Читать книгу A Practical Approach to Special Care in Dentistry - Группа авторов - Страница 73

1 What factors may be impacting on this patient's poor oral health and increased caries risk?Compliance issues in daily lifeLack of perceived needCognitive difficulties due to learning disabilityMotor problems due to hyperactivityFigure 2.1.1 Dentition: generalised plaque, calculus and gingival inflammation, fracture of the incisal tip of tooth # 21.Figure 2.1.2 Maxilla: caries in teeth #54, #53, #65, stained fissures in #16 and #26.Poor oral health habits and dietIrregular dental check‐ups due to dental anxiety and lack of accessOral dryness due to methylphenidateChanges in oral health behaviour during adolescence

2 How would you manage the dental caries?Figure 2.1.3 Mandible: caries in teeth #75, #84 and #85; calculus on the lingual aspect of lower incisors; buccal enamel demineralisation.Reduce caries risk – dietary analysis, educate parents, reinforce oral hygiene, consider fluoride supplementationAcclimatise the patient further – he has already demonstrated improved compliance by allowing bitewing radiographsReattempt an orthopantomogram and consult with an orthodontist as the patient is at a mixed dentition stageIf compliance is limited, plan to allow deciduous teeth to exfoliate if they are asymptomatic and focus on the permanent dentitionPlace fissure sealants and attempt restorations (temporary restorations can be recommended and any local anaesthetics avoided for the patient to get used to)

3 The patient asks you to repair the fractured incisal tip #21 as he does not like its appearance. What factors would you need to consider?Figure 2.1.4 Right and left bitewing radiographs: mixed dentition; caries in #75, #84 and #85.Further information regarding how and when the fracture occurred, and any related symptomsCapacity of the patient to understand what is plannedIn relation to previous successful dental filling placement at the age of 9 years old:Where and how it was carried out?How co‐operative was the patient?What behavioural modification tools were used?In relation to unsuccessful treatment a year ago:Why was clinical holding used, i.e. was it to assist with uncontrolled movements?Was it agreed and consent in place?Why did it go wrong?With this information, confirm the modified plan

4 The patient's mother has also noticed that her son makes a loud noise with his teeth predominantly at night – what could be the cause and why?Sleep and day bruxism has been linked to ADHDIt may also be a side‐effect of the medications used to manage the condition, including methylphenidate

5 What other factors could be contributing to tooth surface loss?Xerostomia due to methylphenidateDietary acid/erosion due to high sugar and acid intake

6 What factors are considered important in assessing the risk of managing this patient?SocialIrregular attender, dental anxietyLearning disability, poor compliance and toleranceSelf‐injurious behaviourAvailability of escortMedicalPotential side‐effects associated with methylphenidate include headache or nauseaSigns of trauma/self‐harmDentalBruxism leading to tooth surface lossIncreased risk of caries due to xerostomia induced by methylphenidateHigh caries rateCariogenic dietHistory of dental trauma