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86 comments:
Tx considerations for children with mental disabilities include: consulting the parent, caregiver, and physician to assess the degree of disability, including the caregiver in the appointment, finding out what things set off or soothe the patient, familiarizing the patient with the office in stages, being repetitive & brief, assessing understanding, keeping appointments short, and scheduling appts early in the day.
Austin Tung 187
Natalie Nguyen #159:
Mental disability is defined as intellectual deficiency and inadequate adaptive functioning. Down syndrome pts often have delayed eruption, missing or malformed teeth, and increased rate of periodontal problems. For pts with special needs, have short appointments that are early in the day and be repetitive but brief.
Some interesting facts that I learned today are:
1. Down syndrome is spelled with small "s" not capitalized "S".
2. People with Down syndrome have increase periodontitis and decreased caries rate.
3. People with Spina Bifida are allergic to latex.
4. People with cystic fibrosis have excess Ca++ in their saliva and therefore have low caries rate.
Naomi Nguyen
158.
Spina bifida patients are more likely to have latex allergies, and Cerebral palsy patients have stronger gag reflexes.
Orly Hendizadeh, #134
1 If pt has cardiovascular dz, we should avoid pulp therapy in primary teeth.
2 Spina Bifida has high risk for Latex allergy.
Tiffany Hsu #529
The Rule of 10s - Decision making for CL and CP closure:
1) Pt has to be at least 10 lb
2) Pt has to be at least 10 months old
3) Pt has to have at least of 10 ml/dl of hemoglobin (blood test)
X. Li #146
Cleft lip happens b/w medial nasal swelling and maxillary process. However Cleft palate (more prevaland in males) occurs b/w the medial nasal process & palatal shelves.
Also, the 1st specialist in line for tx is the plastic surgeon.
Sanaz Hamzehpour #132
-Spina bifida and latex don't mix.
-Kids with Down syndrome tend to have CV problems and leukemia. Watch their cervical spine when entubaing them too.
-People with CP keep reflexes from childhood but not all have developmental delays.
-Cleft lips are closed early so babies can suckle, palates later to help with velopalatal insufficiency related speech problems.
Raquel Ulma #188
Pts. w/ Down syndrome usually have missing or malformed teeth, delayed eruption, increased periodontitis, and decreased caries rate.
Pts. w/ Spina Bifida are allergic to latex.
Pts. w/ cystic fibrosis have an increased concentration of calcium in there saliva resulting in a low caries rate.
Sydon Arroyo #102
Spina bifida pt has higher chance to have latex allergy. Down Syndrome pt could have early perio disease and less prevelance to develop caries. Avoid pulp therapy on CV disease pt.
Eric Cheung 110
Patients w/ spina bifida are more likely to have latex allergies and patients w/ cystic fibrosis have lower caries rate due to excess calcium in their saliva.
Farshid Siami #177
Patients with cerebral palsy who live in institutions have a high rate of caries , most related with the diet.
Heidi Gomzalez 526
1. Donot use latex products or gloves on patients with Spina-Bifida -- causes allergy.
2. Avoid pulp therapy on primary teeth in children with cardiac disease. Indicated for extraction.
Dilshad Abtin #524
-Avoid the use of latex dental supplies in pt with spina bifida.
-Surgical treatment for clefts:
Lip: 3-4 months
Palate: 10-12 months
Alveolar bone grafting: 7-9 years
Claudia Rodriguez #531
Children that have cardiovascular disease should have antibiotic prophylaxis, their anxiety level reduced, and CPR equipment should be ready.
Also, Avoid pulp therapy in primary teeth, with careful selection of endo tx in permanent teeth.
Broc Mushet
#156
Michelle Duong #123
Down Syndrome patients have increase in perio disease, while they have a decrease in caries rate. Cerebral palsy patients have increase in perio disease, increase caries, increase malocclusion , and increase in bruxism. Spina bifida patients commonly have a latex allergy there avoid latex.
While patients with severe systemic problems may not be seen in a general dentists’ office, some special needs patients are able to function relatively well in society. Therefore, the dentist should be aware of any special needs the patient may have in order to treat them.
-Carol Kim (138)
Patients with downs syndrome commonly have missing or malformed teeth. They also are likely to have periodontitis issues, but surprisingly have lower caries rates. Try to keep appointments short and early in the day for those patients with special needs.
Ryan Plewe
#168
Spina bifida = latex allergy!
