Medical-dental findings and management of a child with infantile Refsum disease: a case report.

Infantile Refsum disease (IRD) is a peroxisome biogenesis disorder (PBD), and is part of a larger group of diseases called leukodystrophies, which are inherited conditions that damage the white matter of the brain and affect motor movements. Multiple signs and symptoms of IRD begin in infancy and progress through early childhood, including hearing and visual impairment, intellectual and growth impairment, seizures, liver involvement, and orofacial and dental abnormalities. This paper presents a case history of a 12-year-old female patient with IRD who underwent dental rehabilitation in the operating room under general anesthesia and includes a 2-year follow-up. Medical, dental, and management considerations in the care of this child's condition are presented. This paper also discusses the importance of a multidisciplinary approach in the management of children with special needs.

Comprehensive oral rehabilitation with general anesthesia and prosthetic care in the primary dentition: a case report.

This case report describes the oral rehabilitation of a 5-year-old male referred by a general dentist to a pediatric dentist due to acute psychological stress to dental treatment and extensive dental caries. The patient's dental restorations and extractions were completed under general anesthesia. Maxillary and mandibular prostheses were completed in the outpatient clinical setting. The treatment plan for this child provided options to improve appearance, self-image and oral function.

Dental trauma in children and adolescents with mental and physical disabilities.

AIM: to determine the occurrence of dental trauma in children and adolescents with a mental and/or physical disability compared to otherwise healthy children, and to assess factors associated with and mechanism of such trauma. METHODS: Eighty-six subjects consisting of 43 special needs and 43 otherwise healthy children between the ages of 8 and 15 years were chosen from the patient pool at Special Children's Dental Clinic within Children's Hospital, New Orleans. The study utilized a parent interview questionnaire and a clinical exam of the patient. RESULTS: Although healthy children had a higher number of injuries than children with special needs on average, the difference was not statistically significant. Neither healthy children nor children with special needs exhibited a significant correlation between the number of injuries and the size of the overjet (mm) (p=0.722, 0.712). There was not a significant difference in the number of injuries for children with different oral profiles (p=0.949), or adequate versus inadequate lip coverage (p=0.940). CONCLUSION: In this study population, the children with special needs living at home may have had the same amount of trauma as the otherwise healthy children and studies with larger sample sizes may be needed to further explore this possibility. Excessive overjet, type of facial profile, and adequacy of lip coverage did not seem to increase the amount of trauma noted in our study population.

Educational issues workshop report.

This panel addressed issues affecting the education of dentists, dental hygienists, and nondental health care providers regarding oral health of persons with special health care needs (PSHCN). The panel was composed of individuals representing: (1) dental education; (2) medicine; and (3) parents of special-needs patients. They were charged with: (1) identifying problems related to the education of dentists and nondental health care providers that influence access to oral health care for PSHCN; (2) developing recommendations for action by the American Academy of Pediatric Dentistry; and (3) prioritizing the problems and recommendations.

Tennessee ranks comparatively high in some health measures, but...

State ranking and proportion reports from the United Health Foundation and the Annie E. Casey Foundation on health and social conditions are used to demonstrate the difficulties faced by the State of Tennessee in its effort to provide for the needed services for its residents. The concerns faced by the dental profession, in its effort to provide needed oral health services, are a component of the complexities to improve the modest ranking of the state in a series of health and social attributes.

When should children have their first dental visit?

In summary, the goals of infant oral health care are to: Break the cycle of early childhood caries; Disrupt the acquisition of harmful microflora; Manage the risk/benefit of habits; Establish a dental home for health or harm; Impart optimal fluoride protection; and Use anticipatory guidance to arm parents in the therapeutic alliance.

People with disabilities: how are we going to meet their needs?

The proportion of the population age 65+ years will increase to 20% of U.S. residents in the next decades. It has been shown that the portion of the population with disabilities increases with age. Providing care for individuals with disabilities is expensive and consuming an increasing component of health service benefits. Health providers increasingly will be called upon to provide services for millions of persons with a wide range of ages and disabilities. How well prepared will the health professions, the individual practitioners, including dentists, and society in general be to meet these increasing needs?

Preparing dental graduates to provide care to individuals with special needs.

In 2004, the Commission on Dental Accreditation (CODA) adopted a new standard that directs dental and dental hygiene programs to prepare dental professionals for the care of persons with special health care needs. This article reviews the demographics of individuals with special needs, documents that most dental schools provide their students with very limited educational opportunities related to the care of this population, describes the path that was followed to bring about change in the accrediting standard, and discusses the difficulties involved in developing the needed educational programs. Educational programs at two dental schools are presented as examples of how schools can provide students with learning experiences pertinent to the new CODA standard that states: "Graduates must be competent in assessing the treatment needs of patients with special needs."

More than 56,000 children with disabilities in Tennessee.

Since 1990, Tennessee has been ranked among the states with a series of health and social difficulties. In addition, there are more than 56,000 children with disabilities in the state. In an effort to personalize these findings, the numbers of children with disabilities are presented by city, metropolitan area, county, and congressional districts. There are numerous difficulties associated with the delivery of dental care to these children with special needs. If all dentists were willing to help, however, each practitioner would need to care for twenty of these youngsters.

The American Academy of Developmental Medicine and Dentistry: eliminating health disparities for individuals with mental retardation and other developmental disabilities.

Recent reports by Special Olympics International and the U.S. Surgeon General have revealed significant disparities and unmet health needs encountered by persons with mental retardation and other developmental disabilities (MR/DD). Factors contributing to these disparities include deinstitutionalization, increased survival of individuals with MR/DD, lack of appropriately trained providers, and inadequate financing of dental services. To address these problems, a group of academically oriented dentists and physicians formed the American Academy of Developmental Medicine and Dentistry (AADMD). The mission of the AADMD is to improve the quality of health services provided to persons with MR/DD by improving dental and medical school-based training of dentists and enhancing clinically relevant research. A central theme of the AADMD is full collaboration between physicians and dentists in meeting its goals. The National Action Strategy developed by the AADMD focuses on creating a series of university-based Developmental Medicine and Dentistry Programs (UDMDPs) in medical and dental schools, which collaborate in service, teaching, and research with community-based primary care clinics, community hospitals, intermediate care facilities, and other private service delivery systems such as the Special Olympics Healthy Athletes Program that serve these patients. Oral-systemic interactions will receive special emphasis by the training and research programs.