Dental and Periodontal Care at the Bedside Using a Portable Dental Unit in Hospitalized Special Needs Patients: The Experience of an Italian Pediatric Hospital

Abstract

Patients with special needs (SNPs) include individuals who are disabled due to physical limitations, medical complications, developmental problems, and cognitive impairments. SNPs may be at an increased risk of oral diseases throughout their lifetime. These patients have difficulties in accessing traditional dental studios or clinics. Moreover, orodental problems may cause local and generalized infections, leading to worrisome complications when not properly treated. In this paper, we describe the preliminary experience of treating dental problems in a series of nine hospitalized patients with special needs. This innovative protocol at the Bambino Gesù Children’s Hospital (Rome, Italy) provides an introduction to a portable dental unit in order to perform oral care for hospitalized patients at the bedside. A multidisciplinary team composed of pediatric dentists, dental hygienists, nursing staff, and the patient’s case manager was involved in the operative protocol. The SNPs described were affected by congenital heart or oncohematological diseases and neurodisabilities, and they were all hospitalized for different reasons: Open heart surgery, chemotherapy, organ transplantation, and rehabilitation. The oral evaluation was mandatory for ruling out or treating problems that could cause complications. Dental extractions, caries and fracture fillings, sealing, and oral hygiene procedures were performed at the bedside of the patients in the reference unit of their pediatric hospital. The results of this protocol confirm the feasibility of dental procedures at patients’ bedside with portable dental units, encourage implementation of their use, and may represent an actionable model for oral care management in hospitalized SNPs.

Relevance of dental care in hospitals: a brief systematic review

“…Tooth extractions, caries, fractured restorations, sealing, and oral hygiene procedures were performed at the patients' bedside in the referral unit of their pediatric hospital. These results confirm the feasibility of patient bedside dental procedures with portable dental units, encourage the implementation of their use, and may represent an actionable model for oral care management in hospitalized SNP [8].…”

Multidisciplinary team for patients with neurocutaneous syndromes: The little discussed importance of dentistry

“… 1 , 2 However, thinking about holistic care and better outcomes, other health fields and in particular dentistry should also be essential to be included as part of such teams. Although the role and difficulties faced by dentistry in the management of patients with the most prevalent neurological disorders have already been addressed in the literature, 3 , 4 there is still very little discussion involving specific subgroups. In this brief review the authors discuss general aspects of neurocutaneous syndromes, the potential additional role of dentistry and its benefits in affected patients, with a special focus on Neurofibromatosis type 1 (NF1 [OMIM 162200]) and Tuberous Sclerosis Complex (TSC [OMIM 191100/613254]), in addition to proposing suggestions for actions in dentistry at related levels of care and for further research.…”

“…In addition to individual clinical experience, recent and robust evidence and reports of institutional experience have suggested different positive impacts of specialized dental care for neurological patients, whether in an outpatient 3 or hospital setting 4 In the context of patients with neurocutaneous syndromes, such benefits may be impactful as related conditions requiring this type of specialized management can be alternatively or concomitantly present, including and not only restricted to craniofacial defects, dental and oral anomalies but also neurocognitive alterations. 1 Based on these perspectives, dentistry can play an important role in improving the quality of life, contributing to the prevention of further damage, while allowing a faster recovery with better outcomes.…”

“… 1 Based on these perspectives, dentistry can play an important role in improving the quality of life, contributing to the prevention of further damage, while allowing a faster recovery with better outcomes. 4 , 18 , 19 …”

“…At the outpatient level, the simultaneous presence of neurocognitive disabilities in these patients should always be taken into consideration in the management of oral healthcare. Indeed, apart from the more common expected complications like caries lesion, periodontal and endodontic problems, 4 other more specific associated disorders and anomalies including important occlusal problems, 20 and intraoral fibromas and dental enamel pits 1 , 21 (which are among the criteria for diagnosis of Neurofibromatosis type 1 and Tuberous Sclerosis Complex (TSC) – Table 1 ) may increase the likelihood for patients with neurocutaneous syndromes to autonomously perform inadequate oral hygiene, exposing them excessively to unnecessary and preventable risks.…”