Also cleft lip/palate children may need 2 surgeries in their first year (lip closure at 3-4 months and palate closure at 10-12 months), and 100% have malocclusion.
Brandon Seto
#173
1) Dentist should be able to treat mild to moderate mental disabled patients.
2) There is a high risk of latex allergy in patient with spina bifida
3) cleft lip and palates are multi-factorial both environmental and factors from parents
Jun Flores #130
Jonathan Do #121
Avoid using latex around patients with spinal bifida since they are allergic to latex. Do not do any pulp testing on pediatric patients with cardiovascular disease. Down syndrome patients have decreased incidence of caries but increased incidence of periodontal disease.
When treating a pt with special needs it's important to learn if they have any triggers that might set them off also find out from the parents what things soothe the pt. Always schedule appts in the morning and be prepared to take 2 even 3 appts to accomplish an exam and make the child comforable with the office.
Liz Miltner #150
Pts with spinal bifida are more likely to have latex allergy. Pts who are in a disabled care center are more likely to have a higher caries rate.
Shannon Lazarian
#133
In children with any mental condition, it seems that keeping the patient calm, choosing morning appointments, and keeping appointments short is a good rule of thumb to make appointments run smoothly.
Patient with Spina Bifida are more likely to have latex allergies, so avoid using them on these patients.
Mihir Shah #175
Down syndrome patients have an increased rate of periodontal disease and for an unknown reason a decreased caries rate. Also, spina bifida patients have an increase risk of latex allergy.
Josh Cardwell #108
Patients w/ spina bifida have a higher risk of latex allergy.
-Shelton Chow #111
It is important to remember that patients with spinal bifida are allergic to latex. Also, those with down syndrome need to be monitored for a higher risk of periodontitis even though their risk of caries is lower than the general population.
Niki Zarabian
#194
Spina Bifida patients are more likely to have latex allergies, and so it's always a good idea to use non-latex gloves on patients with this disease even when the allergy is not noted on their med hx. The rule of 10's for tx of cleft lip and palate was also very informative.
Sean Nguyen #160
Patients with mental disabilities will require unique consideration in the management and treatemnt of their dental disease.
Marc Thomas
#182
Sadly, what stuck in my mind was the reference to the old classification of mental disabilities: idiot, imbecile, and moron. I suppose that I learned that there are three levels of mental disability (mild, moderate, severe), that require varying approaches to treatment.
Sean Young #192
Cystic fibrosis patients have a lowe caries rate because of an increased concentration of Ca in the saliva.
Varo Boyajyan #106
Asthma can manifest several problems in oral cavity, including higher caries rate, increased gingivitis, decrease salivary flow, higher prevalence of posterior crossbite, increased overjet and facial height; these could be associated to increased incidence of mouthbreathing; it affects 1 in 10 children, with boys affected 2 x more than girls before adolescence.
Note that spina bifida patients would have higher risk of having latex allergy.
-Jeanne Wong, #195
~There is a high risk of latex allergy in patients with spina bifida.
~Cystic fibrosis patients have a decreased caries rate because of an increased concentration of Ca++ in their saliva.
Steph Morphis
#154
I thought it was funny when Dr. Law mentioned that Down syndrome does not have "'s" because Mr Down does not 'own' the syndrome nor does he have the syndrome. rita chen 109
Patients with spina bifida are at a higher risk of latex allergy. Also, asthma affects as many as 1 in 10 children.
Kevin Omoto
#163
Patients with spina bifida have a very high risk of latex allergy. so you should see them in the morning when all the latex dust has settled.
catherine do #122
Increased propensity for latex allergy in with spina bifida
That patients with trisomy 21 have increased susceptibility to periodontitis but decreased caries rate.
Steve Kim, #528
I found it interesting that people with spina bifida have higher risks of latex allergy. Also people with cystic fibrosis have a lower caries activity due to excess calcium in the saliva.
Stacy Yu #193
Patients with syndromes tend to have or will have a lot of surgeries. Don't use latex with spina bifida patients. Ectodermal dysplasia patients should get age-appropriate dentures corresponding to the expected dental development; the dentures should grow with them. Severely autistic patients also may have hx of seizures.
Shelby Padua #166
Due to the increased amount of Calcium in cystic fibrosis patients, they have lower caries rates.
Spina bifida patients are more likely to be allergic to latex, so a good precaution would be to use non-latex gloves.
