- Childhood impairment and disability - J. H. Nunn
17.1 INTRODUCTION
An impairment becomes a disability for a child only if he or she is unable to carry out
the normal activities of his or her peer group. For example, a child who has broken an
arm is temporarily 'disabled' by not being able to eat and write in the normal way.
However, for some children impairment is a permanent feature in their lives, although
it may become a disability only if they are unable to take part in everyday activities,
such as communicating with others, climbing stairs, and toothbrushing. One definition
that helps to clarify which children are 'disabled', for the purposes of providing dental
care, is as follows: 'dentally disabled' refers to patients who have some gross
condition or deficit in their oral cavities, which necessitates special dental treatment
for example, a cleft of the lip and palate. By contrast, children who are 'disabled for
dentistry' are those who have a physical and/or intellectual or emotional condition that
may prevent them from being treated in a routine manner.
There are a number of reasons why children with disabilities merit special
consideration for dental care:
- The oral health of some children with disabilities is different from that of their
normal peers, for example, the greater prevalence of periodontal disease in people
with Down syndrome and of toothwear in those with cerebral palsy. - The prevention of dental disease in disabled children needs to be a higher priority
than for so-called normal peers because dental disease, its sequelae, or its treatment,
may be life-threatening, for example, the risk of infective endocarditis from oral
organisms in children with congenital heart defects (1114HFig. 17.1). - Treatment planning and the provision of dental care may need to be modified in
view of the patient's capabilities, likely future co-operation, and home care, for
example, the feasibility of providing a resin-bonded bridge for a teenager with
cerebral palsy, poorly controlled epilepsy, and inadequate home oral care.
In the light of these considerations, do such children need special dental care? Most
of the studies which have been undertaken on disabled children have indicated that
the majority can in fact be treated in a dental surgery in the normal way, together
with the rest of their family.
Key Points
The need for special dental care arises because of:
- differences in dental disease prevalence;
- dental disease/treatment may be life-threatening;
- the modifications required to treatment plans;
- the need for special facilities;
- treatment may be time-consuming.
This normality is desirable, provided the disabled person actually receives good
dental care. The evidence from many studies is that, although the overall caries
experience is similar between disabled children and their so-called normal