Special Care Dentistry and Medically Compromised Children
What the exam tests
Special care questions test modification of routine care for medical risk, not avoidance of care.
Core rules
- Down syndrome: hypotonia, macroglossia, delayed eruption, hypodontia and periodontal risk; check atlantoaxial instability before extreme neck extension.
- Autism: predictability, visual supports, desensitisation and short appointments.
- Cerebral palsy: drooling, bruxism and gingival overgrowth with anticonvulsants; spasticity needs careful positioning.
- Epilepsy: know seizure first aid, avoid triggers, and remember phenytoin causes gingival hyperplasia.
- Bleeding disorders: factor replacement or desmopressin; avoid NSAIDs and aspirin.
- Infective endocarditis prophylaxis only for high-risk lesions, not routine joint prostheses.
Worked example
A 10-year-old with Down syndrome needs a stainless steel crown. Reasoning: assess the airway and neck, use a short morning appointment, apply tell-show-do with a mirror, and consider nitrous oxide. Check for congenital heart disease before deciding on prophylaxis.
Traps
Withholding care because of a diagnosis; giving prophylaxis for every murmur; ignoring dehydration risk in a child with cerebral palsy.