manipulated manual brush, in children particularly, the novelty aspect may be a
motivating factor to use this type of brush to greater benefit.
17.8.3 Operative procedures
For those children who can lip-read it is necessary to sit well in front of the child, with
good lighting to the operator's face. Both dentist and assistant should move their lips
clearly during speech and avoid the temptation to shout. Masks are therefore to be put
to one side and bearded operators should ensure that facial hair does not obscure clear
visualization of lip movement! A comment as to the best hearing side should be
inserted in the patient's notes so that staff are aware of this at each visit.
Children wearing hearing devices may be disturbed by the high-pitched noise
produced by handpieces and ultrasonic scalers. This may make them less co-operative
and less amenable to treatment. Similarly, the conduction of vibrations from the
handpiece and burs via bone is more disturbing for the hearing-impaired child. After
initial communications are complete it may be advisable to suggest that the hearing
device is removed or turned off and only re-inserted on completion of the dental
treatment in time for final instructions. Very young children often have difficulty
keeping the aids in place simply because of the size of the immature pinnae. This is
especially so when lying supine in the dental chair.
17.9 SUMMARY
- Children with impairments present the dental team with the challenge of adapting
familiar skills to new situations. - To meet this challenge effectively we need to re-examine some of the stereotypes
of impairment we carry in our own minds. - An impairment becomes a disability by virtue of other people's attitudes, the things
we do or do not do, the facilities we do not offer, as well as the physical barriers the
environment interposes. - Oral and dental health are little different between children with impairments and
others. What is different is the type of treatment provided, with more missing teeth
and fewer filled teeth in populations with impairments. - Some children have specific oral conditions as a result of their impairment, for
example, periodontal disease in Down syndrome. - A degree of common-sense, a willingness to be flexible, as well as a working
familiarity with the commoner medical conditions and their implications for oral and
dental health, are most of what a general dental practitioner requires to provide
dental care for the child with impairments in his or her community.
17.10 FURTHER READING
Nunn, J. H. (2000). Disability and oral care. FDI World Dental Press Ltd., London.
(A comprehensive coverage of aspects of oral and dental care for people with