Dental Management of the Mentally Handicapped Children

Dental Management of the Mentally Handicapped Children

There are many definitions of mental retardation. The most commonly used by all the professionals is the one given by American Association of Mental Retardation. Mental retardation or mental handicap refers to a conditio9n that slows down mental and physical growth. A mentally retarded child is slow or lacking in the development of mental function, when compared to those children of his age level. Therefore, a ten year old mentally retarded child may exhibit behavior like that of a three or four year old child depending on his/her level of retardation.

The number of new special schools for the children with mental retardation is increasing with concern for proper transits, planning and preschool programs. Mental retardation is not an illness. It is a state of arrested development of intelligence, originating in the development period and is associated with diminished adaptive behavior.

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What are the causes of mental retardation?

Mental retardation can be caused by many factors: accordingly before birth, at birth or child’s early years.

  1. Prenatal: causes that occur before birth
  2. Perinatal: causes that occur during the birth process
  3. Postnatal: causes that happen after birth or during childhood

Prenatal causes exert their effects before birth. Examples include genetic and heredity, toxins taken by the pregnant mother, disease, and neural tube defects. Genetics and heredity include conditions such as fragile X syndrome and Down syndrome, as well as phenylketonuria (PKU). Prenatal toxins include alcohol, tobacco, and drug exposure resulting from the behavior of the mother during pregnancy. Diseases and infection, such as HIV/AIDS, can devastate an unborn baby. Neural tube disorders, such as anencephaly (where most of the child’s brain is missing at birth) and spina bifida (incomplete closure of the spinal column), are also prenatal causes of mental retardation.

Perinatal causes occur during the birthing process. They include birth injuries due to oxygen deprivation (anoxia or asphyxia), umbilical cord accidents, obstetrical trauma, and head trauma. They also include low birth weight.

Postnatal causes occur after birth. The environment is a major factor in many of these situations. Child abuse and neglect, environmental toxins, and accidents are examples of postnatal causes. An additional reason for being identified as having mental retardation is societal biases, particularly toward diverse students.

How to prevent dental problems in mentally handicapped children?

Creating awareness of the importance of oral hygiene is a step to be undertaken, to ensure lower incidence of dental problems in the mentally handicapped. This can be achieved by bringing the prevention of dental disorders to the forefront. Primary prevention is a prophylactic measure to prevent the onset of the illness, while secondary prevention is to prevent the symptoms of illness at its earliest. The former can be achieved by giving training for proper cleaning of teeth; the latter enhances the resistance of the body to prevent co-morbid conditions affecting ear, nose, throat and sinus. It is to be noted that gingival disorders are found to be more common in mentally handicapped with problems like the Downs syndrome. The bigger size of the tongue prevents full closure of the mouth, thereby encouraging mouth breathing resulting in dry gums and increasing chances of infection. Poor vascularity, plaque and calculus enhance permanent damage.

Thus the saying, “prevention is better than cure” is an idea, which needs to be emphasized to the parents so that there is an organized effort on their part to give attention to proper oral hygiene. In case of children, the parents can star by helping them hold the toothbrush and clean their teeth. Subsequently, allow the child to clean the front teeth without support and then help clean the back teeth and the sides. Finally, watch whether the child properly does so; if the child does well, some incentives can be given to make the routine dental care a habit

Dental management of the mentally handicapped children

Patient management in the case of the mentally handicapped might cause problems because of the lack of co-operation and ineffective communication. There are certain requirements, which cannot be overlooked. It is to be understood that those children lacking logical thinking can be non-co-operative and may require special treatment chairs with belts etc, to restrain them. In extreme cases of non-acceptance, partial sedation may also be required.

Therefore, special facilities and dental care within familiar surroundings like school premises could help soothe their apprehensions, which, in turn, help in giving treatment effectively. Based on the facts mentioned above, the IDA believes that a permanent setup for free check-up and treatment for these unfortunate children by dental surgeons at a school or an institution is a matter that requires urgent attention.

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