Problems with the teeth of “special” children worry parents quite often: sometimes such children even don't allow their mother to brush their teeth, and they themselves cannot cope with daily hygiene.
How, then, to treat their teeth in a dental clinic and a stressful situation? Olga Wendt, Med Garant pediatrician, family pediatric dentist, tells about the means by which modern dental clinics have facilities to help special children.
REASONS FOR PARTICULAR PROBLEMS WITH TEETH
Indeed, children with disabilities (Down syndrome, autism spectrum disorders, cerebral palsy – cerebral palsy, epilepsy) often have a deplorable state of the teeth associated with a violation of the structure of hard tooth tissues (low mineralization of enamel, dentin underdevelopment), bite defects, malnutrition .
Such children also have non-carious lesions of the teeth (enamel hypoplasia), periodontal diseases and temporomandibular joint.
Oral health is directly dependent on proper care, and parents do not always succeed in properly cleaning the child’s teeth: it can break out, because it is difficult for any tactile contact, especially an attempt to stick a toothbrush in the mouth.
But, in addition to this, there are also health problems associated with the basic diagnosis, as well as the intake of various medications that are necessary for the child, but have a negative impact on the health of the oral cavity. For example, such drugs can thicken saliva, change its pH-balance in the acidic direction, as a result, the tooth enamel does not have time to self-clean and recover.
HOW DOES A DENTIST HAVE GOING TO?
Unfortunately, up to 70% of children with special needs cannot be adapted to dental treatment – neither the Canadian adaptation system, the game form of work, the presence of a psychologist in the clinic, or other methods that work with other babies help. Therefore, with severe lesions of the teeth, with a decompensated form of caries, when almost all the teeth are affected, there are pulpitis, periodontitis, and it is necessary to provide emergency care, children with disabilities are treated under general anesthesia.
Anesthesia is a controlled, time-limited immersion of a patient in a deep sleep with a loss of pain sensitivity, by means of anesthesia drugs.
You can ask for such help both in private clinics and in city hospitals.
However, in any case, parents should first check whether the clinic has a license for the implementation of treatment under general anesthesia, whether the relevant specialists are in the staff.
Of course, there are cases of successful adaptation of dentists to children with special needs, but often even adapted children allow only short-term manipulations in the oral cavity, due to uncontrolled spasm of masticatory muscles.
HOW DOES PREPARATION FOR TREATMENT HAPPEN?
Before treatment under anesthesia, the child should be thoroughly examined. Mandatory set of studies include:
electrocardiogram, clinical blood and urine tests, admission from the pediatrician, in the presence of concomitant pathology – extracts from other attending physicians (neurologist, cardiologist, nephrologist) and other specialists who have a child.
Often, children with disabilities require regular medication, and parents are worried that they will have to break the schedule because of treatment under anesthesia.
But these fears are groundless: you can take medicines as you always do. You only need to slightly move their reception on time – 4 hours before anesthesia will be enough. But there is an important point: the child can not be fed and watered for 4-6 hours before treatment under anesthesia.
What drugs are used for children with special needs?
Propofol and sevoran are used to treat children in the conditions of drug sleep in dentistry.
Propofol is intended for intravenous administration, sevoran – for inhalation. The last drug is by far the safest and allows to treat even the smallest patients. Pluses sevoran:
non-toxic, allows you to quickly put the patient into anesthesia and just as quickly remove the patient from it, making it easy to control the depth of anesthesia, the laryngeal mask and the tracheal tube protect the respiratory tract, increasing the doctor’s working time to 3.5-4 hours, does not affect the mental development .
If long-term treatment is required, and on the basis of the medical history, the pediatrician has given admission only for short-term anesthesia, then the treatment is divided into 2 stages or more (if necessary).
WHAT HAPPENS AFTER TREATMENT OF DRUG?
The child wakes up 10-15 minutes after stopping the drug. After the treatment, the anesthesiologist observes for an hour after the patient’s medication sleep.
In state hospitals (Avant-garde hospital, Mary Magdalene hospital, St. Olga's hospital), the quota treatment is always treated with hospitalization for a period of 3 to 5 days.
You can leave a private clinic in half an hour or an hour, if the child feels well and does not need the help of specialists.