WINTER 2006

Dentistry for Children with Special Needs – Part II

 This is the conclusion of Dr. Richard Mungo’s series on dentistry for Children with Special Needs. Part I which appeared in an earlier issue of The SNAP Report can be found at our website, www.snapinfo.org.

 What accommodations are made for children with special needs?

Non-verbal children Many offices will have one or more staff personnel who have some degree of proficiency in the use of sign language. The parents are the best assistance in these matters. Whatever method they use to communicate with their child can be incorporated within the dental office experience. Discuss your role with the dental team prior to the visit or before a specific procedure is to take place. The dental professionals will guide you in your quest to make the visit a positive and productive one.

Non-ambulatory children Transferring children to the dental chair from their wheel chairs can be done with the assistance of the parents. Parents know comfortable methods of transfer and manipulation that will not bother or harm their child. The doctor and staff learn from the parents what works, and then document their recommendations for usage in subsequent visits.

There are times when we have made house calls to evaluate a dental situation for parents who cannot take the child out of the home. We are obviously limited in what we can do in the way of treatment without the appropriate dental equipment. However, a good assessment of the child’s needs can give us the opportunity to plan an approach to the child’s care and whether it requires a hospital setting or can be handled in the office.

Children in home care facilities or in the hospital can be assessed through a dental examination when a dental consultation has been requested. In the hospital, there are procedure rooms on various floors in which some minor surgical care can be rendered. Otherwise, care can be arranged to take place in the operating room suites of the hospital.

Should we move children from wheelchairs into the dental chair?

I believe it is better to leave the child in their wheelchair, if possible, when offering dental care in the office. The wheelchair has been customized for the child’s comfort and the dental chair may not be contoured well for any limitations in movement that the child may exhibit. Pillows can be used to add an additional secure feeling for the child in either the wheelchair or dental chair. Making sure that the child is comfortable, secure and safe is our most important concern when determining where the child should be placed for treatment. Most wheelchairs can be tilted backwards for better access for the dentist. We then can stand behind the wheelchair and gain good access to the mouth.

When is hospital dentistry appropriate?

We often need the environment of a hospital or surgery center to accomplish our required treatment. If the medical condition or mental status of the child is prohibitive in offering adequate safety or cooperation in a dental office, then the hospital setting is the better alternative. For example, patients who have cerebral palsy, cardiac problems, bleeding disorders, developmental delays are often best treated in a hospital setting. Each child is different and will require a comprehensive plan for their needs.

Children who have autism can be challenged when attempting to perform dental procedures. The dentist and the parents need to create the best approach to the child’s care. Tender love and care in office-conscious sedation or general anesthesia are the options.

Do you have any final recommendations or thoughts?

Identifying the kind of treatment that is necessary and the means of accomplishing those goals are the key factors involved in determining what’s best for the child. From medical issues, to insurance coverage, to dental treatment options, we must always keep in mind: “It is all about the children.” What we can offer the children is a healthy and happy smile. This task involves a team of caring people – the parents, the dentist, the staff and other healthcare professionals - -who have the child’s best interests at heart.