Oral injuries contd

FUNCTIONAL PERFORMANCE
AN ACCURATE ASSESEMENT OF A PATIENT`S
EXPECTED FUNCTIONAL PERFORMANCE DEPENDS
UPON THE EVALUATION OF TASKS NECESSARY TO
COMPLETE ORAL HYGIENE.
ONCE THE DIFFICULTY HAS BEEN IDENTIFIED IT
REQUIRES A DEVICE TO COMPENSATE FOR A
PATIENTS INADEQUACY.
GROSS MOTOR SKILLS SUCH AS GRASPING A TOOTH
BRUSH HANDLE CAN OFTEN BE IMPROVED BY
ORTHODONTIC APPLIANCES SPECIFICALLY THE
ELECTRIC TOOTH BRUSH MAY SERVE AS A HIGHLY
EFFECTIVE SUBSTITUTE FOR THIS LACK OF
DEXTERITY.
ATTENDENT CARE

THERE WILL BE MANY COMPROMISED INDIVIDUALS WHO WILL BE
UNABLE TO HANDLE THEIR OWN HYGIENE DUE TO
SENSORY,COGNITIVE OR PHYSICAL DEFICITS.
FOR THESE INDIVIDUALS AN ATTENDENT OR FAMILY MEMBER
SHOULD BE INSTRUCTED IN THE PROPER ORAL HEALTH CARE
FOR THE PATIENT.
FOR EXAMPLE IF PATIENT HAS TENDER,FRIABLE GINGIVA TISSUE
THAT CAN EASILY BECOME DAMAGED BY AN INITIALLY DRY
TOOTH BRUSH THE BRUSH CAN BE PRE-WETED TO SOFTEN IT.
FOR AN INDIVIDUAL WHO IS UNABLE TO LEAN OVER THE BASIN
SUCH AS AN ARTHRITIC PATIENT OR FOR AN INDIVIDUAL WHO
CANNOT MOVE THE LIPS TO EXPECT THE FLUID AS IS THE CASE
WITH MUSCULAR DYSTROPHY,TWO PAPER CUP TECHNIQUE IS
USED.
IF THE PATIENT WOULD LIKE TO RINSE HIS OR HER MOUTH AFTER
BRUSHING WITH WATER OR A MOUTH WASH,THAN ONE PAPER
CUP HOLDS THE RINSE AND THE OTHER IS FOR THE
EXPECTORATE;SINCE THE CUPS ARE LIGHTWEIGHTED,PATIENT
CAN OFTEN HOLD BOTH BRINGING EACH UPTO THEIR LIPS AS
NEEDED.THIS TWO CUP TECHNIQUE PROVIDES A MEAN TO
CONTROL DRIBBLING.
PREGNANCY

IT IS A COMMON BELIEF THAT EVERY PREGNANCY INVITES THE
LOSS OF A TOOTH BY THE MOTHER.BUT INFACT IT HAS NO
DIRECT CAUSATION OF TOOTH LOSS,BUT THERE ARE NUMBER
OF FACTORS WHICH INFLUENCES THE RAPIDITY AND
PROGRESSION OF INCIPIENT OR ALREADY WELL ESTABLISHED
ORAL DISEASES.
THE EXPECTANT MOTHER MAY BE INVOLVED IN A MULTITUDE OF
EXTRA ACTIVITIES.DURING THIS TIME HER OWN ORAL CARE MAY
BE NEGLECTED BOTH WITH REGARD TO HOME CARE AND ALSO
VISITS TO DENTIST. THERE MAY BE A CHANGE IN EATING
HABITS,WITH AN INCREASE INTAKE IN CARBOHYDRATE,SWEETS
WHICH MAY COINCIDE WITH A DESIRE FOR EXOTIC FOODS.
THE FACTORS RESPONSIBLE FOR DENTAL CARIES MAY BE LISTSD
AS FOLLOWS:-
1. DIET-THE EXPECTANT MOTHER MAY HAVE DESIRE FOR SUGARY
DRINKS OR SWEETS AND OTHER CARIOGENIC FOODS
2. HOME CARE-IN VIEW OF THE EXTRA PLAQUE WHICH MAY FORM
BECAUSE OF THE INCREASED SUCROSE INTAKE,THERE SHOULD
BE MORE CAREFUL BRUSHING.
3. OTHER FACTORS-ACID ATTACK IN THE PLAQUE MAY BE
ACCELERATED BY ACID FROM THE STOMACH FROM NAUSEA
OCURRING EARLY AT THIS TIME.

