Orthodontic Considerations in the Management of Children with Special Health Care Needs

Abstract

Background: Children with special health care needs (CSHCN) include individuals with any form of physical, behavioral, cognitive, emotional impairment and those with specific conditions that are at risk of developing chronic conditions. Due to the peculiarities of this group of individuals, orthodontic treatment should be modified to suit their peculiar needs.
Methods: This review will consider the peculiarities of children with special health care and how it will affect the decisions taken during orthodontic management.
Results: Children with special health care needs are grouped into physical, developmental, behavioral/emotional and those with sensory impairment. They include children with autism, bipolar, Down's syndrome, cerebral palsy, epilepsy and other chronic conditions like asthma and haemophilia. The general presentation of CSHCN like uncoordinated movement and stability, below optimal intellectual performance and poor communication makes management of CSHCN challenging. Also, the increasing prevalence of malocclusion among CSHCN is now making most parents of children with special needs to seek orthodontic care to improve their facial aesthetics and to further enhance social interaction. Modifications of treatment protocol have to ensured in order to be able to accommodate CSHCN especially with behavioral management, maintenance of oral hygiene and orthodontic biomechanics.
Conclusion: Orthodontic treatment of special need patients should be personalized and simplified as much as possible to meet the patient need. Apart from the motivation to have orthodontic treatment, parents and CSHCN must show enough willingness before they can embark on orthodontic treatment. In the light of this, unbiased orthodontic case selection is critical.