Managing Systemic Conditions in Pediatric Dentistry

Endocrine and Systemic Disorders

Endocrine Disorders

• Hypothyroidism
• Hypopituitarism

Systemic Defects of Neutrophils

• Qualitative: Papillon-Lefèvre syndrome
• Quantitative: Cyclic neutropenia

Acrodynia (Pink Disease)

Acrodynia is a connective tissue disease caused by mercury toxicity. Oral manifestations include:

• Premature exfoliation of teeth
• Inflammation and ulceration
• Increased salivation
• Loss of alveolar bone
• Exfoliation of skin

Management of Hemophilia

• Consult a hematologist.
• Use infiltration only; no nerve blocks (NB).
• Plasma factor transfer before major surgeries.
• Control superficial wounds with powder hemostatic agents such as thrombin.
• Prioritize pulp therapy over extraction.
• Avoid suturing.
• Aspirin and NSAIDs are contraindicated.
• Use paracetamol for moderate pain and narcotics for severe pain.
• Post-surgery instructions: Liquid diet for 72 hours, soft diet for the following week, and normal diet after 10 days.

Insulin Shock and Diabetes

Insulin Shock Symptoms

• Shakiness and anxiety
• Increased sweating
• Hunger signs: Tachycardia, tremors, altered consciousness, and a blood level < 60 mg/dl.

Management of Insulin Shock

• Conscious patient: Administer 15mg of simple carbohydrates. If the blood level is > 60 mg/dl, ask the patient to eat or drink; if < 60 mg/dl, repeat the dose.
• Unconscious patient: Administer 5–25g of 50% dextrose IV.
• Without venous access: Apply glucose gel inside the mouth (glucagon emergency kit).

Oral Manifestations of Diabetes

• High caries risk
• Reduced salivation
• Oral infections

Seizures and Cerebral Palsy

Causes of Seizures in the Dental Office

• Epileptic patients
• Hypoglycemia
• Hypoxia secondary to syncope
• Local Anesthetic (LA) overdose

Cerebral Palsy

Cerebral palsy involves a number of neuromuscular dysfunctions. Types include spasticity, athetosis, and ataxia.

Oral Manifestations

• Bruxism and mouth breathing
• Malocclusions
• High caries risk and enamel hypoplasia
• High risk of periodontal disease

Management

• The cough reflex is delayed; use a rubber dam to avoid aspiration.
• Restraining devices may help or intensify the condition.

AHA Antibiotic Coverage Recommendations

Antibiotic prophylaxis is recommended for:

• Previous Infective Endocarditis (IE)
• Prosthetic cardiac valves
• Unrepaired Congenital Heart Disease (CHD)
• Cardiac transplant with valve regurgitation

Space Maintainers in Pediatric Dentistry

Factors Affecting Space Maintainer Construction

1. Age
2. Bone
3. Congenital absence of permanent teeth
4. Delayed eruption of permanent teeth
5. Eruption sequence
6. Time

General Requirements for Space Maintainers

Space maintainers should:

• Maintain space
• Be passive
• Be esthetic
• Allow natural growth

They should not:

• Interfere with growth
• Interfere with permanent tooth eruption

Adverse Effects of Space Maintainers

• Dislodged, broken, or lost
• Increased plaque and caries
• Interference with successor eruption
• Undesired tooth movement
• Alveolar bone growth disruption
• Soft tissue irritation and pain
• Overeruption
• Nonfunctional

Contraindications for Space Maintainers

1. Successor erupts in ≤ 6 months
2. Succedaneous tooth erupting (two-thirds root formed)
3. < 1 mm of bone over the erupting tooth
4. Severe alveolar bone loss
5. Late mixed dentition
6. Inadequate space for successor
7. Future orthodontic treatment planned
8. Long delay after extraction