Special Needs Children
Special Needs Children
At Pandit Clinic, we welcome children with special needs with open arms and treat them with gentleness and positivity.
Dentistry for Special NeedsChildren
Pandit Clinic is a medical practice that is kind and compassionate to all its patients, especially with special needs children. Our clinic does not make any distinction between special needs children and others. We welcome them with open arms and treat them with gentleness and positivity.
We understand the hurdles parents face when raising children who are physically or mentally challenged. Our Pediatric Dentist Dr Pratibha Kukreja Pandit is calm, kind and understanding. Her sole focus when treating special needs children is to make the process as comfortable and as painless as possible.
Dr. Pratibha is trained at the prestigious Chang Gung Memorial Hospital, Taiwan, in advanced areas including Dental Rehabilitation of children with special health care needs and Nasoalveolar molding and dental rehabilitation of cleft lip and cleft palate.
Why Choose Us For Your Special Needs Child?
The Staff:The clinical and non-clinical staff at Pandit Clinic is associated with the clinic since its inception. They are courteous, polite, empathic and highly experienced in the field.
The Clinic: Pandit Clinic is located in the heart of the city. It is in the close vicinity of major hospitals like Joshi hospital, Ratna hospital, Poona hospital and KEM hospital. Levelled on two floors in sprawling 4000 square feet area, the clinic is accessible by elevator and is also wheelchair accessible. Ample amount of parking and parking assistance is available on request.
The Operating Room: Our operating room is very well equipped with state-of-the-art equipment and monitors for procedures under general anaesthesia, inhalation and intravenous sedation. Strict protocols for sterilization and disinfection are followed at our operating room.
State-of-the art equipments at our Pediatric Dentistry and Special Needs centre
Dr. Pratibha Kukreja Pandit – Preventive and Special Needs Pediatric Dentist
Cleft lip and Palate
Pandit Clinic has been a centre for specialized cleft lip and palate surgery ever since its inception 38 years ago. Dr Shrirang Pandit is a pioneer cleft surgeon in India and has about 7000 successful cleft surgeries to his credit.
In 2017, Dr Vikram Pandit, Oral and Maxillofacial surgeon, completed his fellowship in Cleft and Craniofacial surgery from the world renowned Chang Gung Memorial Hospital in Taiwan for super speciality cleft, and jaw corrective cleft orthognathic surgery.
Dr Pratibha Kukreja Pandit, Pediatric and Preventive dentist, has a vast experience of treating dental problems in children with cleft deformity at Smile Train Centre at KLE Hospital in Belgaum. She has also completed her training at Chang Gung Memorial Hospital at Taiwan for Nasoalveolar molding and dental rehabilitation of children with clefts. Cleft care being a multidisciplinary speciality, Pandit clinic offers a team that is well trained, competent and experienced.
The challenges accompanying cleft defects:
An array of symptoms accompany the development of cleft lip and palate. The most common functional difficulties that accompany cleft lip and palate include:
1) Feeding difficulties: one of the earliest challenges
2) Hearing difficulties and repeated ear infections: A common clinical observation among children with cleft palate is high prevalence of recurrent upper and lower respiratory tract infection.
3) Teeth: Misaligned teeth, irregular spacing and crossbites are common issues.
4) Mental retardation: If the cleft is part of a cluster of other problems (a syndrome), learning ability is sometimes affected. It is estimated that more than 40% of children with cleft palate but without cleft lip have it as part of a syndrome. Van der Woude syndrome, Pierre Robin sequence, Stickler syndrome and Treacher Collins syndrome are some of the syndromes related with cleft lip and palate.
5) Speech: The gaps caused due the cleft lip and palate lead to an inability to speak normally.
Early Dental Care
With proper care, children born with a cleft lip and/or palate can have healthy teeth. This requires proper cleaning, good nutrition, and fluoride treatment.
Appropriate cleaning with a small, soft-bristled toothbrush should begin as soon as teeth erupt. We recommend that the first dental visit be scheduled at about one year of age or even earlier if there are special dental problems. The early evaluation is usually provided through the Cleft Palate Team at Pandit Clinic. The treatment recommended depends upon many factors. Some children require only preventative care while others will need fillings or removal of a tooth.
The Cleft Lip and Palate procedure can be carried out at any stage of the child’s dental development, especially when there is a caries problem. Erosive tooth surface loss due to the excessive intake of acidic food or drink is also a potential problem in this age group. Any observed tooth wear needs to be carefully monitored and addressed.
Dental care for children with cleft lip and palate:
- Difficulties with tooth brushing often arise as the upper permanent incisors erupt, due to lack of sulcus depth and tightness of the repaired lip.
- Simple measures such as showing the child and parent the cleft region in a hand mirror and disclosing the plaque deposits, especially on the teeth around the cleft, will assist with toothbrushing instruction. This will also help the child in coming to terms with the appearance of the cleft.
- Worries about bleeding from inflamed gingiva around the cleft region should be identified. The child and parent can be nervous about brushing the area for fear of traumatizing the soft tissues, especially following alveolar bone graft surgery.
