Understanding the medical background, possible oral manifestations, and potential treatment risks is essential to ensure both safety and effectiveness during dental care.
This comprehensive guide summarizes key pediatric diseases that require special attention from dental professionals.
1. Congenital Heart Disease (CHD)
Children with CHD are at increased risk of infective endocarditis following invasive dental procedures. Preventive measures include:
✔ Antibiotic prophylaxis when indicated (according to AHA or ESC guidelines).
✔ Avoiding unnecessary extractions or surgical interventions.
✔ Maintaining excellent oral hygiene to minimize bacteremia risk.
Clinical tip: Always consult the child’s cardiologist before initiating treatment and limit epinephrine in local anesthesia when necessary.
2. Diabetes Mellitus (Type 1)
Poorly controlled diabetes affects wound healing and increases the risk of periodontal disease and oral infections such as candidiasis.
✔ Schedule dental visits in the morning, after a normal meal and insulin dose.
✔ Monitor blood glucose levels before procedures.
✔ Avoid long fasting periods or stressful treatments.
Dental focus: Emphasize preventive care—fluoride varnish, sealants, and plaque control.
3. Asthma
Asthmatic children may experience xerostomia and enamel erosion from inhaler use.
✔ Encourage mouth rinsing after each inhaler use.
✔ Avoid triggering agents (e.g., sulfite-containing anesthetics).
✔ Keep a bronchodilator readily available during dental visits.
Clinical precaution: Avoid dental treatment during an active asthma attack.
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4. Epilepsy
Children with epilepsy require careful planning to prevent seizure-related injuries during dental care.
✔ Schedule appointments when medication levels are stable.
✔ Avoid flashing lights and stress triggers.
✔ Protect oral soft tissues with bite blocks if necessary.
Medication effect: Chronic phenytoin use may cause gingival overgrowth, requiring regular periodontal maintenance.
5. Hemophilia and Bleeding Disorders
Children with hemophilia or thrombocytopenia need coordination with a hematologist before any invasive dental procedure.
✔ Use minimally traumatic techniques and apply local hemostatic measures (tranexamic acid, sutures, oxidized cellulose).
✔ Preoperative factor replacement may be required.
Recommendation: Non-invasive treatments like fluoride therapy and ART (atraumatic restorative treatment) should be prioritized.
6. Leukemia and Childhood Cancers
Oral manifestations may include mucosal pallor, petechiae, gingival enlargement, and susceptibility to infection.
✔ Delay elective care during active chemotherapy or neutropenia.
✔ Implement gentle oral hygiene measures to reduce mucositis risk.
✔ Coordinate closely with the oncology team.
Note: Chlorhexidine rinses and topical antifungals may be prescribed for oral mucositis control.
7. Cerebral Palsy and Neurological Disorders
Motor dysfunction and poor coordination make oral hygiene difficult.
✔ Use mouth props, gentle restraints, and caregiver-assisted brushing routines.
✔ Short, calm appointments in the morning are preferable.
✔ Monitor for bruxism and drooling, common in these patients.
Goal: Establish preventive recall programs with parental education.
8. Renal Disease
Chronic kidney disease can lead to uremic stomatitis, altered drug metabolism, and bleeding tendencies.
✔ Avoid nephrotoxic medications (NSAIDs, certain antibiotics).
✔ Schedule appointments the day after dialysis when possible.
✔ Monitor for anemia and delayed healing.
Dental management: Prioritize non-invasive care and stress infection control.
9. Down Syndrome (Trisomy 21)
Children with Down syndrome frequently present macroglossia, delayed eruption, malocclusion, and periodontal susceptibility.
✔ Short appointments with behavior guidance.
✔ Reinforce home hygiene with adaptive toothbrushes.
✔ Evaluate cardiac status prior to invasive procedures.
Insight: Early orthodontic and speech therapy referrals improve long-term outcomes.
10. Autism Spectrum Disorder (ASD)
Sensory sensitivities and communication difficulties require a desensitization-based approach.
✔ Use consistent routines, minimal sensory stimuli, and visual cues.
✔ Allow familiar caregivers during treatment.
✔ Consider pre-visit acclimatization and behavior management techniques.
Tip: Collaboration with pediatric psychologists enhances cooperation and outcomes.
Conclusion
Pediatric patients with systemic conditions require individualized dental management that integrates medical history, communication with physicians, and preventive strategies.
Dentists play a crucial role not only in treating oral problems but also in maintaining the child’s overall health and quality of life.