Pts with spina bifida are allergic to latex
Kids with cleft lips have them closed earlier than those with cleft palates so that babies can suckle vs speech problems can be corrected later
Alina Tiraspolskaya (#183)
When treating children with mental disabilities keep appointments short, schedule appointments early in the day and be repetitive but brief.
Paul Hoang #135
When working with children who have psychological or mental conditions/ disabilities, it is important for the dentist to be extremely sensitive/ aware of the habits unique to individual patients and to note those observations in the chart (e.g. dislike or fear of hand-clapping). Also, cleft lip and palate is a multifactoral condition that, 100% of the time, results in malocclusion due to problems involving the number, location, and size of teeth.
C.Chung #112
Patients with Down Syndrome have a higher incidence of cardiac defects, leukemia in infancy, and upper respiratory infections. Their dental features include delayed eruption times, increased rate of periodontal disease, and decreased rate of caries.
Bozhena Fisher #128
- 11 million children and adults have a disabling condition
- Most children with disabilities are treated by a pediatric dentist
- Generally, patients with disabilities are best treated in the morning.
- Asthma affects 1 in 10 children, and is associated with increased caries rate and mouthbreathing (with its associated malocclusions)
Daniel Nelson #157
Spina bifida has latex allergy. CP occurs at 6-11 weeks and can have missing or supernumerary teeth.
Jing Lee #144
In dealing w/ pediatric patients with special needs, the role of the parent/caregiver is very important in decsion making and treatment for the child. Adjustments need to be made to accomodate these patient population.
Kim Pham #167
Each disability has its own specific oral manifestations. For example, patients with Down syndrome have an increased rate of periodontal disease but a decreased caries rate. Patients with Spina Bifida have a higher chance of having latex allergy.
Joanne Kim #140
The most important thing I learned from the lecture on children with special needs is to: be repetitive, be brief, assess level of understanding by the child, and keep appointments short. With this in mind, most dentists should be able to treat children with mild to moderate disabilities.
Cristen Dismuke #118
Avoid using latex on Pts with spina bifida, be aware that Cerebral palsy patients have stronger gag reflexes.
Soheil Yashari #191
Pt with medical hx of Spina Bifida should be treated with more caution since they have increased risk for caries and higher risk for latex allergy.
Sonia Lee (145)
In order to minimize complications associated with CL and CP surgeries, we must apply the rule of 10's to aid us in Decision making for Cleft Lip and Cleft Palate closure:
1. The Child must weigh at least 10 pounds
2. The Child has to be at least 10 months old
3. Undergo a blood test to determine if the Child has at least of 10 ml/dl of hemoglobin
Jeff Flores #129
1 Pts with Spina Bifida have high risk of latex allergy.
2 Pts with down syndrome have high rate of periodontal disease but surprisingly low risk of caries.
3 For pts with special needs, schedule appointments in mornings ,also be repetitive but brief.
Amandeep Iqbal
# 527.
When dealing with children with cerebral palsy, consider immobilizing the patient with a papoose board and mouth props. Also try to avoid sudden motions, and try to minimize the patient's gag reflexes.
Matthew Moadel #151
While most patients with mental disabilities will require treatment in a hospital setting, but some are high-functioning enough to be seen in a general office setting. For this reason it is important to know the limitations associated with the major syndromes.
[Colby Smith #178]
When treating children with disabilities, consult the caregiver on degree of disability and any triggers that may affect the child. Familiarize the pt. with the office, keep appointments short and in the A.M.
Diana Craft 115
To provide dental care to mentally challenged children, you really need to know what is going on. Most children are physically challenged too,e.g,a high percentage of Down Syndrome kids have heart defect which may need prophylaxis use of antibiotic. Make short apt, thoroughly understand pt's physical and mental status before any treatment, don't just focus on teeth.
Lei Zeng, #535
The three criteria which must be satisfied in order to perform CL and CP reconstruction child are:
-pt has to be at least 10 months of age, weigh 10lbs, and have Hb levels >10mg/dl
Latex gloves should not be used with Spina bifida pts.
Edvin #100
When deciding to perform a closure of cleft lip and palate, remember the following rules of 10:
1) Patient must be at least 10 months old.
2) Patient must weight at least 10 lbs.
3) Patient must have at least 10 ml/dl of hemoglobin.
William Traynor #186
Down Syndrome pts have high rate periodontitis issues as my wife's uncle, who has DS, was in dentures before he was 20. Also, spina bifida pts can be linked more often to latex allergies.
