- weakness of the facial muscles;
- poor oral hygiene secondary to the general inability to provide oral self-care;
- increased dental decay;
- increased potential for periodontal disease;
- malocclusion secondary to decreased facial muscle tone while retaining tongue
function; - decreased protective reflexes and reduced ability to swallow or clear secretions from
the oropharynx, thus increasing the potential for aspiration.
17.5.3 Operative procedures
Consideration needs to be given to wheelchair transfer techniques and padding as well
as the length of appointments (see above). The use of sedation and general anaesthesia
may need to be avoided due to the decrease in respiratory function and the risk of
post-anaesthetic complications. Frequent recall is important, with applications of
topical fluorides and antiplaque agents (0.2% chlorhexidine gluconate). There are no
contraindications to dental treatment, with the exception of orthodontics because of
the changing muscle forces. As a consequence of tooth movement seen as part of the
disease, and the likely development of anterior or posterior open-bites, prosthetic
appliances may become non-functional.
17.5.4 Home care
Appropriate support and training needs to be given to the parent or carer so that in the
later stages of the disease, when contact with dental services may be difficult,
adequate plaque control can be maintained. Dental treatment may need to be provided
within the home environment, although this will usually be at the stage when the
patient has reached adulthood. It is important that every effort is made to optimize
oral function and facial appearance and thereby encourage a positive self-image.
17.6 OTHER MUSCULOSKELETAL IMPAIRMENTS
There are a variety of other defects, some degenerative and some developmental,
which also affect children; however, these are relatively rare and unlikely to be
encountered regularly in practice⎯for example, osteogenesis imperfecta, juvenile
arthritis, and multiple sclerosis. When patients present with such disabilities there
may be significant oral signs, for example, in rheumatoid arthritis there is an
increased incidence of Sjogren's syndrome (autoimmune) and anaemia (secondary to
anti-inflammatory and steroid medication). Aggressive prevention is vital to prevent
dental disease.
17.7 BLINDNESS AND VISUAL IMPAIRMENT
17.7.0 Introduction
Visual impairments vary from total blindness to sight limitations of size, colour,
distance, and shape. The prevalence is in the order of 3 per 1000 children.
17.7.1 Oral health