Conditions that can impede the delivery of dental treatment in children

Condition	Effect on dental care delivery	Dental management
Cerebral palsy	Wheelchair access; immobility; uncontrolled movements; reflex problems	Treatment in wheelchair; use of restraints; use of pharmacologic agents to manage movement
Muscular dystrophy	Wheelchair access; immobility; risk of aspiration; lack of muscle control	Treatment in wheelchair; use of restraints and supports
Intellectual and developmental disabilities	Inability to cooperate	Behavior guidance; use of pharmacologic agents to manage behavior
Autism	Inability to cooperate	Behavior guidance; use of pharmacologic agents to manage behavior
Attention deficit hyperactivity disorder	Short attention span	Behavior guidance; treatment when medicated
Sensory disorders	Communication difficulties	Use of adjunctive communication means/interpreters; use of pharmacologic agents to manage behavior
Spinal cord injury	Wheelchair bound; pressure sores; autonomic dysreflexia	Treatment in wheelchair; positioning/stabilizing techniques
Spina bifida	Intellectual impairment; wheelchair bound; positioning difficulties	Behavior guidance; treatment in wheelchair; positioning and stabilizing techniques
Obesity	Failed procedures, other adverse outcomes with pharmacologic management	Behavior guidance; alternatives to operative procedures such as silver diamine fluoride

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