ORTHODONTIC CARE OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS MENTAL RETARDATIONDOWN SYNDROME HEMOPHILIA CEREBRAL PALSY SICKLE CELL SYNDROMES CYSTIC FIBROSIS HEMATOLOGIC MALIGNANCIES JUVENILE RHEUMATOID ARTHRITIS HEART DISEASE
Mental retardationMental retardation is defined as a significant decrease in the intellectual ability with consequent limited ability to adapt to the environment.Mental retardation is frequently associated with a greater occurrence of malocclusionThe orthodontic treatment plan for a mentally challenged patient should be individualizedand developed keeping the child’s strengths and weaknesses in sight. Short appointments should be planned, and the clinician should ensure that a good level of communication is established with the child, and that all explanations and instructions are simple and well understood by the patient.
Down syndromeThere is a generalized retardation of growth and development. Eruption of both deciduous and permanent teeth is frequently delayed, and there is also a delay in the exfoliation of the deciduous teeth. Pseudoprognathism, decreased lower facial height, small midface, perioral hypotonia, a large and protruded tongue, crossbite, anterior open bite, and crowding are common associated craniofacial featureshave an increased susceptibility to rapid, destructive periodontal disease due to both local and systemic factorsthese children often have a wide range of comprehensive and performance capabilities
Down syndromeThe extent to which orthodontic appliance therapy can be successfully instituted varies with the cooperative abilities of the patient, but a good orthodontic treatment result is certainly achievablefor many patientsIn the more severely mentally retarded patients, the initial placement of limited fixed appliances or bonded/cemented bite planes can be accomplished under general anesthesia. Surgical orthodontic treatment is an important consideration in this group of patients.
Cerebral palsyCerebral palsy is a collection of disabling conditions due to permanent brain damage in the prenatal and perinatal period. Cerebral palsy is characterized by variable severities of muscle weakness, stiffness or paralysis, poor balance, irregular gait, and uncoordinated, involuntary movements. Mental retardation, seizures, strabismus and speech problems may accompany the neurologicalproblems.
Cerebral palsyChildren with cerebral palsy often have severe attrition due to bruxism, and a higher frequency of periodontal disease and gingival hyperplasiathat is related to both local factors and anticonvulsant therapy. They frequently have a marked overjet, open bite, posterior cross bite, and are more susceptible to trauma to the anterior maxilla, thus implicating the need for orthodontic treatment.