1112H
Fig. 16.9 These grossly hyperplastic gingivae are associated with cyclosporin and
nifedipine medication in this 11-year-old boy who has had a kidney transplant. This
combination of drugs is required to prevent rejection and to control his blood
pressure.
16.9 SUMMARY
In all children who are medically compromised the dental team can not only play a
vital part in the overall medical management but also in helping these children and
their parents adjust to normal life following recovery. Oral care is extremely
important in enhancing the quality of life by reducing the morbidity and mortality of
oral conditions, and by allowing the child to eat without pain and so gain optimal
nutrient intake. Preventive care should be the cornerstone of any oral care programme.
Since many children travel long distances to regional and supra-regional units, shared
care between the hospital paediatric dentistry specialist and the primary care provider
can facilitate the child's reintegration into their local community and avoid lost
schooling.
- An increasing number of children with complex medical problems now survive due
to improvements in medical care, and present difficulties in oral management. - An accurate, detailed medical history must be obtained for all children before any
dental treatment is undertaken. - An aggressive preventive regimen is required for all children with significant
medical problems; this must encompass dietary counselling, suitable fluoride therapy,
fissure sealant applications, and oral hygiene instruction. - Congenital heart disease is more common in children than acquired conditions.
Many of these malformations require prophylactic antibiotics prior to carrying out any
invasive dental procedures. - Children with bleeding disorders, such as haemophilia, thrombocytopenic purpura,
and Von Willebrand's disease, must be haematologically investigated prior to dental
treatment. Haematological replacement therapy may be required before operative
treatment. - Children with anaemia, whether from iron deficiency or from such inherited
conditions as sickle-cell anaemia or thalassaemia, represent general anaesthetic risks