A Practical Approach to Special Care in Dentistry. Группа авторов

children with disabilities.

      There is a significant geographical variation in access to SCD related to lack of training, appropriate infrastructure and financial factors. Nevertheless, it is rapidly growing due to increased demand and is now acknowledged as an essential field of dentistry across the world. Dramatic improvements in medicine, mainly in areas related to early diagnosis and new therapeutic approaches, have resulted in increased life expectancy and the quality of life of chronically ill patients and individuals with severe disability. Hence, individuals requiring care are not limited to hospitalised patients and more commonly include those living in the community, either independently or with support.

      As a consequence, it is essential that undergraduates, postgraduates and general dental practitioners acquire specific knowledge in the field of SCD, so that they can integrate this discipline into their daily practice. To enable this, we have created this book, which contains 61 topics based on clinical cases from across the world, reflecting the most common clinical conditions which may present in general dental practice. This scenario‐based approach enables the application of elements of problem‐based learning and structured clinical reasoning, allowing the reader to appreciate that patients rarely present with a single medical condition or risk factor, and that multiple factors must be taken into consideration when providing care.

      Each case includes the application of a risk assessment framework of medical, social and dental risk factors. This allows the systematic consideration of appropriate modifications that should be implemented prior to commencement of dental treatment, thereby reducing complications and treatment planning errors.

      Subsequently, the main oral findings and the specific considerations for dental management for each condition/disease are discussed. The ACCESS mnemonic is utilised to ensure that six domains which address different aspects of care are considered:

      1 Access

      2 Communication

      3 Consent

      4 Education

      5 Surgery

      6 Spread of infection

      Lastly, each chapter concludes with background information on each condition/disease, with updated medical content on their definition, aetiopathogenesis, clinical presentation, diagnosis, treatment and prognosis.

      In 2006, under the guidance of Professor Crispian Scully, we published the book entitled Special Needs in Dentistry (Handbook of Oral Healthcare). A few years later, in December 2015, we received an email announcing that ‘The Special Care Dentistry book will be 10 years old next year! I am intent on producing something that focuses on the younger generations and that can be regularly updated’. The tragic and premature loss of Professor Scully deprived us of his academic guidance, editorial experience and enormous knowledge. We have therefore put all our efforts into this new publication, which launches today thanks to the contribution of a group of relevant collaborators. We hope it will serve as a tribute to our master, mentor and friend.

      Pedro Diz Dios and Navdeep Kumar

1 Physical Disability 1.1 Cerebral Palsy

      Section I: Clinical Scenario and Dental Considerations

      Clinical Scenario

      A 24‐year‐old patient attends your dental practice with acute pain from a lower right molar tooth. Two courses of antibiotics prescribed by the general medical practitioner have been ineffective. She attends alone and has used a private taxi that has been able to accommodate her wheelchair.

      Medical History

       Spastic cerebral palsy

       Degenerative disc disease and spondylosis of the cervical spine

       Adjustment disorder (presented after divorce; undergoing follow‐up by psychiatry)

      Medications

       Trihexyphenidyl hydrochloride

       Baclofen

       Bromazepam

       Lormetazepam

       Mirtazapine

       Omeprazole

      Dental History

       Irregular dental attender – avoided attending as she is anxious that dental treatment will make her gag

       No experience of local anaesthesia to enable dental treatment in the dental clinic setting

       Previous dental treatment provided under general anaesthesia on 2 occasions, when she was a child

       Good level of co‐operation

       Brushes her teeth regularly herself, although she admits difficulty accessing the posterior teeth due to her gag reflex and involuntary movements

      Social History

       Lives alone and is not currently working

       Divorced and does not have a good relationship with her ex‐husband's family; no children or close family

       A caregiver visits every morning to help with basic activities of daily life

       Wheelchair user (Figure 1.1.1)

       Limited financial resources

      Oral Examination

       Involuntary movements of the jaw

       Moderate sialorrhoea – saliva does not spill over the vermilion border

       Pronounced gag reflex

       Mouth in very poor condition, with numerous carious teeth and deposits of calculus (Figure 1.1.2)

       Caries: #11, #15, #17, #21, #22, #25, #26, #27, #35, #37, #41, #42, #44, #45 and #48

       Tenderness on palpation: #48; no associated swelling

       Missing teeth: #36, #46 and #47

      Radiological Examination

       Orthopantomogram – artefacts due to the patient's movement

       Supplemented by long‐cone periapical radiography anteriorly

       Endodontic treatment of #11 and #21 (obturation satisfactory; no periapical radiolucent areas)

       Extensive, deep and unrestorable caries in #15 and #48 (with pulpal involvement)

       Restorable caries in #17, #22, #25, #26, #27, #35, #37, #41 and #44

       Recurrent caries associated with the dental fillings in #16, #42 and #45

       Missing teeth #36, #46 and #47Figure 1.1.1 Patient with spastic cerebral palsy and preserved intellectual ability in the dental practice.Figure 1.1.2 Extensive caries upper central incisors.

      Structured Learning

      1 The #48 is painful on palpation and you suspect periapical periodontitis. The patient's temperature is not elevated and there is no associated lymph node enlargement. What emergency management would