~GINGIVAL DISESES CAN BE SIGNIFICANT DURING THIS TIME.THERE
ARE HORMONAL CHANGE AT THIS TIME THAT EVEN MILD
INFLAMMATION MAY BECOME QUITE MARKED WITH GROSSLY
ENLARGED AND BLEEDING GINGIVAE.
~ISOLATED ENLARGEMENT MAY RELATE TO THE PAPILLAE OF ONE
OR TWO TEETH AND THESE MAY INTERFERE WITH EATING
BECAUSE OF BLEEDING.
~ALTHOUGH TUMOURS ARE COMPOSED OF INFLAMMATORY TISSUE
AND SHOULD,EVENTUALLY RESOLVE WITH THE REMOVAL OF
IRRITANTS,BUT OCASSIONALLY SURGERY IS REQUIRED
FOR COMPLETE RETURN TO NORMAL.
~THESE CONDITIONS DO NOT OCCUR WHERE THERE HAS BEEN
CAREFUL PLAQUE CONTROL FROM BEGINNING.
THEREFORE IT IS NECESSARY TO GO OVER BRUSHING AND OTHER
HOME CARE METHODS WITH SUCH PATIENTS.
PREVENTIVE ATTENTION FOR EXPECTANT
MOTHER
THE DENTIST SHOULD BE ATTENDED AS EARLY AS
POSSIBLE IN FIRST STAGE ,FOR A THROUGH EXAMINATION
SO THAT ALL NECESSARY TREATMENT CAN BE CARRIED
OUT WELL IN ADVANCE.
ADVICE SHOULD BE GIVEN ON A SUITABLE DIET TO BE
ADAPTED BOTH TO PROTECT THE PARENT AND THE
DEVLOPING CHILD.
APART FROM THE MIXED DIET OF CARBOHYDRATE
FATS,AND PROTIENS;MOTHERS DIET SHOULD INCLUDE ALL
THE PROTIENS MINERALS AND VITAMINS WHICH THE FETUS
NEED.
THE EXPECTANT MOTHER SHOULD BE CAREFUL TO AVOID
TAKING TETRACYCLINE ANTIBIOTICS;OTHERWISE THERE
WOULD BE A DANGER OF DISCOLOURED TEETH IN THE
CHILD.

THE NEW BORN BABY
MATERNAL FEEDING IS PREFERABLE TO BOTTLE
FEEDING FOR NEWBORNE.
THE MATERNAL MILK CONTAINS IMMUNE FACTORS
WHICH HAVE BEEN ACQUIRED BY THE THE MOTHER
AGAINST VARIOUS DISEASES SO THAT THE CHILD
HAS BUILT IN RESISTENCE TO SUCH DIESEASE FOR
THE FIRST FEW WEEKS OF LIFE.
THE MILK CONTAINS ALL THE BALANCED NUTIRENTS.
THE ACT OF SUCKING IS IMPORTANT FOR THE
PROPER DEVELOPMENT OF JAWS AS IT INCREASES
THE ACTION OF TONGUE AND PRESSURE OF JAWS
AND LIPS.
IN BOTTLE FEEDING IT SHOULD BE WARNED THAT A
TEAT WITH LARGE HOLE CAUSES EASY
SUCKING,WHICH MAY LEAD TO TONGUE THRUSTING
AND DEVELOPMENTAL ERRORS.


THE HANDICAPPED CHILD
SPECIAL ATTENTON SHOULD BE GIVEN TO HANICAPPED
CHILD OR ADULT.
AS HANDICAPPED PATIENTS REQUIRE MORE TIME,THOUGHT
AND CARE IN ORAL HYGIENE TRAINING AND MANY OF THEM
WILL NEED MORE EFFICIENT PLAQUE REMOVAL THAN
THEIR MORE FORTUNATE COMPANIONS.
THE FOLLOWING HANDICAP CATEGORIES ARE CONSIDERED:
1. ORAL CIEFT PALATE, MUCOSAL LESION,CLEFT LIP,
2. CARDIAC CONGENITAL HEART DISEASE, RHEUMATIC
HEART DISEASE
3. SENSES BLINDNESS, DEAFNESS
4. LIMBS ARM MOVEMENTS DEFECT, LEG MOVEMENTS
DEFECT.
5. MENTAL CONTINOUS RETARDATION; PSYCHOLOGICAL
DISORDERS
6. PERIODIC PETIT MAL EPILEPSY,GRAN MAL EPILEPSY.
ORAL LESION
FOR THE PATIENT WITH CLEFT PALATE IT IS ESSENTIAL TO
USE ALL PREVENTIVE MEASURE POSSIBLE TO PRESERVE
THE REMAINING TEETH.

