Children with an intellectual disability often demonstrate lack of cooperation during dental treatment and require behavioral management. A child with mild intellectual disability can be managed adequately using restraints and medication. However, in cases of profound intellectual disability, dental treatment under general anesthesia is usually required. In cases where the patient is an intellectually disabled child who has intellectually disabled parents, it is difficult to evaluate the patient's preoperative condition and to obtain consent for treatment under general anesthesia. Furthermore, they are unable to respond to emergencies after treatment. Therefore, dental treatment should be performed under general anesthesia with hospitalization for children with an intellectual disability. This case presents the dental treatment of an intellectually disabled child, who has intellectually disabled parents, and who required general anesthesia and hospitalization.
Anesthesia, General* ; Child ; Dental Care for Disabled ; Disabled Children* ; Emergencies ; Hospitalization ; Humans ; Intellectual Disability ; Parents*

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.
Adult* ; Anesthesia ; Anesthesia, General* ; Anxiety ; Child ; Dental Anxiety ; Dental Care for Chronically Ill ; Dental Care for Disabled ; Humans ; Informed Consent ; Methods ; Surgeons

The demand for medical care and welfare for patients with disabilities is expanding, and healthcare professionals are also increasingly interested in the need for medical care for patients with disabilities. The purpose of this study was to evaluate the competency of disabled patients' management and the education experience of dental hygiene students, who are the main players of oral health care for disabled patients. A total of 196 students in the dental hygiene department and 3rd and 4th grade students were surveyed using questionnaires. As a result, most of the students had a positive awareness of disabled patients; 84.7% answered with the need to train dental hygienists in specializing in handicapped patients, 76.5% were willing to attend seminars related to disabled patients after graduation, and 71.4% of the students provided dental treatment for patients with disabilities in curriculum and comparative curriculum. The students who provided treatment for disabled patients showed that their competence in most areas of knowledge of disabled patients, oral health education, and oral disease prevention was highly evaluated as significant. The competence of respondents who answered that the theoretical education was sufficient was significantly higher. Based on this, institutional support for the education of dentistry for disabled patients is needed, and sufficient theoretical education and practical training should be offered to foster personnel capable of contributing to the improvement in the oral health of patients with disabilities. In addition, in-depth discussions on the training of dental hygienists specialized in handicapped patients should be conducted.
Clinical Competence* ; Curriculum ; Delivery of Health Care ; Dental Care for Disabled ; Dental Hygienists ; Disabled Persons ; Education ; Humans ; Mental Competency ; Oral Health ; Oral Hygiene* ; Surveys and Questionnaires

AIMTo review the perceptions of dental/medical educators and their students in the United States on the adequacy of didactic and clinical preparation to provide service for individuals with disabilities.

METHODOLOGYAn e-mailed questionnaire with follow-up was sent to 198 deans of dental/medical schools, 1,628 directors of residency programs in nine medical/dental residency programs, 427 medical students in 12 medical schools, and 368 health related organizations, facilities and programs.

RESULTSMore than half (58%) of the responding deans of reported that a curriculum for patients with disabilities was not a high priority at their school. A majority (61%) of deans of medical schools, and 47% of the deans of dental schools, reported that their graduates were competent to treat patients with disabilities. However, majorities of dental/medical school seniors and graduates expressed inadequate competency in the care of these patients. A majority of the directors of medical/dental residencies indicated a need for additional training for their residents.

CONCLUSIONThere is need for increased didactic and clinical preparation of dental/medical school graduates in the care of individuals with special health needs. The interest expressed by health profession educators in an effort to develop appropriate curriculum modules provides an opportunity to prepare new graduates for the care of an increasing population of individuals with disabilities.

Administrative Personnel ; Attitude of Health Personnel ; Clinical Competence ; Curriculum ; Dental Care for Disabled ; Disabled Persons ; Education, Dental ; Education, Medical ; Electronic Mail ; Faculty, Dental ; Faculty, Medical ; Health Services ; Humans ; Internship and Residency ; Schools, Dental ; Schools, Medical ; Students, Dental ; Students, Medical ; Surveys and Questionnaires ; United States

