Special needs patients

Lately, there has been many special needs patients coming to the clinic, and somehow or rather, I end up seeing them. Not that I'm complaining, but it is definitely a challenge for me, seeing that I have never seen patients apart from those requesting restorative care during my student life, and also those who seek orthodontic treatment during my attachment at the orthodontic clinic.

The first case that came in last week was a 12 year old girl with learning difficulty. She was willing to be examined with a mouth mirror, but at the sight of any other instruments, she mouth clamps shut. Her Mother has taken her to various other dental clinics but all have failed to extract her teeth. Even with a history like this, my senior officer somehow had confidence that i could carry out the extractions! After several failed attempts to inject the anaesthesia, it was decided that she had to be sedated. So a dose of midazolam was prescribed. 30 minutes later, even in her drowsy state, she still managed to struggle and push my hand away. 5 people ( mother, aunt, specialist, 2 nurses) had to restrain her while i injected the last bit of anaesthesia. With all the commotion, one tooth was finally extracted. After over 2 hours!  And worst of all, she was so pissed, she refused to bite on a cotton roll. So she had bloody saliva dribbling from her mouth onto her clothes and the dental chair. And when someone finally managed to get a roll into her mouth, she threw the blood soaked roll on the floor. One of it ended up on my foot :S

The state of my hair after the extraction

Patient number 2 came in yesterday. He is a 15 year old boy with cerebral palsy. He has spasms of his arms and legs, making him unable to walk, and so had to be carried by his mother. Unsurprising for a case like this, he has multiple teeth with large carious lesions requiring extractions. Since nothing can be done with the patient so uncooperative, the patient was put on the waiting list for dental clearance under general anaesthesia.

Patient 3 came in this morning with Down's syndrome. He complained of pain from upper front teeth. Again, he too needs multiple extractions but refuses to let me put anything into his mouth besides the mouth mirror. How to work like that?? So another patient on the waiting list for GA.

Patient 4 came in shortly after Patient 3. He is a 5 year old boy diagnosed with Mental Retardation with Hyperactivity. OMG! This patient is a handful. Even in the waiting room itself, he managed to fall and hurt himself. He could barely stay still for 2 seconds and his dad had to hold on to him the whole time. When he got free, he ran around the clinic, into the specialist's room  and out again. He is one of the worse cases so far. He needs extractions of all his primary molars. Imagine the level of decay! Daddy refused to go to the Paeds specialist in JB for the extractions, so one more case on the waiting list! 

Parents, please! Do keep your child's teeth clean! Don't bring them in only when their teeth can no longer be restored! And with the amount of decay, there must be long term neglect. 

*****

I saw another patient today with a heart wrenching story. An old man of 73 years, was involved in a car accident. He could not remember how or when it happened, or who he was with. He was hardly responsive when asked. Later, i heard from one of the nurses that he was in a car driven by his son, who sadly didn't survive the crash. I was thinking, maybe it wasn't that he couldn't remember the crash. Maybe he just didn't want to remember it.