PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

  1. Medical disability - M. T. Hosey and R. R. Welbury


16.1 INTRODUCTION


16.1.0 Overview


There are many general medical conditions that can directly affect the provision of
dental care and some where the consequences of dental disease, or even dental
treatment, can be life-threatening. An increasing number of children who now survive
with complex medical problems due to improvements in medical care present
difficulties in oral management. Dental disease can have grave consequences and so
rigorous prevention is paramount. The decline in childhood mortality has led to
increasing emphasis on maintaining and enhancing the quality of the child's life and
ensuring that children reach adult life as physically, intellectually, and emotionally
healthy as possible. Dental care can play an important part in enhancing this quality
of life. Indeed, management within the primary dental services helps to 'normalize'
life for these children who appreciate attending along with their family even though
sometimes they might still require specialist expertise.


Even though the infant mortality rates (deaths under 1 year of age) have declined
dramatically in the United Kingdom, the death rates are still higher in the first year of
life than in any other single year below the age of 55 in males and 60 in females. The
rates are highest for the very young. The main causes of death in the neonatal period
(the first 4 weeks of life) are associated with prematurity (over 40%) and by
congenital malformations (30%). In the remainder of the first year, however, the main
causes of death occur at home and often nothing abnormal or suspicious is found
(SUDI⎯sudden unexpected death in infancy and SIDS⎯sudden infant death
syndrome). Although the unexpected death of a child over 1 year of age is rare, a few
infants still succumb to respiratory and other infective diseases (e.g. meningitis),
congenital malformations, and accidents.


16.1.1 The medical history


All patients should have an accurate medical history taken before any dental
treatment is undertaken. This is important for several reasons:



  1. To identify any medical problems that might require modification of dental
    treatment.

  2. To prioritize children who require intensive preventive dental care.

  3. To identify those requiring prophylactic antibiotic cover for potentially septic
    dental procedures.

  4. To check whether the child is receiving any medication that could result in adverse
    interaction(s) with drugs or treatment administered by the dentist. This would include
    past medication that could have had an effect on dental development.

  5. To identify systemic disease that could affect other patients or dental personnel;
    this is usually related to cross-infection potential.

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