Dental concerns of children with intellectual disability - A narrative review

Abstract

Intellectual Disability is a general term is applied to person whose intellectual development is significantly lower than that of normal people and whose ability to adapt to their environment is consequently limited, 1.3% of the population is affected and factors which play an important role are environmental, chromosomal and monogenic. It may be associated with syndromes like Down syndrome. Clinical manifestations are tensely reclined head, poor mobility, increased tone in limbs, persisting fisting and abnormal behaviour. Self-mutilation (biting, head banging and scratching), hunger for non-food items such as dirt, hair etc. Salivary flow is altered due to the multiple medications leads to Early Childhood caries. Increased plaque and calculus formation which give rise to poor oral hygiene further leads to halitosis. Early loss of anterior teeth leads to speech impairment. Congenitally missing permanent teeth and enamel hypoplasia fractured anterior teeth. More prone for self injurious habits like Lip biting and they tend to yearn for non-food items such as dirt and hair etc. Material for the carious teeth is glass ionomer cement due to the fluoride release; stainless steel crowns are beneficial for multi surface carious teeth. Single visit endodontic treatment is considered, an apex locator would be helpful rather radiographs for working length. Fixed prosthodontics is more appropriate than removable partial dentures. Powered tooth brushes are relatively preferable than conventional tooth brushes. If the child is having drug induced gingival over growth and interferes the occlusion gingivectomy is the treatment of choice. Some anxious children Desensitization is effective in the first line of treatment and restraints can be used when other types of techniques failed. Mouth props can be used during the treatment. A child who cannot be managed with physical restraints oral sedation with vallium, chloralhydrate, and hydrazine is useful to reduce the anxiety during treatment. General anesthesia is the last resort in behavior management in these children. This article discusses about etiology, clinical features along with dental management.