PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

carried out on an out-patient basis. Consultation with the child's physician is
necessary before prescribing steroids, and anaesthetists must be aware of such
medication in order to avoid a precipitous fall in blood pressure during anaesthesia or
in the immediate postoperative period.


16.6.3 Other disorders


Many other metabolic and endocrine disorders occur in children but these are rare
events.


16.6.3.1 Thyroid disease


Thyroid disease may present in early adolescence, although it is generally more
common in adults. Dental management should present no problems if the thyrotoxic
patient is medically well controlled; however, liaison with the physicians is important.


16.6.3.2 Renal disorders


Nephrotic syndrome is a condition where protein leaks from the blood into urine via
the glomeruli of the kidney resulting in hypoproteinaemia and generalized oedema.
Left untreated, sufferers would die of infections but fortunately the majority respond
to treatment using corticosteroids, usually prednisolone.


The kidney undergoes a complex developmental and migratory process leading to a
high frequency of congenital anomalies, such as polycystic disease and unilocular
cysts. Acute pyelonephritis is more common when there is a congenital abnormality
present and so, even though it is simply treated with antibiotics, children often
undergo further medical investigations to rule out congenital abnormality. Therefore,
children with renal problems are likely to be, or have been, under specialist medical
care. From a dental viewpoint, children with reduced renal function, or more
importantly, progressive renal failure need extra consideration when prescribing
drugs. Such children may: fail to excrete a drug or its metabolites, be more sensitive
to the drug's effect; be less tolerant of side effects; and same drugs may even be less
effective. Examples of drugs where caution should be exercised by the dentist
include: midazolam and other benzodiazepines, chloral hydrate, NSAIDs,
Fluconazole and co-trimoxazde. The BNF should always be consulted.


16.7 NEOPLASTIC DISORDERS


There are approximately 1200 new cases of childhood cancer each year in the United
Kingdom. Child cancer patients largely reflect the child population in general and as
such, represent a cross-section of the population. Cancer causes more childhood
deaths between the ages of 1 and 15 years than any other disease, but is still
considerably behind trauma as the most common reason for mortality. The incidence
of malignant tumours in children under 15 years of age in developed countries is
estimated to be in the region of 1 in 10,000 children per year but the mortality rate is
high, at between 30% and 40%. Although leukaemia is the most common form of
childhood cancer, tumours of the central nervous system and neural crest cells and
lymphomas also form a significant proportion (1109HTable 16.9). Prognosis varies with the
type of tumour, the stage at which it was diagnosed, and upon the adequacy of

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