Jake Cragun #117
CL starts around 4-6 weeks and 100% of those patients will have malocclusion.
Dave Tajima
#181
Increased association of Spina Bifida and latex allergy.It is wise to avoid Root Canal therapy in children with infective endocarditis.
Asha Sethu Madhavan
#532
A few specifics about certain conditions:
- Spina bifida patients often are allergic to latex.
- Down's syndrome patients often have increased perio disease but decreased rate of caries.
- Cerebral palsy patients often have increased perio, caries, malocclusion and bruxism.
Jonathan Miller #149
Spina Bifida is an abnormality of the spinal cord caused by deficiency of Folic acid in women during the first 6 weeks of pregnancy. Spina Bifida has declined due to supplements (Folic acid) and the public awareness.
Paredes #164
Do NOT do pulpal therapy on primary teeth in patients with cardiovascular disease because you can maintain a chronic infection. Instead, do restorative or extract.
Sanam Soroudi
#180
Patients with spina bifida are more likely tobe affected by latex allergy.
Jan Slapnicka
#533
Magic moment:Patients with cystic fibrosis have excess Ca++ in their saliva hence decreased caries rate.
poonam rai #530
When treating pts with mental disabilities, it is important to assess the level of disability, consult with pt's physician, and include the caregiver in the appts.
Rick Shamo #176
Although patient's with Down's syndrome have a decreased rate of caries, they have an increased rate of periodontal disease.
Richard Duong #124
Isolated cleft palate is seen twice as often in females. On the other hand, the other orofacial cleft types (isolated cleft lip and cleft lip/palate) occur twice as often in males. The etiology is believed to be multifactorial. 20% of cases have supernumerary teeth. And, there are four eras of treatment which target specific developmental issues related to the patients age.
J. Oka #162
Patients with Spina Bifida are more likely to be allergic to latex, and patients with Down syndrome have an increased risk for periodontal disease.
It is good idea to schedule your special needs patients in the AM when both you and your patient are fresh. Always consult with parents for any trigger points you should avoid. Spend time familiarizing your patient with your office, even if it means no treatment at the first appointment.
Emmy Le #142
For the patients with cleft palate and lip the surgery should be done according to the rule of 10s:
weight- 10 lb, age- 10 months old
and hemoglobin 10 ml/dl.
Cornel Crasnean #525
100% of cleft lip and/or palate patients have malocclusion and need multiple corrective surgeries.
There is a high association of spina bifida pts with latex allergy.
#184 Amy Tran
For patients with intelligence disabilities, we need to emphasize education to increase independence and skill. When treating Autistic patients, be sure to ask the caregiver if they have any "triggers".
Chris Claus 113
Down syndrome patients tend to develop early perio disease, but less caries.
Spina bifida patients tend to have latex allergies.
Trish Barsanti #105
Magic moments:
Some of the most interesting things that I learned were that Children with Spina Bifida have a very high chance of having latex allergy. So Latex gloves should not be used. In addition children with Down syndrome are more prone to perio disease.
Paul Field #127.
It was interesting to discover that learning disabilities are 4x more prevalent in boys. This makes me more aware of the disability and now might even have a part in its dx.
Morris Poole
#169
--Patients who have Spina bifida are likely to have latex allergy.
--Patients with cystic fibrosis have a lower caries rate caused by an increased concentration of calcium in there saliva.
--And patients with Down syndrome are more prone to perio. problems.
-Harry Virk #189
I learned that Down syndrome patients have an increased occurance of periodontal disease but a decreased caries rate. Also, that spina bifida patients are allergic to latex.
Cynthia Morford #153
Avoid the use of latex when treating a patient with spina bifida. Patients with mental disabilities often can tolerate a morning appointment better than an afternoon appointment.
Jared Martin #147
Tx considerations for a cleft lip cleft palate patient for a neonatal patient can depend on the rule of 10. 10lbs, 10g//ml of hemo, 10 months.
Ernest Lai #141
For a patient with a high risk for latex allergy, early appointment times should be given. Over night, latex residue will settle, therefore there won't be any latex residues in the air.
Regina Espinoza #126
In patients with Spina Bifida, patients may have a high caries rate because they have bad nutritional habits, poor hygiene and long term therapy.
Patient of this category should use non-latex gloves and early morning appointments.
- neil patel
165
Very nice post, thanks for sharing the information. Keep up the good work.
wenham pediatric dentist
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