EFFORTS SHOULD BE MADE TO AVOID EXTRACTION,AS
BOTH DECIDOUS AND PERMANENT TEETH ARE NEEDED FOR
RETENTION OR STABILIZATION OF ANY APPLIANCES.

PREVENTIVE CARE, AND THE INTERVALS BETWEEN RECALL
SHOULD BE FREQUENT.

SOME PARENTS INITIALLY MAY REJECT THE DEFORMITY,
AND THEREFORE AVOID THE NECESSARY CLEANING OF
MOUTH.THE PARENTS MUST BE TOLD THE IMPORTANCE OF
HOME CARE AND ITS BEARING ON FUTURE SUCCESS.
CONGENITAL HEART DISEASE
HERE EXCEPTIONAL ORAL HYGIENE CONTROL IS IMPERATIVE,
WITH ANTIBIOTIC COVER FOR ALL PROCEDURES WHICH MIGHT
PROVOKE BACTERAEMIA.INCREASE OF ANTIBIOTIC DOSAGE
MAY BE NECESSARY DURING DENTISTRY FOR THOSE ON
REGULAR MAINTENANCE ANTIBIOTIC THERAPY.
RHEUMATIC HEART DISEASE REQUIRES THE SAME
CONSIDERATIONS AS ABOVE, AND THESE PATIENTS ARE MORE
LIKELY TO BE ON PERMANENT ANTIBIOTIC COVER.
THE RISK FOR ALL THESE HEART PATIENTS IS THE POSSIBILITY
OF BACTERIAL ENDOCARDITIS. ALL SEPTIC AREAS SHOULD BE
REMOVED UNDER SUITABLE CHEMOTHERAPY COVER. THE
SUCCESSFUL HANDLING OF THESE CASES WILL DEPEND ON A
CAREFUL HISTORY, RECORDS AND A CLOSE CO-OPERATION
WITH PATIENTS PHYSICIAN.
SENSES
.DEAFNESS AIDS AND CAREFULLY WRITTEN
INSTRUCTION SHEETS FOR HOME READING.OR AN
INTERMEDIATE WHO USES FINGER SIGN LANGUAGE MAY
HELP TO SOLVE THEIR COMMUNICATION PROBLEM.

.BLINDNESS THE BLIND WILL BENEFIT BY USE OF
LARGE TACTAILE TEACHING AIDS SUCH AS MODELS WITH
LARGE TOOTH BRUSHES WILL HELP CONSIDERABLY.OR
CASSETE TAPES MAY ALSO BE PREPARED AND GIVEN FOR
HOME USE.

.DEFECTIVE LIMB MOVEMENT THIS CALLS FOR
ASSISTANCE OF THIRD PARTY OR IN LESSER HANDICAPS
THE USE OF VARIOUS AIDS SUCH AS AUTOMATIC BRUSHES
FLOSS HOLDERS, PERIO AIDS MAY BE TRIED.

MENTAL HANDICAP
MENTALLY RETARDED PATIENT MAY REQUIRE A GREAT
DEAL OF PATIENCE THEREFORE THE APPROACH MUST
BE GRADUAL SO THAT PATIENT CAN COPE WITH IT.

LEUKEAMIA
CAREFUL ORAL CLEANSING WITH PREVENTION FROM
TRAUMA IS ESSENTIAL WITH LEUKAEMICS.
DENTAL HYGIENE CARE PLAN
IT INCLUDES :-

1. PREVENTIVE THERAPY
2. EDUCATIONAL PROGRAMES
3. THERAPEUTIC

CONCLUSION
INDIVIDUALS WITH PHYSICAL, MEDICAL, MENTAL, OR
EMOTIONAL PROBLEMS OFTEN HAVE A GREATER
NEED FOR DENTAL CARE THAN THEIR HEALTHY
COUNTER PARTS.