health is increasingly recognized as a foundation for health and wellness, caregivers for special needs patients are an essential component of the oral health team and must become knowledgeable and competent in home oral health practice. Education and training for caregivers should become a standard of care early in the first year of life for any child with developmental delay or any person, regardless of age, who experiences an illness or event that compromises their ability to provide self oral health care. Given the implication of poor oral health to general health and health care costs, home oral health practice is a significant factor in dental care, general health, quality of life, and controlling health care costs.

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