contemporaries, the type of treatment they have experienced is different: disabled
children have similar levels of untreated decay, but more missing teeth and fewer
restored teeth. A minority of children with complex disabilities need special facilities,
usually only available in dental or general hospitals, or from specialized community
dental clinics. What is needed by all patients with disabilities is a very aggressive
approach to the prevention of dental disease. Because of the potential for dental
disease, or its treatment, to disable an impaired child, priority must be given to
preventive dental care for such individuals from a very young age.
Children with a significant degree of impairment are termed 'children with special
educational needs' or 'children with learning difficulties'. These terms, used
synonymously, encompass a wide variety of impairments, but three main areas ⎯
intellectual, physical, and sensory impairments⎯predominate and will now be
considered in more detail. It is important to stress, however, that impairment does not
always present as a discrete entity; in any population of affected children, at least a
quarter of the group will be multiply impaired, making it difficult to assign a 'label' to
that child's impairment. Medical compromise, considered in more detail in 1115HChapter
16 , may also be imposed on these impairments. The way in which some of these
present to a dentist are given below, together with the dental management issues
relevant to each. Many of the issues raised are, of course, common to a number of
impairments.
1116H
Fig. 17.1 A 13-year-old boy with Down syndrome and gross caries, who was
prevented from going on a combined heart and lung as well as a renal transplant
register because of his dental disease.
17.2 INTELLECTUAL IMPAIRMENT
17.2.0 Introduction
The causes of intellectual impairment are numerous and for many children a cause for
their disability may never be identified. Approximately, 25 per 1000 of the child
population are affected, and the majority, as with other impairments, will be males.
Children with intellectual impairment can be divided broadly into those who are either
mentally retarded or have a learning difficulty. These are broad groups, often without
a well-defined aetiology or consistent presenting features, but there are two distinct
subgroups where the cause is known and the features are well described, namely