There are, I think, some risk factors. In addition of regular use of sugar-sweetened medicines, frequent intake of cariogenic foods and drinks, a study of Parry et al 2000 reported that many general dental practitioners in UK did not feel confident providing treatment for medically compromised children.
Dear researcher,
Yes its the fact.. I have came across many such children during my daily ward rounds. This is most commonly seen in children from rural areas and those who are exposed to the environmental hazards, the immunity gets suppressed and they are easily prone to such ailments when exposed to the risk actors.
I completely agree with my colleague and I have to add that some parents, having a guilt complex for their children give them many sweets and a soft food which associated with bad oral hygiene will increase the risk of dental caries and periodontitis.
Dear Fethi, that's right. I have divided the reasons in
1. Oral hygiene deficiency - local consequences of disability - low manual power,
2. Infections,
3. Attention Deficit,
4. Retarded ability to swallow or difficulty breathing - open mouth posture,
5. Resulting gingival inflammation with bleeding (fear plastered against bleeding tissues),
6. Exaggerated facial expressions and gestures,
7. Metabolic disorders (cf., diabetes),
8. Imbalance of growth factors, tendency to hyperplasia,
9. Poor mouth hygiene because of nausea with the use of aids and hygiene,
10. Various syndromes with symptoms participation.
My students are sensitized to care against wrong habits of the patient (and in spite to care for their relatives better understanding of the pathogenesis).
Sure dear Heinz, and unfortunately, the oral diseases which affect such patients lead to dental extraction what is going to stress their disability.
I do accept with Heizz Spranger. Most common problem with these children is maintenence of oral hygiene.
Dear Fethi Maatouk I would like to congratulate you for the question asked. Here in Brazil we suffer similar problems. In addition to the facts discussed, the dentists often through ignorance of therapy, not undermine the application of a full anamnesis to the child and the caregiver to relate drugs that the children uses, and does not correlate with possible unwanted side effects from the use of medicines, besides the problem of unwanted drug interactions when the dentist may prescribe a drug for the child. I believe that an education process for both practitioners (multiprofessional, interdisciplinary) as for parents and for children, and a rational use of drugs can be a good way to fight the problem. But education is a process of construction and takes time.
Medically compromised and hospitalized children must be evaluated considering the increase in risk factors to develop oral diseases. Preventive therapy must be available to all children and restorative therapy must be carried out when possible.
Oral hygiene maintenance goes a long way in preventing oral diseases.
I am glad that you share my interest for medically compromised patients because unfortunately their number increases with advances in Neonatology and intensive care medicine.
It is no novelty that the general health is in close correlation to the oral health. In fact, it is being said that the oral cavity is a mirror to the general health of the patient. There are many conditions especially in young patients that appear with oral symptoms or can be a cause for deterioration of the oral health. Many of this conditions appear as genetic congenital syndromes that can affect the shape and the composition of the teeth structure, others can be acquired and can affect the development of the teeth. All of these conditions may increase the risk of caries, periodontal disease or other oral diseases.
Since Weston A. Price and Francis M. Pottenger's focal infection theory, the human body should not be construed as watertight compartments, as in a submarine. There are no hatches that separes the human body in closed systems in isolated organs ... and the stomatognathic system is the door to our nutrition, to our health and also for it loss when not properly preserved. Viva the prevention and the holistic health.
Dr Spranger congratulations for the fantastic response. I would like to draw attention only by the use of antibiotics in these patients contributing to the imbalance in the normal flora. Furthermore the nutritional deficit that normally accompanies many of these patients
Dear Leonardo, your objection is important. It allows me to come on indication for antibiotics because I feel it to be important. Basically, we give in the case of periodontal disease in children no antibiotics. For the rare cases of systemic infections we have strict ideas. Since the detection of pathogens in acute diseases (including all critical symptoms fever etc.) usually cannot wait, we think different
- A targeted antibiotic therapy: selection of the antibiotic according to antibiogram, i.e. with knowledge of the pathogen,
- An untargeted antibiotic therapy: selection of the antibiotic on the pathogen is suspected, i.e. without concretely proven pathogen and
- A calculated antibiotic therapy.
In all situations, we prescribe according to the principle, the shortest treatment time' and ‘dosage at the upper limit'. You must know that we always are in fear of immune hyperactivities. Please remember that our regular therapy is periodontal and our aim is primarily sanitizing.
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