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.