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Many medically compromised and special needs children are under the care of specialist paediatric dentists. There are many barriers and obstacles to overcome in order to put these children at ease in order to facilitate their acceptance of dental treatment. Most of these children will have had multiple hospital visits and procedures carried out that will have affected their compliance for dental treatment. White coat syndrome is well documented in the literature and many of these children will be wary of health professionals..

As specialist paediatric dentists we are trained in behaviour management techniques to deal with the anxiety of all children including these medically compromised children. We have a range of techniques from "tell-show-do" and "tender-loving-care" to voice modulation, use of models, desensitisation or the use of aversive conditioning techniques like parental exclusion or the controversial "hand-over-mouth" technique. Each clinician will have their own preferences of which of these behavioural management techniques to use for their patients. The key to success is the relationship and bond that is developed between the child and their paediatric dentist. Communication and empathy are the most important factors that help to secure a lasting patient-clinician relationship. Therefore paediatric dentists are very knowledgeable of all aspects of child growth and development as well as having a widespread interest in children's hobbies and pastimes. These interests range from child sports, TV programmes, comics, magazines, pop music, fashion and of course school subjects for both boys and girls of all ages up to the age of 18 years. One moment we may be talking about Thomas the tank engine with a four year old boy and later we might be discussing the latest hit pop record with a teenage girl. Being able to engage children in discussions of their hobbies and pastimes shows them that we are interested in them and with time this helps to gain their trust and hence facilitate their dental treatment.

Prevention including relatively simple procedures like plaque disclosure, scaling, prophylaxis, fluoride applications and placement of fissure sealants can be extremely difficult in some children with medical disabilities. Frequently sedation techniques or general anaesthesia are required to carry out full mouth dental rehabilitation when dental restorations and extractions are needed. The work up of these cases often requires communication and liaison with paediatricians, cardiologists, haematologists, oncologists, anaesthetists etc in order to prepare for the treatment.

In this issue of the European Archives of Paediatric Dentistry are a number of papers related to medically compromised children and oral hygiene and periodontal treatment of children. The paper of Hansson and co-authors from Sweden reports on the oral microflora of children with congenital heart disease related to their dietary intake. Hebbal and Ankola from India have developed a new 'audio tactile performance' (ATP) technique for training visually impaired children in oral hygiene maintenance. We seldom see dental calculus in children and Ashkenazi's group from Tel-Aviv, Israel report the effect of non-functional teeth on the accumulation of supra-gingival calculus in children. There is also a case report by Seremidi and co-authors describing the therapeutic management of an 8-year-old child with generalised aggressive periodontitis. Many medically compromised children are prescribed long term medications and some of these medications can have an effect on dental oral health. Soares and co-workers from Brazil report on their in vitro investigations of three paediatric liquid oral medicines on bovine enamel.
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Title Annotation:dental treatment
Author:Toumba, Jack
Publication:European Archives of Paediatric Dentistry
Article Type:Editorial
Geographic Code:4E
Date:Oct 1, 2012
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