Child Dental Patient with DIABETES

Clinical cases

Clinical case 1

Antonia, age 5y

Main dg: DM

Dental dg:

  • multiple untreated caries in deciduous dentition, pulp involvement
  • chronic periodontal inflammation;
  • expected crowding in permanent dentition

Barriers for dental treatment:

  • Overindulged child due to her medical condition, with very poor cooperation, attitude endorsed by parental sympathy
  • Complex oral pathology requiring complex management

 

Treatment planning

Objectives:

Physical:

1. Eliminate pain

2. Eliminate infection

3. Improve periodontal condition

4. Caries prevention for first permanent molars

 

Psychological:

1. Win CHILD’s trust

2. Win PARENTS’ cooperation

3. Win CHILD’s cooperation

4. Establish a long-term relationship

 

 

First important achievements: Acceptance of nitrous oxyde mask and panoramic x-ray

 

Treatment sessions - as short as possible, maximum one quadrant/session
Analgesia – was obtained by infiltration local anaesthesia (articaine+adrenaline)
preceded by topical anaesthetic gel; non-traumatic infiltration technique

 

Compromised deciduous molars were extracted, restorations were placed and permanent molars were sealed with glass-ionomer sealants (GC Fuji Triage)

 

Oral hygiene did not dramatically improve with time

 

Frequent food intake (due to main pathology) and poor hygiene continuously induced caries and gingivitis.
Non-cavitated lesions were resin-infiltrated.
Professional cleaning and fluoride varnish were applied on every occasion

 

Clinical case 2

Andreea (f) age 10 y

Dg. (gen): type I DM
Dg. (dental): mixed dentition, untreated caries, +/- pulp involvement
Dg. (orthodontic): class II sub.2, crowding

Main concerns:

  • pain
  • gingival bleeding
  • practitioners’ reluctance to provide treatment ­čí¬ repeated refusals

Focus :

  1. On main complaint of the patient – pain from untreated caries
  2. On the periodontal status (gingivitis)
  3. On the orthodontic problem (?)

Problems encountered :

  1. Poor cooperation for hygiene orthodontic treatment
  2. Poor understanding for the need of regular check-ups

Successful endodontics, restorations, caries prevention by sealants provision
BUT
Hygiene still needs improvement
Orthodontic aspects remain unsolved