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Posted by: The Probe 3rd May 2018
A number of problems can occur in children’s mouths that could impact the wellbeing of their adult teeth. Early loss of baby teeth caused by poor oral health or dental trauma can lead to issues, as the spaces left can allow for surrounding teeth to shift, creating gaps and other misalignments that may require orthodontic attention when the adult teeth emerge.[i]
Whilst solutions to these problems can be straightforward, various factors that effect children may add difficulty to providing effective care, and in these cases referring these patients to a specialist may often be the best option.
Dental fear and anxiety
Dental fear and anxiety affects a considerable amount of children and adolescents and can cause significant problems for professionals. It’s estimated that up to 5-20% of children and adolescents experience dental fear to some degree, and that the condition manifests in different levels, the most severe of which is usually labelled as dental phobia.[ii]
Dental anxiety can cause panic and unwillingness, and children who suffer are likely to refuse treatment, cry, scream and even avoid visits to the practice, meaning that effective treatment without taking extra measures can be almost impossible.Arguably one of the most effective ways to deal with patients with dental fear is through the use of sedation.
Sedative measures relax the patient and make them less aware of treatment, and aneasthetic numbs them to any possible discomfort caused.[iii]
The term “special needs” is a huge umbrella that covers many different conditions. Many of these can cause physical or mental inhibitions, and these can prevent patients from looking after their teeth properly.
Studies have found that children with special needs or developmental disorders are more likely to develop caries than their non-disabled counterparts.[iv] This may be because they are unable to apply the daily oral care necessary to control plaque, and whilst this task will often fall to a parent or guardian, many individuals are unable to offer the intensive care that these children require.[v]
In the practice, children and adolescents with behavioural disorders and special needs can cause a variety of challenges. Depending on the challenges these patients face, they may experience anxiety and other behavioural disorders which make them unwilling to have treatment, or, in some cases, more extreme complications like seizures or uncontrolled body movements, which can jeopardise the ability to provide safe, effective care.[vi]
In these cases, sedation and anaesthesia could again offer the best results. These methods calm patients, making them less likely to exhibit unwilling or anxious behaviour, allowing professionals to provide treatment safely without worrying that they may disrupt treatment and cause themselves harm.[vii]
Dental trauma is a common occurrence among children and adolescents, and research has found that up to 21% of 6-11 year olds experience dental trauma of some variety.[viii] Dental trauma cases can vary from non-serious injuries such as cuts to the lip, to far more significant injuries such as tooth luxation and avulsion.[ix]
Competitive sports and recreational activities have both been identified as the main causes of dental trauma for this age group, with falls being identified as the leading culprit.
One study found that luxation injuries caused on deciduous teeth lead to a number of problems in the development of the adult teeth. The research identified that the impact of the original trauma can possibly influence crown formation problems and cause discoloration of the enamel in the adult teeth below.[x]
Therefore, in order to prevent these problems from occurring, trauma cases may benefit from being referred. Specialists who have experience with dental trauma can perform the tricky aspects such as tooth replantation in cases of avulsion.
Though only a small proportion (0.1 – 2.4%) of the population are affected, hypodontia, or congenitally missing teeth, still causes numerous difficulties for patients and professionals alike. Children who have missing teeth may suffer from insufficient alveolar bone growth, difficulty chewing, and inarticulate pronunciation, and these gaps may even create further problems within the oral cavity such as retained primary teeth and a delayed eruption of other teeth.[xi]
Treatment for this condition usually involves orthodontic solutions or prosthetics designed to fill the gaps and provide normal function. However, in children these may not be viable options until the mouth is fully developed, and therefore specialist attention may be required to treat the problem as effectively as possible before a permanent solution can be achieved.
Refer to a specialist
Due to the nature of these cases, a standard GDP practice may not be able to deal with the challenges that they bring. In these scenarios referral is the best option to ensure these patients receive the level of care they require. Working with a referral practice such as Ten Dental is ideal in such situations. The specialist in paediatric dentistry, Dr Zoi Tzelepi, provides high quality dental treatment for children and adolescents and is well equipped to deal with children with anxious behaviours, dental trauma, developmental anomalies and special needs.
By referring young or adolescent patients with these conditions to a specialist, you can help ensure that they receive the care and advice they need and develop the healthy permanent teeth that can last with them for a lifetime.
For more information visit www.tendental.com or call on 020 33932623
[i] Pokorna, H., Marek, I., Kucera, J., Hanzelka, T. Space Reduction After Premature Loss of A Deciduous Second Molar – Retrospective Study. Journal of Dental and Medical Sciences 2016; 15: 1-8.
[ii] Gao, X., Hamzah, S., Yiu, C., McGrath, C., King, N. Dental Fear and Anxiety in Children and Adolescents: Qualitative Study Using YouTube. J Met Internet Res 2013; 52: e29.
[iii] Wang, Y. Lin, I., Huang, C., Fan, S. Dental Anesthesia for Patients With Special Needs. Acta Anaesthesiologica Taiwanica 2012; 50 (3): 122-125.
[iv] Desai, M., Messer, l., Calache, H. A Study of the Dental Treatment Needs of Children with Disabilities in Melbourne, Australia. Australian Dental Journal 2001; 46(1): 41-50.
[v] Rao, D., Amitha, H., Munshi, A. Oral Hygiene Status of Disabled Children and Adolescents Attending Special Schools of South Cannara, India. Hong Kong Dental Journal. 2005; 2: 107-113.
[vi] The National Institute of Dental and Craniofacial Research. Developmental Disabilities. Link: https://www.nidcr.nih.gov/health-info/developmental-disabilities/more-info [Last accessed March18].
[vii] Wang, Y. Lin, I., Huang, C., Fan, S. Dental Anesthesia for Patients With Special Needs. Acta Anaesthesiologica Taiwanica 2012; 50 (3): 122-125.
[viii] Alkhadra, T., Preshing, W., El-Bialy, T. Prevalence of Traumatic Dental Injuries in Patients Attending University of Alberta Emergency Clinic. Open Dent J. 2016; 10: 315–321.
[ix] Azami-Aghdash, S., Azar, F., Azar, F., Rezapour, A., Moradi-Joo, M., Moosavi, A., Oskouei, S. Prevalence, etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis. Med J Islam Repub Iran. 2015; 29(4): 234.
[x] Assuncao, L., Ferelle, A., Iwakura, M., Cunha, R. Effects on permanent teeth after luxation injuries to the primary predecessors: a study in children assisted at an emergency service. Dental traumatology 2009; 25(2): 165-170.
[xi] Rakhshan, V. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment. Dent Res J (Isfahan). 2015; 12(1): 1–13.
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