A Practical Approach to Special Care in Dentistry. Группа авторов

with hearing aids and cochlear implants (surgically implanted electrical devices) (Figure 3.2.5)

      Prognosis

       The prognosis for deafness depends on its aetiology

       Conductive hearing loss usually has a better prognosis than sensorineural, which in some cases is irreversible

       Deafness in the elderly usually leads to psychological problems and significantly increases the risk of dementia

      A World/Transcultural View

       The prevalence of hearing impairment in children and adults is substantially higher in low‐ to medium‐income countries than in high‐income countries; the regions with the highest prevalence of hearing impairment are southern Asia, sub‐Saharan Africa, Central/Eastern Europe and Central Asia

       A significant percentage of cases of non‐syndromic deafness have a genetic origin; a number of mutations (especially in the GJB2 gene) are common in Middle Eastern countries, where carriers belonging to numerous ethnic groups have been identified

Recommended Reading

      1 Alsmark, S.S., García, J., Martínez, M.R., and López, N.E. (2007). How to improve communication with deaf children in the dental clinic. Med. Oral Patol. Oral Cir. Bucal 12: E576–E581.

      2 Ávila‐Curiel, B.X., Solórzano‐Mata, C.J., Avendaño‐Martínez, J.A. et al. (2019). Playful educational intervention for improvement of oral health in children with hearing impairment. Int. J. Clin. Pediatr. Dent. 12: 491–493.

      3 Bimstein, E., Jerrell, R.G., Weaver, J.P., and Dailey, L. (2014). Oral characteristics of children with visual or auditory impairments. Pediatr. Dent. 36: 336–341.

      4 Champion, J. and Holt, R. (2000). Dental care for children and young people who have a hearing impairment. Br. Dent. J. 189: 155–159.

      5 Roberts, S., West, L.A., Liewehr, F.R. et al. (2002). Impact of dental devices on cochlear implants. J. Endod. 28: 40–43.

      6 Shetty, V., Kumar, J., and Hegde, A. (2014). Breaking the sound barrier: oral health education for children with hearing impairment. Spec. Care Dentist. 34: 131–137.

      7 Suhani, R.D., Suhani, M.F., and Badea, M.E. (2016). Dental anxiety and fear among a young population with hearing impairment. Clujul Med. 89: 143–149.

      8 Wilson, B.S., Tucci, D.L., Merson, M.H., and O'Donoghue, G.M. (2017). Global hearing health care: new findings and perspectives. Lancet 390: 2503–2515.

4 Infectious Diseases 4.1 Tuberculosis

      Section I: Clinical Scenario and Dental Considerations

      Clinical Scenario

      A 43‐year‐old male presents to the dental clinic complaining of generalised pain in his mouth of several years' duration. He reports that the pain makes eating very difficult and feels that this is linked to his weight loss in the past year. You note that the patient is unable to communicate clearly and appears intoxicated.

      Medical History

       Tuberculosis diagnosed at the age of 18 years of age – completed 8 months of drug therapy with pharmacological cure criteria achieved

       Pulmonary mycetoma diagnosed 1 year earlier (pending surgery, which the patient has deferred on several occasions)

       Tuberculous reinfection 4 months earlier (has been undergoing drug therapy since then)

       Post‐trauma cataract in the right eye

       Asthma

       Depression/low mood

       Constitutional syndrome (including malaise, fatigue, anorexia, weight loss) with protein‐calorie malnutrition

      Medications

       Isoniazid and rifampicin

       Tiotropium bromide

       Budesonide/formoterol

       Folic acid

       Lorazepam

      Dental History

       Irregular attender as generally feels too tired to go out of the house

       Last visit many years ago

       Reports good co‐operation in the past

       Does not brushing his teeth regularly

      Social History

       Married but separated and now lives with his mother

       Unemployed/unable to work due to poor general health

       Minimal financial resources

       Tobacco consumption: 20 cigarettes/day since his adolescence

       History of excess alcohol consumption (stopped consuming alcohol 5 years ago)

       Intermittent use of recreational drugs; his wife, whom he sees occasionally, has drug addiction problems

      Oral Examination

       Neglected dentition, with numerous caries and severe periodontal disease

       Fixed prosthesis in the aesthetic zone #13–23

       Caries in #16, #24 and #27

       Missing teeth: #11, #12, #14, #15, #21, #22, #36, #37 and #46

       Muscles of mastication tender on palpation

      Radiological Examination

       Orthopantomogram undertaken as the patient is unable to tolerate intraoral radiographs (Figure 4.1.1)

       Generalised alveolar bone loss demonstrated

       Caries in #16, #23, #24, #25, #26 and #27

      Structured Learning

      1 Is it likely that the patient's tuberculosis was active a year ago and led to the development of the pulmonary mycetoma?It is more likely that the patient had latent tuberculosis rather than active tuberculosis disease when the mycetoma was diagnosedA pulmonary mycetoma is a chronic, progressively infectious disease which can occur within a pulmonary cavity that is usually generated during the previous episode of active tuberculosisFigure 4.1.1 Orthopantomogram showing multiple caries and alveolar bone loss.It consists primarily of fungi, especially of the genus Aspergillus

      2 What risk factors does this patient have for the development of tuberculosis?The use of recreational drugs is known to increase the risk of contracting tuberculosis, whether or not the individual has HIVThis has been linked to the sharing of drug equipment, such as marijuana water pipes

      3 What factors could be contributing to the patient's oral symptoms?Poor oral health/recurrent dental infectionsTemporomandibular dysfunctionDepression/atypical facial painChronic pain associated with constitutional syndrome

      4 The patient requests that all his remaining teeth are removed and dental implants