MANAGEMENT OF

PHYSICALLY DISABLE
PATIENT
CONTENTS
• Definition of handicapped child
• Classification of handicapped child
• Barriers in providing care to physically disable
patient
• The role of dental assistant
• Wheelchair transfer
• Management of disable patient: in general
• Radiographic examination of disable patient
• Management of uncooperative physically disable
patient during treatment
• conclusion
Definition of
handicapped child
• A person should be considered dentally
handicapped if pain, infection or lack of
functional dentition which affects the
following
1) Restrict consumption of diet adequate to
support normal growth and development
needs
2) Delays or alters growth and development
3) Inhibits performance of any major life
activity including work , learning
communication and recreation
Classification of
handicapped child
1) Physically handicapped
2) Mentally handicapped
3)Congenital – cleft lip and cleft
palate
4)Convulsive - epilepsy
5)Communication – deafness
6) Systemic – hemophilia
7)Metabolic – Juvenile diabetes
8)Osseous disorder- rickets
9)Malignant disorders- leukemia
Barriers in providing care
to physically disable
patient
• 1) Assesiblity- The person with disability
experiences physical and mental obstacles to
access , the most overt being the architectural
barrier.
2) Psychosocial – The person with special care needs
may develop in an environmental of chronic care,
painful procedure and emphasis on aspects of
health other than dentistry.
3) Financial – Cost of dental care is an issue for many
patients.
4) Communication – The dentist – patient chair side
relationship demands a functional communication
cycle
5) Mobility and stability
Dental offices are designed for fully functional
humans. Some patient with special needs require
stabilization , support and assistance while seating
or leaving the dental chair.
6) Preventive- Basic oral hygiene and home care may
need to be supplemented with fluoride rinses,
antimicrobials , saliva substitutes and other
adjunctives.
7) Treatment planning- The special needs patients
may need and want treatment that balances cost
,longevity, difficulty of achievement , esthetics and
function
8) Continuity of care
The role of dental
assistant
• Obtaining preliminary information which
the dentist later reviews with the patient
or family.
• Instructing the patient or family in oral
hygiene
• Assisting in the use of restraints and other
methods of patient behavioral control
• Anticipating problems and preparing for
emergencies and other contigencies
Wheelchair transfer
• Severely physically disabled patient who
come to the dental office may employ
wheelchair as their principal means of
mobility .
• Transfering most of these individuals from
this chair to the dental chair is not a
difficult procedure.
• Steps
1) Wheelchair should be positioned beside
the dental chair with its wheels locked.
2) The person who is to do the major part of
lifting stamnds behind the patient.
3)Places his arms underneath the patients arms and
grasps the patient’s left forearm with his right
hand and the right forearm with his left hand.
4)The dental assistant will be facing the patient with
her hands under the patient knees.
5) The height of the dental chair should be adjusted
so that the patient will not will not have to be
lifted for high to clear the arms of chairs.
6) At a pre arranged signal, the patient is lifted from
the wheelchair into the dental chair.
Management of the disable
patient: in general
It includes following approaches
1. Family involvement
2. Expectation and motivation
3. Psychological approach to
treatment
4. Treatment of particular disorder
5. Nitrous oxide analgesia
6. General anesthesia
Radiographic examination
of disable patient
• Adequate radiographic records are
often necessary in planning dental
treatment for disable patient
• For patients with limited ability to
control film position , intraoral films
with bite- wing tabs are used for all
bite-wing and periapical radiographs
• An 18 inch length of floss is attached
through a hole made in the tab , to
facilitate retrieval of the film if it
falls towards the pharynx.
Preventive dentistry in
physically disable patients
• It includes
1) Home dental care
2) Fluoride exposure
3) Preventive restoration
Home dental care:
• For patients who are physically unable to
cooperate the dentist should teach the
parent or guardian correct tooth brushing
technique that safely restrain the child
when necessary.
• Powered tooth brush should be used for
such patient . These patient show poor
oral hygiene, show mouth wash such as
chlorhexidine should be used.
Fluoride exposure
• Special emphasis should be placed on
ensuring adequate systemic fluoride for
patients with diabetes.
• The dentist should first determine the
concentration of fluuoride in patients daily
water supply
• If the level of fluoride is between 0.7 to 1
ppm , no supplementation is normally
required
• If level of fluoride is below 0.7 ppm then
systemic fluoride supplementation is
necessary , along with the various forms
available.(ie drops and tablets)
Preventive restoration
• Pit and fissure sealants have been
shown to reduce occlusal caries
effectively .
• Sealants are appropriate in patients
with disabilities .
• For a patient who requires dental
work under general anesthesia ,
deep occlusal pits and fissures
should be restored with amalgam or
long wearing composites to prevent
further breakdown and decay.
Management of uncooperative
physically disable patient
during dental treatment:
1. Treatment immobilization
2. Nitrous oxide analgesia
3. General anesthesia
The use of immobilization is indicated in the
following situation:
1) A patient requires diagnosis or treatment
and cannot cooperate because of lack of
maturity.
2) A patient requires dental treatament and
cannot cooperate because of mental or
physical disabilities
3) In patient where behavior management
techniques have failed
Commonly used immobilization devices
For body :
Pappose board
Triangular sheat
Pedi wrap
Bean bag
Safety belt
For exteremities:
Posey straps
Towel and tape
For head :
Forearm body support
Head positioner
Conclusion

In this topic we discussed

about the dental problems
associated with physically disable
patient and their management.
Preventive and curative procedure
are indicated for these patients .
Dental procedure in these patient
require more time and attention than
normal patient.
References

• Ray E Stewart : Pediatric dentistry

• McDONALD: Dentistry for the child
and adolescent
• Nikhil Marwah: Comprehensive
Pediatric dentistry
• Shobha Tandon :Text book of
pedodontics.