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Prepared by Dr. Rana Darwish DDS, MPH. Impairment Disability Handicapped Special needs.

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Presentation on theme: "Prepared by Dr. Rana Darwish DDS, MPH. Impairment Disability Handicapped Special needs."— Presentation transcript:

1 Prepared by Dr. Rana Darwish DDS, MPH

2 Impairment Disability Handicapped Special needs

3 The term "Special Patient" is used in the oral health field to describe an individual with special needs, including physical, medical, developmental and/or cognitive conditions, resulting in limitations in their ability to receive dental services and prevent oral diseases by maintaining daily oral hygiene. * * Prevention of Oral Diseases. 2003

4 Public Health Associations (American & Canadian) Academy of Dentistry for Persons with Disabilities British Society for Disability & Oral Health Special Care Dentistry Association International Association for Disability & Oral Health

5 Physical disabilities Mental disabilities Learning disabilities Syndromes ( e.g. Down syndrome) Cerebral palsy Muscle atrophy Autism

6 Source: Palestine Childrens Relief Fund (PCRF Institution)

7 Atfaluna Society for Deaf Children – Gaza Strip

8 The development of personal dental services Lack of funding for training Cost of specialist services & facilities Unwillingness of some general dental practitioners to provide dental treatment for such groups

9 Some countries developed special dental units or chairs Wheelchair platforms provide a better, cheaper, and more effective service to special care dentistry patients * Design Specific, Special Needs Dentistry.

10 Full Function Wheelchair platform Mobile Wheelchair platform Wheelchair Recliner * Design Specific, Special Needs Dentistry.

11 Carers (nurse, social Worker, …) Medical doctor Family Relatives


13 Poor cooperation Resistance to mouth cleaning Challenging behavior Limited access to dental services

14 Dental caries prevalence in patients with impairments is higher More untreated decay More missing teeth Fewer restorations Oral health can be maintained at high level if preventive & treatment services were provided for such target group

15 Topical Fluorides (High doses) High Fluoride toothpastes (for certain groups) Toothpastes alternatives (Fluoride mouthwash) Dietary constituents & form Liquid oral medicines Chlorohexidine (gel, varnish)

16 Atraumatic Restorative Treatment ART * * WHO, Oral Health Program. ART Manual 2008

17 Atraumatic Restorative Treatment ART * * WHO, Oral Health Program. ART Manual 2008

18 Carisolv *: chemo-mechanical minimal invasive approach that removes necrotic decayed dentin only leaving healthy tooth structure Ozone therapy: no need for using dental handpiece or local anesthesia…useful method Feb

19 Neurological impairment clenching or grinding causes attrition Cerebral palsy gastroesophageal disease vomiting causes erosion Bizarre oral habits abrasion

20 If no toleration for extensive treatment remove badly worn teeth With toleration under sedation or GA full coverage of affected teeth & molars Cleaning aids not to be erosive

21 Poor oral hygiene resulting in plaque accumulation and gingivitis Down syndrome more prevalent periodontal disease & early tooth loss Epilepsy medications gingival hypertrophy Mouth cleaning mission (carers & relatives)

22 Change medication or modify dose (physician) Modified manual toothbrushes Mouth cleaning resistant patients powered toothbrush or Superbrush (opposing bristles clean 3 surfaces with one stroke) Barmans Superbrush –

23 Difficult cases (extremely ill) mouth care carried out in bed by nurse or carer toothpaste or toothbrush dipped in mouthwash or chlorhexidine gel Also chlorhexidine varnish can be used (sustained up to 6 months) Patients refusing or resisting cleaning aids behavior modification desensitization

24 Self mutilation involving oral tissues in certain syndromes. Teething sometimes triggers it Lip & tongue biting pain & swelling mouth is too sore to drink or eat dehydration hospitalization

25 If offending teeth were primary extract Use soft splints to prevent soft tissue trauma If malocclusion teeth adjustment & orthodontic treatment depending on case

26 Excessive drooling especially in poor neuromuscular control (cerebral palsy or cerebro- vascular accident) Prevention & management: Surgical Pharmacological Radiotherapy Palatal training aids ( Hyoscine patch /anticholinergic ) Behavior modification

27 Associated with: Syndromes Medications (elderly patients) Patients on radiotherapy Results in increased rate of dental caries and ill-fitting dentures

28 Radiotherapy: preoperative dental care to avoid extractions High dose fluoride (varnish) Chlorhexidine mouthwash or gel Saliva stimulation (Pilocarpine) Saliva substitution

29 Each dentist should do his/her best in trying to improve the quality of life for those in need


31 Palestine Childrens Relief Fund (PCRF). Design Specific, Special Needs Dentistry. World Health Organization, Oral Health Program. ART Prevention of Oral Disease, J. J. Murray, 4 th edition, 2003, Oxford Press. Carisolv presentation. Februray MediTeam Dental. February

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