OBJECTIVE: To retrospectively figure out the oral health status, treatment and follow-ups after dental treatment under general anesthesia (DGA) of disabled children or adolescents. METHODS: Clinical data of disabled children or adolescents and normal children as control received DGA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from August 2008 to September 2015 were recorded, including: gender, birth date, treatment date, disability type, oral health status before treatment, treatment content and follow-ups (in 1 year). Differences among ages and disabilities were analyzed statistically. RESULTS: Sixty-two disabled patients and fifty-seven controls were recruited, mean aged (9.38±5.22) years and (3.00±1.41) years. Most patients had 10 to 15 problem teeth with which the mean number of the disabled children and adolescents was (11.79±4.98) while that of the normal controls was (12.40±4.11). Caries, pulpitis, periapical periodontitis, dental trauma and developmental tooth anomalies of the disabled patients accounted for 67.56%, 13.54%, 15.15%, 1.07%, and 2.68%, respectively and the DMFT/dmft index was 11.55±5.56 while in the control group those were at 65.35%,19.09%,14.14%,0,1.41% and 12.23±4.42. The DMFT/dmft index of the disabled patients in the group 6-12 years (8.35±4.69) was significantly less than that of the other three groups (P<0.01) while no differences were found in disabilities (P=0.239). Resin restoration, pit and fissure sealant, preventive resin restoration, pulpotomy, pulpectomy/RCT, extraction and crown of the disabled patients were performed as 52.71%, 7.24%, 8.56%, 0.72%, 17.13%, 10.01% and 3.62% respectively whereas those made up as 56.31%, 1.27%, 0.13%, 2.29%, 19.87%, 7.90% and 12.23% in the control group. Thirty-five (56.45%) disabled patients and forty-three (75.44%) controls recalled. Problem teeth within one year after operation in diabled patients and controls were both nearly twice as much as the number within half a year. Restoration loss/fractured mainly occurred in anterior primary teeth while secondary/ recurrent caries and pulpitis/perapical periodontitis mostly occurred in primary molars. CONCLUSION Oral health status in our disabled children and adolescents is poor. Though dental treatment under GA is an effective way to improve the oral health of disabled children and adolescents, periodic follow-ups and family oral health care are equal important for oral health maintenance.
Adolescent ; Anesthesia, Dental ; Anesthesia, General ; Child ; Child, Preschool ; Dental Care ; Dental Caries ; Dental Restoration Repair/methods* ; Disabled Children ; Female ; Humans ; Male ; Molar ; Pediatric Dentistry ; Pit and Fissure Sealants ; Pulpitis ; Retrospective Studies ; Tooth, Deciduous

Spinal muscular atrophy (SMA) is an autosomal recessive, severe neuromuscular disorder in which degeneration of alpha motor neurons in the spine progressively weakens and ultimately paralyzes the proximal muscles. It occurs in one per 6,000-10,000 infants, and is a genetic disorder with the second-highest mortality rate worldwide. An 18-year-old male patient with SMA was referred for general anesthesia for difficulty in performing dental treatment due to limited mouth opening caused by temporomandibular joint (TMJ) pain. However, the patient had a high risk of general anesthesia complications, so TMJ pain during mouth opening was reduced through local anesthesia of the TMJ. Fortunately, the anesthesia was successful in reducing pain during mouth opening, enabling the patient to receive dental treatment with an adequate mouth opening.
Adolescent ; Anesthesia ; Anesthesia, General ; Anesthesia, Local* ; Dental Care for Disabled ; Humans ; Infant ; Male ; Mortality ; Motor Neurons ; Mouth* ; Muscles ; Muscular Atrophy, Spinal* ; Spine ; Temporomandibular Joint Disorders ; Temporomandibular Joint*

Spinal muscular atrophy (SMA) is an autosomal recessive, severe neuromuscular disorder in which degeneration of alpha motor neurons in the spine progressively weakens and ultimately paralyzes the proximal muscles. It occurs in one per 6,000-10,000 infants, and is a genetic disorder with the second-highest mortality rate worldwide. An 18-year-old male patient with SMA was referred for general anesthesia for difficulty in performing dental treatment due to limited mouth opening caused by temporomandibular joint (TMJ) pain. However, the patient had a high risk of general anesthesia complications, so TMJ pain during mouth opening was reduced through local anesthesia of the TMJ. Fortunately, the anesthesia was successful in reducing pain during mouth opening, enabling the patient to receive dental treatment with an adequate mouth opening.
Adolescent ; Anesthesia ; Anesthesia, General ; Anesthesia, Local* ; Dental Care for Disabled ; Humans ; Infant ; Male ; Mortality ; Motor Neurons ; Mouth* ; Muscles ; Muscular Atrophy, Spinal* ; Spine ; Temporomandibular Joint Disorders ; Temporomandibular Joint*

