W5 - Mgmt of the "Special" Child - Mani

Question 1

Describe the behaviour of retarded children (3)

Answer 1

• Short attention span
• Restlessness / Hyperactivity
• Erratic Emotional behaviour

Question 2

Secondary dental consideration of retarded kids

Answer 2

• High dental caries
• Periodontal problems
• Enamel hypoplasia
• not directly caused by mental deficit*
• these pts are probably cared for by parents/caretakers → they have bigger problems than dental care*

Question 3

How to manage mentally retarded pts (5)

Answer 3

• Familiarize pt to clinic
• Slow and simple speech
• One instruction at a time
• Short, morning appointments
• Listen to them carefully

Question 4

Physical features of downs’ heads (not oral feats) (4)

Answer 4

Flat nasal bridge

Flattened face

Round skull

Small maxilla

IQ retarded

Question 5

Features of Downs’ eyes (3)

Answer 5

Oblique palpebral fissures (upward slanted)

Scanty eyelashes

Epicanthic folds

Question 6

Feats of Downs’ neck, muscles and joints

Answer 6

Short neck

Hypotonic muscles

Hyper extensive joints

Question 7

Associated medical conditions with Downs (4)

Answer 7

Congenital heart problems (ASD, VSD) → consider AB

Acute lymphoplastic leukemia

Duodenal atresia

Umbilical Hernia

Question 8

Oral manifestations of Downs (8)

KNOW ALL

Answer 8

Relative macroglossia

Thickened lips

anterior open bite

High arched palate

Bifid uvula

Delayed eruption

Perio

Hypo and microdontia

Question 9

Dental tx of Downs pts

Answer 9

AB prophylaxis

Normal preventive regimen

Tell show do / sedation / GA

Pulp therapy contradicated if they are cardiac pt

Question 10

Pt comes in

Has downs, cardiac condition, pulpally involved primary tooth.

Tx?

Answer 10

Extract

Pulp therapy contraindicated in cardiac conditions

Question 11

Pt comes in

Has downs, no cardiac condition, pulpally involved primary tooth.

Tx?

Answer 11

Pulp therapy as needed

Treat as normal

Must confirm they do not have any cardiac condition

Question 12

What is CP

Answer 12

Cerebral palsy

Nonprogressive lesion which occurs in developing brain

/ Damage to CNS

Question 13

Etiology of CP (4)

Answer 13

Meningitis

Toxemia

Jaundice

Metal poisoning

Question 14

Describe how CP affects movement (5)

Answer 14

Spastic and Dyskinetic

Increased motor tone → difficulty in moving limbs

Limited control of neck muscles

Lack of coordination of intraoral, perioral and masticatory musculature

Involuntary movements (slow writhing, quick jerking)

Facial grimacing

Question 15

Are removable appliances (ex. space maintainers) appropriate for CP?

Answer 15

Depends on the severity of the spastic, uncontrolled movements

• not directly contraindicated

Question 16

Feature of ataxic CP

Answer 16

Poor uncoordinated movements

Difficulty in grasping objects

Question 17

What is asymmetric tonic neck reflex

Answer 17

Seen in CP pts

when pts head is turned to one side, the arm and leg on that side will extend and stiffen

The opposite side will flex

Question 18

What is the tonic labyrinthine relex

Answer 18

Seen in CP pts

IF pts head falls backwards, back will arch and arms and legs will straighten out (postural extension)

Question 19

3 reflexes seen in CP

Answer 19

Startle reflex

Tonic labyrinthine reflex

Asymmetic tonic neck reflex

Question 20

Dental problems of CP pts (5)

Answer 20

Dental caries

Perio

Overjet & Openbite

Bruxism, TMJ

Trauma

Question 21

Mgmt of CP pts (5)

Answer 21

Consider treating in wheelchair itself

Avoid abrupt mvmts, light, noises

Rubber dam to avoid hyperactive tongue and aspiration

GA if necessary

LA admin needs stabilisation to protect against sudden movements

Question 22

Nondental features of ectodermal dysplasia (5)

Answer 22

Fine sparse hair

Dry skin

Dysplastic nails

Protuberant lips

Frontal bossing

Question 23

Oral feats of ectodermal dysplasia

Answer 23

Oligodontia

Developmental defects of enamel

Conical teeth

Reduced alveolar growth

Maxillary hypoplasia

Reduced VDO

Question 24

Types of epillepsy / seizures (4)

Answer 24

Primary generalised seizures

• Tonic-clonic / grandmal
• Petit mal
• Tonic
• Atypical

Partial / focal seizures

Status epilepticus

Recurrens

Question 25

Oral manifestations of epillepsy (5)

Answer 25

Gingival overgrowth (from phenytoin)

Prone to facial injuries

Ulcerations / trauma

Secondary infections

cervical lymph adenopathy

Question 26

How to manage pts with epillepsy

Answer 26

pts very sensitive to lights and loud noises

Avoid sudden movements

Slow introduction of dental chair light

Short Appts

Reduce stress

No removable appliances

Avoid seizure promoting drugs

Question 27

How to manage deaf patients

Answer 27

DONT speak louder

Speak directly facing patient

Tell show do

Non-verbal (smile, facial expression, physical contact)

Question 28

How to manage blind patient (5)

Answer 28

Describe the office setting and procedure

Physical contact → dont suddenly move pt

Touch / Taste / Smell

Keep instruments away

Caution when administering LA

Question 29

What to say if you are unsure about AB prophylaxis

ex. articial prosthesis in other parts of the body such as hip replacement

Answer 29

“Generally not required, however the decision would be at the discretion of the treating physician”

Question 30

Does a general examination warrant AB prophylaxis

Answer 30

No - even selective CPITN 6 teeth