- Oral hygiene before bone grafting must be of a very high standard as gingival inflammation can cause loss of the new bone.
- Access to the teeth in the cleft region is often difficult and a baby-sized toothbrush is still useful even at this age, especially where the upper lip is tight. This can be supplemented with an interspace brush. Teeth often need to be targeted individually when toothbrushing, as conventional brushing round the arch will exclude abnormally positioned teeth in the cleft region, particularly those placed palatally. The child is shown by the dentist how to lift the upper lip out of the way to facilitate brushing . The cleaning of any anterior teeth positioned high in the labial sulcus should be given attention.
- Home use of disclosing tablets and the importance of a hand-held or bathroom mirror to aid toothbrushing should be discussed. Parental support with toothbrushing is helpful throughout the mixed dentition period and supervision is advised until at least 7–8 years of age.
- Fissure sealants are an important consideration for this group of patients. The procedure is advisable for first and second permanent molars, and premolars where indicated. Fissure sealing should be carried out as soon as the teeth have erupted sufficiently to allow adequate moisture control of the occlusal surfaces.
- The application of fluoride varnish is a valuable preventive measure. It is particularly useful for hypoplastic permanent incisors, areas of early demineralisation, teeth in the cleft region and partially-erupted permanent molars prior to fissure sealing. Fluoride tablet supplements should be continued throughout this phase if appropriate, or fluoride mouthwash usage could be introduced at this stage if only a topical effect is required.
A child with a cleft lip/palate requires the same regular preventive and restorative care as the child without a cleft. However, since children with clefts may have special problems related to missing, malformed, or mal positioned teeth, they require early evaluation by a dentist who is familiar with the needs of the child with a cleft.
Communication with the Cleft Team
The permanent dentition – adolescence to adulthood
Orthodontic Care for Cleft Lip
The first orthodontic evaluation may be scheduled even before the child has any teeth. The purpose of this visit is to assess facial growth, particularly the growth of the jaws. Later as teeth begin to erupt, the orthodontist will make plans for the child’s short and long-term dental needs. For example, if a child’s upper teeth do not fit together (occlude) properly with the lower teeth, the orthodontist may suggest an early period of treatment to correct the relationship of the upper jaw to the lower jaw. It is not unusual for this initial period of treatment to be followed by a long rest period when the orthodontist monitors facial growth and dental development. With the eruption of the permanent teeth, the final phase of orthodontics completes alignment of the teeth.
Coordinated Dental-Surgical Care for Cleft Lip
Coordination of treatment between the surgeon and dental specialist is important since several procedures may be completed during the same anesthesia. Restorations or dental extractions can be scheduled at the same time as other surgery.
Coordination between the surgeon and the orthodontist becomes most important in the management of the bony defect in the upper jaw that may result from the cleft. Reconstruction of the cleft defect may be accomplished with a bone graft performed by the surgeon. The orthodontist may place an appliance on the teeth of the upper jaw to prepare for the bone graft. A retainer is usually placed after the bone graft until full braces are applied. When the child approaches adolescence the orthodontist and the surgeon again coordinate their efforts if the teeth do not meet properly because the jaws are in abnormal positions. If the tooth relations cannot be made normal by orthodontics alone, a combined approach of both orthodontics and surgical repositioning of the jaws is necessary. Such surgery is usually performed after the pubertal growth spurt is completed.
Prosthodontic Care for Cleft Lip
The maxillofacial prosthodontist is a dental specialist who makes artificial teeth and dental appliances to improve the appearance of individuals with cleft and to meet their functional requirements for eating and speaking. The prosthodontist may make a dental bridge to replace missing teeth. Oral appliances called “speech bulbs” or “palatal lifts” may help close the nose from the mouth so that speech will sound more normal. The prosthodontist must also coordinate treatment with the surgeon and/or the orthodontist to assure the best possible result. When a speech bulb or palatal lift is developed, the prosthodontist usually coordinates treatment with the speech pathologist to help in normalizing the child’s speech patterns.
Pandit Clinic is a leader in Cleft Lip and Palate cases. Our team is dedicated to ensuring that our patients end up leading lives which are normal and face minimum restrictions even when they endure problems like Cleft Lip and Palate.
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Dr. Pratibha Kukreja Pandit is available for Virtual Video Consultations from Monday – Saturday between the hours of 11 am – 2pm and 4pm – 7pm.
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Dr. Pratibha Kukreja PanditBDS, MDS
Meet the Doctor
Pediatric and Preventive Dentistry Specialist
Dr. Pratibha is the Chief Dentist at Pandit Clinic. She is also a Consultant Pediatric Dentist at Kotbagi Hospital and KEM Hospital, Pune.
Dr. Pratibha has trained at the prestigious Chang Gung Memorial Hospital, Taiwan, in advanced areas including Pediatric dental treatment under General Anesthesia and Intravenous sedation, Dental Rehabilitation of children with special health care needs, and Nasoalveolar molding and dental rehabilitation of cleft lip and cleft palate.
She’s the lifetime member of Student Clinician Association, American Dental Association (SCADA), USA.