BACKGROUND: This study retrospectively investigated outcomes following dental implantation in patients with special needs who required general anesthesia to enable treatment. METHODS: Patients underwent implant treatment under general anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital between January 2004 and June 2017. The study analyzed medical records and radiographs. Implant survival rates were calculated by applying criteria for success or failure. RESULTS: Of 19 patients in the study, 8 were males and 11 were females, with a mean age of 32.9 years. The patients included 11 with mental retardation, 3 with autism, 2 with cerebral palsy, 2 with schizophrenia, and 1 with a brain disorder; 2 patients also had seizure disorders. All were incapable of oral self-care due to serious cognitive impairment and could not cooperate with normal dental treatment. A total of 27 rounds of general anesthesia and 1 round of intravenous sedation were performed for implant surgery. Implant placement was performed in 3 patients whose prosthesis records could not be found, while 3 other patients had less than 1 year of follow-up after prosthetic treatment. When the criteria for implant success or failure were applied in 13 remaining patients, 3 implant failures occurred in 59 total treatments. The cumulative survival rate of implants over an average of 43.3 months (15-116 months) was 94.9%. CONCLUSIONS: For patients with severe cognitive impairment who are incapable of oral self-care, implant treatment under general anesthesia showed a favorable prognosis.
Anesthesia, General* ; Autistic Disorder ; Brain Diseases ; Cerebral Palsy ; Cognition Disorders ; Dental Implantation ; Dental Implants* ; Disabled Persons ; Epilepsy ; Female ; Follow-Up Studies ; Humans ; Intellectual Disability ; Male ; Medical Records ; Prognosis* ; Prostheses and Implants ; Retrospective Studies ; Schizophrenia ; Self Care ; Seoul ; Survival Rate

PURPOSE: Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. MATERIALS AND METHODS: Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). RESULTS: End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and gamma value were lower in the mentally disabled patients (C50=0.37 vol %, gamma=16.5 in mentally intact patients, C50=0.19 vol %, gamma=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and gamma value to pharmacodynamic model. CONCLUSION: A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients.
*Anesthesia Recovery Period ; Anesthesia, Dental/*methods ; Anesthesia, General/*methods ; Anesthetics, Inhalation/*administration & dosage/pharmacology ; Case-Control Studies ; Child ; Child, Preschool ; Consciousness/drug effects ; Dental Care for Disabled/*methods ; Dose-Response Relationship, Drug ; Female ; Humans ; Male ; Mentally Disabled Persons ; Methyl Ethers/*administration & dosage/pharmacology

This study was conducted to detail tooth loss patterns in older adults with special needs. A total of 491 elderly subjects with special needs were retrospectively selected and followed during 10/1999-12/2006. Medical, dental, cognitive, and functional assessments were abstracted from dental records and used to predict risk of tooth loss. Tooth loss events were recorded for subjects during follow-up. Chi-squared tests were used to study the association between tooth loss and the selected risk factors. Logistic, poisson, and negative binomial regressions were developed to study tooth loss patterns. Overall, 27% of the subjects lost at least one tooth during follow-up. Fourteen subjects had tooth loss events per 100 person-years. Tooth loss pattern did not differ significantly among different special-needs subgroups (i.e. community-dwelling vs. long-term care, physically disabled vs. functionally independent). Special-needs subjects with three or more active dental conditions at arrival had more than twice the risk of losing teeth than those without any existing conditions. After adjusting other factors, the number of carious teeth or retained roots at arrival was a significant predictor of tooth loss for older adults with special needs (P = 0.001). These findings indicate that appropriately managing active caries and associated conditions is important to prevent tooth loss for older adults with special needs.
Aged ; Analysis of Variance ; Chi-Square Distribution ; Cohort Studies ; Dental Care for Aged ; statistics & numerical data ; Dental Caries ; epidemiology ; Disabled Persons ; statistics & numerical data ; Follow-Up Studies ; Geriatric Assessment ; Humans ; Incidence ; Independent Living ; Logistic Models ; Longitudinal Studies ; Minnesota ; epidemiology ; Nursing Homes ; Prognosis ; Retrospective Studies ; Risk Factors ; Tooth Loss ; epidemiology