Behavior Management of Differently-Abled Child in Pediatric Dentistry

It has been difficult task to manage behavior of differently-abled children while doing clinical procedures. So on the dental profession, there has been lack of knowledge, understanding and actual experience in treating the differently -abled children.The following disabilities can be diagnosed in child patient during the dental treatment.

Behavior Management of Differently-Abled Child in pediatric dentistry.

Mental Retardation 

According to American Association of Mental Deficiency (AAMD) mental retardation is defined as “ Sub-average general intellectual functioning which originates during the developmental period and is associated with impairment in adaptive behavior.”

Dental treatment of a person with mental retardation:
The following procedures have been used for establishing a good patient- dentist relation and reducing patient’s anxiety about dental care.

1. At very first give the patient and his/her family to brief tour of the dental office before attempting treatment.
2. Introduce patient and family to office staff that helps the patient to familiarize and reduce the patient’s fear of unknown.
3. Allow the patient to bring a favourite stuff such as toys, blanket etc to hold during the visit.
4. Be repetitive, speaks slowly and in simple and polite terms.
5. Give only one instruction at a one time.
6. If individual has difficulty with verbal communication, you can use alternative communication such as picture boards or electronic device use only if that will be fruitful for all the dental explanations.
7. Invite the parents to the operatory as a assistance and to aid them in communication with patient.
8. Give reward to the patient with compliment after the successful completion of each procedure.
9. Gradually progress to more difficult procedure such as restorations, anesthesia once patient is fully adopted to the dental environment.
10. Make the appointment short and schedule the patient early in the day when everyone feel fresh enough.

Cerebral Palsy

Cerebral Palsy is the group of non progressive disorders resulting from malfunctioning of the motor centers and pathways of the brain.

Dental treatment of a person with cerebral palsy:

The following suggestions is given to the clinician while treating the patient with cerebral palsy.

1. Consider treating patient who uses a wheelchair in the same itself.
2. If patient is to be transfer to the dental chair, ask the patient preference for mode of transfer. If they don’t have any preference then used two person lift.
3. Keep the patient in the supine position with back elevated that minimize swallowing and try to place and maintain the patient in the midline of the dental chair with arms and legs close to the body.
4. While placing the patient in dental chair determine the degree of patient comfort and assess the position of the extremities.
5. Use the immobilization judiciously for controlling the movement of extremities.
6. For the control of involuntary jaw movements, chose from a variety of mouth props and finger splint.
7. To minimize startle reflexes reactions, avoid stimuli such as abrupt movement, noises,and lights.
8. Consider using rubberdam, a highly recommended technique, for restorative procedures.

Childhood Autism

Childhood Autism is the clinical syndrome in children with inability to  relate appropriately to people and situations.

Dental treatment of person with autism:

1. The main symptom of infantile autism is an intense desired to maintain a consistency in the environment.
2. Small changes in the environment may elicit the anxiety in the children, there they exhibit an extreme resistance being held and show an inappropriate reaction to fearful situations.
3. It is very difficult to achieve an eye contact , and the children show aggressive and destructive behavior and prone to throw tantrums.
4. Those kind of child have very poor oral hygiene due to finicky dietary habits.
5. Behavior modifications techniques is recommended  that helps to brings behavioral changes in the autistic child. And key to all behavior modification programs lies in the positive reinforcement. 
6. Appropriate reward for autistic child is difficult to find but during early stages of the program, sweet foods can serve as desirable rewards and in the later stages of program, social rewards such as a pat on the back or a hug can serve.