Table 3.146.

Key considerations for dental management in spina bifida (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Latex allergy
Appropriate dental care	2	Latex-free appliances; latex-free environment; antibiotic prophylaxis (shunt)
Pain and anxiety control
– Local anaesthesia	1	Latex-free cartridges
– Conscious sedation	1	Latex-free equipment
– General anaesthesia	3/4	Latex-free operating theatre
Patient access and positioning
– Access to dental office	1	Many are chairbound
– Timing of treatment	1	Early morning
– Patient positioning	1	Avoid supine position
Treatment modification
– Oral surgery	0
– Implantology	0
– Conservative/Endodontics	0
– Fixed prosthetics	0
– Removable prosthetics	0
– Non-surgical periodontology	0
– Surgical periodontology	0
Hazardous and contraindicated drugs	1	Many are given anticoagulants; possibly antibiotic resistance

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.