Classification of handicapped
conditions
Definition :
• W.H.O in 1980 defined a handicapped person as one
who over an appreciable period is prevented by physical or
mental conditions from full participation in the normal
activities of their age groups including those of a social ,
educational , recreational and vocational nature.
• American Association of Pediatric Dentistry , states that
a person should be considered dentally handicapped if there
is pain , infection or lack of functional dentition that affects
him/her as follows :
Restricts consumption of a diet adequate to support growth
and energy needs.
Delays or alters growth and development.
Inhibits performance of any major life activity.
Various Classifications
Frank and Winter in 1974 have classified handicap
conditions as:
Blind or partially sighted
Deaf or partially deaf
Educationally subnormal
Epileptic
Maladjusted
Physically handicap
Defective in speech
Senile
Agerholm 1975 classified handicapping conditions
as :
Intrinsic category
Extrinsic category
For convenience of management they are classified
as :
Developmentally disabled child
Medically compromised patients
Nowak in 1976 classified handicapping conditions into nine
categories :
Physically handicapped
Mentally handicapped
Congenital defects
Convulsive disorders
Communication disorders
Systemic disorders
Metabolic disorders
Osseous disorders
Malignant disorders
The most common techniques employed to manage a
handicapped child in the operatory are :
Tender loving care
Local anesthesia
Premedication and sedation
Nitrous oxide analgesia
Physical restraints/ Protective stabilization
Behaviour modification
Hypnosis
General anaesthesia
MENTALLY CHALLENGED CHILDREN
Mental sub normality can be defined by American association
of Mental Deficiency as , subaverage general intellectual
functioning which originates during the developmental period
and is associated with impairment in adaptive behaviour.
Associated Dental problems
Multiple anomalies of facial structures , eruption time ,
sequence , number , presence of malocclusion and
enamel hypoplasia.
Higher prevalence of dental caries and periodontal disease.
Management :
Familiarize the patient to the office and dental personnel to
reduce his/her fear of unknown.
speech must be slow and simple.
Only one instruction at a time should be given.
TSD and TLD in mild cases whereas sedation in moderate cases.
Carefully listen to patient .
Appointments should be short and scheduled in early part of the
day.
GA indicated in cases where extensive rehabilitation is required.
DOWN’S SYNDROME
It is a malformation syndrome which occurs due to trisomy of
chromosome 21 (95%) , translocation (3%) , or due to mosaicism (2%) .
Oral manifestations :
Mouth
- small drooping mouth
- open mouth posture
Tongue
- Protrusive , fissured (scrotal) tongue.
- Circumvallate papillae may be enlarged , but filiform papillae may
be absent.
- Macroglossia
Lips -
Thick , dry , fissured.
Occlusion -
Anterior open bite and crossbite , class III tendency.
Small maxilla.
Palate -
Often appears high with horizontal palatal shelves (omega
palate) .
Bifid uvula , cleft lip and palate.
Eruption of teeth –
Retarded
Early shedding of deciduous teeth
Teeth -
Hypodontia
Microdontia
Hypocalcification and hypoplastic defects
Low incidence of caries
Periodontium -
Severe , early onset periodontal disease.
Management :
Congenital defects – Cleft lip and cleft palate
Classification of cleft and cleft palate :
• Morphological classification
Put forward by Davies and Ritchie (1922) and Veau (1931)
Based on site and extent of the cleft
The Veau classification is as follows :
Group I: Cleft of the soft palate only
Group II: Cleft of the hard and soft palate till the incisive foramen
Group III: Complete unilateral cleft of soft palate , hard palate ,
alveolar ridge and the lip on one side.
Group IV: Complete cleft of the soft palate , hard palate , alveolar
ridge and the lip on both the sides .
• Embryological classification
Kernahan and Stark in 1958 and Spina in 1974 have classified
cleft lip and palate based on embryological principles.
Kernahan and Stark classification
Group I : Cleft of the primary palate
▫ Unilateral - Total , Subtotal
▫ Bilateral - Total , Subtotal
Group II : Cleft of the secondary palate
▫ Total
▫ Subtotal
▫ Submucous
Group III :Cleft of both primary and secondary palate
▫ Unilateral - Total , Subtotal
▫ Median - Total , Subtotal
▫ Bilateral - Total , Subtotal
Spina classification
Group I : Pre incisive foramen clefts
▫ Unilateral
▫ Bilateral
▫ Median - cleft of the lip with or without an alveolar cleft
Group II : Trans incisive foramen clefts ( cleft of the lip , alveolus and palate)
▫ Unilateral
▫ Bilateral
Group III : Post incisive foramen clefts
▫ Total
▫ Partial
Group IV : Rare facial clefts