The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.

1. Dept.of Pedodontics
Presented By-
Sonam Gehi
Vidhya Bhikonde

3. Definition-
American Association Of Pediatric Dentistry (1996)
states , a person should be considered dentally
handicapped if there is pain , infection, or lack of
functional dentition that affects him/her as follows :
Restricts consumption of a diet adequate to support
growth and energy needs.
Delays or otherwise alters growth and development.
Inhibits performance of any major life activity
including work , learning , communication , and recreation.

4. • Blind Or Partially blind
• Deaf Or Partially deaf
• Educationally Subnormal
• Epileptic
• Maladjusted
• Defective In Speech
• Senile
Frank and
Winter (1974)
• Intrinsic
• ExtrinsicAgerholm (1975)
• Developmentally disabled child
• Medically compromised child
Convenience Of
Management

5. Physically Handicapped
Mentally Handicapped
Congenital Defects
Convulsive
Disorders
Communication
Disorders
Systemic
Disorders
Metabolic ,
Osseous ,
Malignant
Disorders

8. PHARMACOLOGICAL
METHODS-
 Premedication
Sedative and hypnotics
Anti-anxiety drugs
Antihistamines
 Conscious sedation
General anesthesia

13.  Behavior management techniques.
 Dental procedures must be explained slowly,
simply and repetitively.
 Give only one instruction at a time.
 Actively listen to the patient.
 The visits should be short.
 Gradually progress to more difficult
procedures.

14. We must learn from the parents or guardians
about the patients habits, comprehensive words
or gestures to facilitate our work.
 Use of physical restrictions on patients.
 Consideration of patient behavior, age and type
of treatment needed.
 Need of helpers.
 Sedation techniques.
 Use of general aneasthesia.

19. SPECIAL CONSIDERATIONS-
Incidence of cardiac disease.
 Incidence of leukemia and acute and chronic infections.
 Role of nitrous oxide analgesia, TSD , general
anesthesia.
 PREVENTIVE MEASURES.
 Pulp treatment.

22. Based on anatomical involvement-

23. Based on neuromuscular involvement-

24.  DENTAL CARIES-
 PERIODONTAL DISEASE-
 MALOCCLUSION-

25.  BRUXISM-
 TRAUMA-
 TONGUE THRUSTING-
 MOUTH BREATHING-

26.  Thorough medical and dental history should be taken, maintain calm atmosphere , be
empathetic.
Modification of regular toothbrushes to cope with grip or arm extension problems are
usually easily done.
 Correction of malocclusion.

27.  Patients preference to be treated in the wheelchair.
Patient’s head stabilization.
Physical restraints.
 Minimize startle reflex.
 Use of local anesthesia.

28.  Use of rubber dam ,gauze shields.
 Premedication.
 Use of general anesthesia.
 Use of sealants and stainless steel crown on permanent posterior tooth..

30. •About 10 % of children below 20 yrs of age have visual defects.
•A person is considered affected by blindness if visual acuity does not exceed
20/200 in the better eye ,with the correcting lenses, or if the visual acuity is
greater than 20/200 but accompanied by a visual field of no greater than 20
degrees.
•A dentist providing treatment for these patients first determine the degree of
sight present , overall personality defects and speech disorders are most
frequently observed along with blindness.

32. Prolonged immature swallowing pattern due to
reluctance to consume solid foods.
Poor oral hygiene related to learning
disabilities as well as hypoplastic teeth.

33.  Trauma to anterior teeth also occurs with a
higher frequency.
 Increased gingival inflammation due to inability
to visualize and remove the plaque.

34.  Complete medical history along with the degree of visual
impairment is ascertained prior to treatment.
 Paint a picture in the mind of your patient describing office
settings , office personnel, and treatment procedures before
starting anything.
 Make physical contact reassuringly and do not suddenly grab
or move patient without prior notice.

35.  The dentist can make use of TTS rather than TSD
 Many visually impaired child are photophobic.
 Avoid using any signs, expressions of pity and
references to blindness as an affliction.
 Oral hygiene education.