Dental management of the child with developmental dyslexia

Dyslexia, a biologically determined reading disorder effects an estimated 3 percent to 10 percent of school-age children in the United States. Standard pediatric dental protocols frequently have to be modified because many of these children concurrently suffer attention-deficit-hyperactivity disorder (ADHD), asthma, thyroiditis and inflammatory bowel disease (ulcerative colitis and Crohn's disease). Youngsters suffering from dyslexia and ADHD should have their dental appointments scheduled in the morning when they are most attentive and best able to remain seated in the dental chair. An aspirating dental syringe must be used in order to avoid an intravascular injection and the possibility of an adverse interaction between the pressor agents used with local anesthesia and the medication used to treat ADHD. Aspirin, other nonsteroidal antiinflammatory agents (e.g., ibuprofen) and local anesthetic agents containing vasoconstrictor and preservative (antioxidants, i.e., sulfite) agents should be avoided in children with concurrent asthma because of their propensity to trigger an asthmatic attack. Children with uncontrolled hyperthyroidism should receive only emergency care and this care should be provided in a hospital. Children with hypothyroidism are hyperresponsive to even small dosages of analgesics and anesthetic agents; proper dosing and venue of dental procedures should be a joint decision between the child's dentist and pediatrician. Children with dyslexia and concurrent inflammatory bowel disease may require shorter appointments and nitrous oxide sedation to reduce stress. Those receiving corticosteroids or with a history of steroid therapy within the past year may need supplementation to avoid an adrenal crisis brought about by the stress of dental care.(ABSTRACT TRUNCATED AT 250 WORDS)