Med Comp Paed Pt

• Obtaining MH?

  • ‘similar’ routine to that for an adulT
  • Take history from parent/ carer – involve child (depending on age)
  • Update (& record changes) every visit
  • Emphasis on certain conditions
• Why is MH important

  • combined medical and oral findings may help with diagnosis
  • check whether the child is receiving any medication - adverse reaction on dental tx, pt complience or dental development
  • Identify systemic disease that could affect other personnel
  • Identify if medical colleagues are involved with patient care
  • Alert to possible medical emergencies
  • Prioritise children who may require enhanced preventive care
  • Medicolegal requirement
• key points for special care dentistry:

  • Prevention of oral & dental disease is paramount. (4 pillars of prevention: Oral hygiene, Diet advice, Fluorides & Fissure sealants)communication difficulties & anxiety
  • Support from parents
  • Sedation & GA?
  • Acclimatisation, behaviour management & a variety of communication techniques may be required.
  • Reduce barriers to delivery of dental care, physical barriers,
  • Frequent reviews (~ 3-6 months) to identify & manage disease early.
  • DBOH/ SDCEP – enhanced prevention
• Asthma?

  Diffuse obstructive lung disease - reversible episodes of airflow obstruction & bronchospasm
• Aetiology of Asthma?

  • Complex
  • Irritants (allergens) include house dust mite, pollen, moulds, cigarette smoke & foods
  • Immunological, infectious, biochemical, genetic & psychological factors
  • genetic predisposition & environmental influences
• symptoms of asthma?

  • coughing
  • wheezing
  • breathlessess
  • tight chest
• medical management of asthma:

  • prophylactic drugs to reduce hypersensitivity and inflammation eg corticosteriods
  • symptomatic relief - bronchodialators, inhaler
  • classification of exacerbation: controlled, partially controlled and uncontrolled
• oral implication of asthma:

  • mouth breathing
  • GORD - gastro-oseophageal reflus
  • medication SE - xerostomia, taste altered, extrinsic stains, candidiasis
  • caries? erosion?
• what do we ask a pt with asthma?

  • frequency of symptoms
  • when/what was the last trigger
  • hospitalisation?
  • has usual medication been tooth
  • anxiety? - may be a trigger
• what medicament can we not use on asthmatics?

  • fluoride varnish
  • aspirin/NSAIDS
  • steroid - may cause adrenal suppression
• How do we prevent oral candidiasis in asthmatics?

  • spacer device to deliver inhaled drug directly into airways
  • rinsing with water or toothbrushing after using inhaler
• Diabetes:

  • endocrine/metabolic disease resulting from defects in insuline action
  • so body unable to regulate blood glucose levels
• what is the most common endocrine/metabolic disorder of childhood?

  diabetes
• Type 1 Diabetes:

  • insulin deficient
  • not associated with obesity
  • peak presentation 5-7 years or puberty
  • tx - insulin therapy - injection/insulin pump
• type 2 diabetes:

  • insulin restistance
  • associated with obesity
  • middle/old age or younger overweight
  • tx - diet, exercise, oral hypoglycaemic agents
• symptoms and features of diabetes:

  • polydipsia
  • polyuria
  • polyphagia
  • weight loss, lethargy weakness
  • hyperglycaemia
  • glucosuria
  • ketosis
• oral manifestation or diabetes?

  • xerostomia
  • increase caries risk - snacking
  • perio
  • oral candidiasis
  • increased oral infections - impaired neutrophil chemotaxis and phagocytosis
  • imparied wound healing
  • taste dysfunction, burning mouth, lichen planus
• dental management: diabetes

  • establish level of control
  • morning appointments
  • short waiting times, short appointment
  • make sure pt eaten & taken medication
  • DBOH/SDCEP
  • sugar snack advice
• epilepsy: braiin disorder characterised by excessive neuronal discharge that can produce seizures. unusual body movement and loss or change in consciousness
• features of epilepsy:

  • generalised - entire cortex affected - tonic-clinic (seizure) and absence seizures (trance)
  • partial - affects part of brain
  • triggers - stress, infection, fever, sleep deprivation, sugar, flashing lights, loud noises
• medical management of epilepsy?

  long term anticonvulsant therapy eg sodium valproate, carbazepine, phenytoin. Rescue medication, midazolam
• oral implications of epilepsy?

  • drug induced hyperplasia
  • increase caries - sugared liquid medication
  • ulceration, glossitis from medication
  • dental trauma from falls/seizures
• what to ask if a pt has epilepsy:

  • obtain history of management and control
  • ensure medication taken as normal
  • check pt has rescue mediation
  • morning appointment
  • avoid triggers
• dental management of epilepsy?

  • prevention
  • intensive OHI
  • sugar free medication advice
  • inhalation of removable prostheses
• what are the two types of congentital cardiac defects?

  • congenital heart defects
  • aquired after birth
• did the mother have a normal pregnancy and was the birth normal?
• has the child had GA before?
• common for parents to forget to note learning difficulties as not a specific question on a MH form, as ask if child has any support on reading or writing at school? EHCP?
• med comp paeds pt would be considered pt of concern when looking at DBOH/SDCEP
• normal asthmatic regiene

  • blue inhaler - reliever
  • brown inhaler 2x morning and night
• what cant we use duraphat on asthmatics?

  contains colophony which can trigger an attack
• when is epilespy more common?

  in childhood
• aetiology of congenital heart defect?

  • genetic
  • environmental eg infection during pregnancy
• congenital heart defects can be associated with chromosomal abnormalities eg Down, DiGeorge's
• example of defects with congenital cardiac defects?

  • ventricular septal defect
  • atrial septal defect
  • pulmonary stenosis
  • aortic stenosis
  • coarctation of aorta
  • transposition of greater arteries
  • tetralogy of Fallot
• signs and symtoms of congenital cardiac defects:

  • Wide range of presentations
  • Breathlessness on exertion, tire easily & recurrent respiratory infections
  • Severe defects - cyanosis & finger clubbing. Some children assume a ‘squatting’ position to relieve breathlessness
  • Feeding difficulties, failure to thrive, delayed growth & development
  • Little disability -severe impairment
• general managment of congenital heart defect:

  • surgical correction
  • medications - diuretics, digoxin, ACE inhibitors, anticoagulants
• oral imps of congenital cardiac defects:

  • delayed eruption
  • enamel defect - mostly primary dentition, from chronic hypoxia
  • increased caries risk - multi-factorial – enamel hypoplasia, sugary medication, medication side effects (e.g. xerostomia). High calorie/sugar diet to
  • cyanosis oral mucous membrane
• how do we manage congenital cardiac defects in dental practice?

  • risk of endocarditis, bleeding risk, other conditions - learning disabilities
  • regular reviews with rads
  • prevention DBOH/SDCEP - emphasis important of good OH
  • active disease must be manages before cardiac surgery
  • short appointments, reg breaks, morning
  • caution lying surpine if breathless, minimis stress
  • Pacemakers? uss or pulp testing
  • contraindication of pulp therapy, risk of infection
  • LA - drug interaction with adrenaline
  • GA? Sedation?
• if treating patient with congenital cardiac defect ALWAY check with cardiologist regarding antibiotic cover for patient