In discussing appropriate treatment the guiding principle should be to provide the highest quality dental treatment possible for each particular patient.
Gingivectomy may be considered for the patient with drug-induced gingival overgrowth if the tissues interfere with occlusion or oral hygiene. Since periodontal packs may not be well tolerated; electrosurgery or laser surgery techniques should be considered.
Due to poor oral hygiene, frequent recall examinations and prophylaxis are often indicated as often as every 2 or 3 months.
Restorative procedures generally require few modifications; however, dentistry can be somewhat frustrating if the patient cannot tolerate the rubber dam or cooperate during the procedure. Sedation or general anesthesia may be required.
Glass ionomer restorations may be appropriate for patients with a high caries rate due to fluoride release.
Stainless steel crowns may be appropriate for restoring severely damaged teeth when the patient’s lack of cooperation precludes more complicated procedures required for fixed prosthodontics or where lack of funds is a consideration. In addition, bonded restorations can eliminate the need for pins and thereby reduce the overall time for the procedure.
Individuals who cannot tolerate a removable prostheses will benefit from maintaining even severely worn teeth as occlusal stops.
Endodontic treatment should be considered when a tooth is restorable and the patient can cooperate.
When possible, one-appointment procedures are advisable.
When working-length radiographs cannot be obtained, an apex locator is helpful in determining working length.
Fixed prosthodontics are feasible if the patient can cooperate and adequate oral hygiene can be maintained by the patient or caregiver. Resin bonded bridges can be useful since they require less time for tooth preparation.
Replacement of anterior teeth with fixed prosthodontics for the patient who has a poorly managed seizure disorder is contraindicated. Abutment teeth may be fractured if trauma occurs from a fall during a seizure.
Patients must be able to remove, clean and place removable prostheses. Removable prostheses are contraindicated for patients with a poorly controlled seizure disorder.
Treatment or interim removable partial dentures may be used when financial considerations are a limiting factor.
Complete dentures are not indicated for the patient with insufficient muscle control or mental capacity to adapt to the dentures. Such patients include those with Parkinson’s Disease, tardive dyskenesia and stroke. Dentures should be labeled with the patients name; confused patients often mislay or lose dentures.
Complete dentures are not be indicated for patients with uncontrolled seizure disorders.
Positioning and Airway Protection
Individuals with disabling conditions may not possess the ability to protect their own airway during intraoral procedures. This may be due to their specific disabling condition or their inability to cooperate. An uncooperative patient who has cerebral palsy might inadvertantly dislodge dental instruments or materials that could be swallowed or aspirated.
These patients must be properly positioned to prevent aspiration of materials, fluids, or instruments. Some patient will have to receive treatment in a siting or semi-reclined position.
The use of the rubber dam should be considered for many situations. The use of the rubber dam may be contraindicated in some situations because of the patient’s inability to handle their own oral secretions, e.g., a person with Parkinson’s disease may have a diminished ability to swallow and therefore be unable to handle saliva accumulation under the rubber dam.