By Dr. Pratibha Pandit

Dentistry for children with special health care needs Handle with care!

Over years, Dentistry has evolved from being merely the art and science of ‘removal of the painful tooth’ to a wider specialty ranging from Pediatric dentistry, dental implants, orthodontics and Geriatric dentistry. With time, the needs for aesthetics and perfection has embraced dentistry to a finesse practice, just getting better by the day. However, a large population of children with special needs still have their comprehensive dental care needs unmet. Physical or intellectual disability, poly pharmacology, other priority medical needs, parental unawareness and the lack of will or expertise of the practicing dentist are potential barriers in providing dental care for these children and young adults.

Special health care needs, by definition include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. Implied to dentistry, the definition becomes very subjective and many children may have impaired performance of even routine activities, including basic tooth brushing! Ranging from milder forms of autism, children with diabetes, renal disorders, epilepsy, liver disorders, hearing and speech disorders, childhood cancer, congenital heart diseases to severe forms of cerebral palsy, each child needs an individualized and multidisciplinary dental care plan.

A lot of myths roll around milk teeth and their importance. Milk teeth fall off anyway! Why do so many efforts to save teeth that will fall off eventually! Just pull the painful tooth out! These, and a lot more. Yes, contrary to permanent teeth, milk teeth do exfoliate at a certain age (between 7-14 years). But these years happen to be crucial for growth and development. Nutritional deficiencies in these age groups have been linked to many systemic and medical conditions. All efforts should be made to retain as many milk teeth as possible until natural exfoliation.

Awareness and Action- can be the focus points to begin with. Awareness of both, the parents and the primary physicians of the child. It’s sad to see severely mutilated dentitions causing chronic pain in children, where in parents are unaware of any sort of available dental treatment. Prevention and maintenance has, and will always be the cornerstone for all dental treatments. Surprisingly, oral hygiene has been linked to many systemic diseases and vice versa. Routine dental visits every 3-6 months, catering to individualized brushing armamentarium and techniques, dietary changes in consultation with child’s pediatrician and parent motivation can improvise oral hygiene in children with special needs. Once sensitized to the dental environment, a large number of these children are cooperative for dental treatment. Various other pharmacologic means of behavior management like sedation and general anaesthesia are available and practiced routinely with good amount of safety. Children with decayed dentition needing extensive dental treatment are usually treated in Operating rooms with the safety of General anaesthesia, wherein all treatments can be completed in a single sitting. This is particularly beneficial in children with limited cooperative ability, intellectual deficits or very young children. At KEMH Pune, the dental care and implant center is equipped and well experienced for carrying out mostly all dental procedures (multiple root canal treatment, dental extractions, restorations, crowns etc.) in the operating room with the help of our experienced anaesthesia team. Apart from this, we have been constantly striving to increase awareness by the means of oral health check up camps and parental education lectures at many schools in Pune and around.

Dr. Pratibha Pandit

Consultant - Paediatric Dentistry