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ePaper created 2018-04-25, 10:58:32 | version 1.38.0
| systemic diseases We have an enormous infl uence on children’s overall health By DTI Parents of children with systemic disease often won- der in the dentist’s office what oral health problems they can expect for their child. Depending on the type of systemic disease, there can be complications in terms of the child’s oral health. In this context, Dr Karolin Höfer, senior physician at the University Hospital of Cologne, studies oral disease in children with chronic renal insuffi- ciency or congenital heart defects. In her presentation at the Oral-B Up-to-Date event, she spoke about the typical oral health problems of paediatric kidney and heart patients based on her own research and compared these with current systematic reviews. She then, in a very personal interview gave helpful suggestions for the support and treatment of these children in everyday life. Dr Höfer, why do you like working with children? Dr Karolin Höfer: My passion lies in working with chil- dren and young people; that’s why I specialised in pae- diatric dentistry, with a special focus on children with systemic disease. In dentistry, we say: one either loves it or leaves it. With every one of my young patients, whether they have a medical history or are healthy, I have to gain their confidence on an emotional level first, aside from the dentistry challenge. Working with children who are traumatised and have medical histories in particular re- quires sensitive handling in order to build trust, which is the foundation of successful treatment. Intuition, taking sufficient time, patience and empathy are essential here. Successful treatment of children with cancer or severe heart problems or others at high risk is achievable by using special techniques, such as ritualised behaviour management. After a difficult treatment, having a child smile and ask when he or she can come back is the best endorsement in daily practice. ourselves: Are there correlations between these systemic diseases and oral disease and/or disease that affects tooth development? As dentists, we should know how these systemic disease can affect oral health. We are already aware of the well-known interactions with some chronic diseases, such as congenital heart disease, dia- betes mellitus, arthritis and chronic diseases of the bowel and kidney. What questions do dentists have to ask when treat- ing these patients? First of all, it is important to identify the child’s dental problem. Secondly, it should be determined whether the child has certain diseases and whether there are inter- actions with oral disease. And thirdly, which specialists in other disciplines should be consulted before dental work commences must be established. How do you see your position as a dentist within the holistic therapy of these children? I am not responsible for the patient’s entire medical recovery. However, I see myself as a physician, mediator and member of a team of paediatric specialists. When we treat patients with systemic disease, we need to be in contact with specialists from all disciplines. As experts in oral health, we have an enormous influence on chil- dren’s overall health. Every dentist should consult with the treating paediatricians of children with pre-existing conditions. It’s about the overall well-being of the child. Even a tooth cleaning can take on another meaning for these children. Healthy people associate it with health, well-being and aesthetics. For children with systemic dis- ease, however, an intensive prophylaxis can have major implications for their general health, for example, should pathogenic bacteria enter the bloodstream of a child, say, with immunosuppression. What patients do you work with? Most of my patients have a systemic disease and are with me from birth up to age 25. The period between ages 18 and 25 is considered a transition phase; from child to adult. After careful paediatric treatment, a de- terioration of the condition is frequently reported during the transition phase. For example, we treat patients with cystic fibrosis, congenital heart defects, chronic kidney disease and immunosuppression, for example, after a transplant or during cancer treatment. Every day, we ask You work with children who have congenital dis- ease. You have conducted interesting studies on the prevalence of caries and gingivitis. What have your results been? If one considers the tooth decay process of healthy children in Germany 20 years ago, about five teeth were affected by tooth decay, while today, only one tooth on average is affected. Up to 85 per cent of 3-year-olds have no caries; however, the remainder may have up to four car- ious teeth. As I said, these figures involve healthy children. 28 prevention 1 2018