Infantile reflexes and their effects on dental caries and oral hygiene in cerebral palsy individuals

Access to dental care and caries experience among children with cerebral palsy: a Singapore experience

INTRODUCTION

Cerebral palsy (CP) is one of the most severe childhood neurodevelopmental disabilities resulting from non-progressive insult to the developing brain. We aimed to report our experience regarding dental visit attendance, caries prevalence and factors affecting dental access in children with CP in Singapore.

METHODS

Patients diagnosed with CP who were born in or after 1994 were included in this study. We reviewed the data of all 151 patients recruited under the CP Registry in Singapore (SingCPR) from September 2017 to May 2020. The SingCPR was launched in September 2017 to assist in future planning of services and resources for CP in Singapore.

RESULTS

The mean age of the patients was 7.8 years, with the interquartile range being 3 years and 8 months-10 years and 10 months. Only 41.7% reported a visit to the dentist ever, with 25.4% reporting presence of dental caries. Age was the only statistically significant factor influencing access to dental care. None of the children less than 2 years old ever received any dental care, and 20% of the children with CP aged 2-6 years had received dental care before. Age range with the highest percentage of dental visits was 7-12 years, with up to 44.0% having ever received dental care. We believe the prevalence of dental caries was underreported as many children did not receive any dental care and therefore may have undetected dental caries.

CONCLUSION

Dental care in children with CP should be advocated early for prevention and detection of caries.

Dental caries and mean values of DMFT among children with cerebral palsy: a systematic review and meta-analysis

INTRODUCTION

One of the most prevalent causes of physical disability in children is cerebral palsy (CP), which is a series of complicated neurological disorders. Children with cerebral palsy suffer from multiple problems and potential disabilities, including dental caries. Hence, this study aimed to determine the pooled prevalence of dental caries and mean DMFT (Decayed, Missed, and Filled Permanent Teeth) among children with cerebral palsy in Africa and Asia.

METHODS

A comprehensive search of the literature was made to locate relevant studies in PubMed/Medline, HINARI, Web of Science, Science Direct, the Cochrane Library, the Worldwide Science Database, and Google Scholar. The data were extracted in Microsoft Excel and transferred to Stata version 17 software for further analysis. A random-effect model was employed to estimate the pooled prevalence of dental caries and the pooled mean value of DMFT among children with cerebral palsy in Africa and Asia. Heterogeneity between studies was checked using the Cochrane Q test and I2 test statistics. Sub-group analysis by continent was done, and sensitivity analysis was checked. A small study effect was checked using Egger's statistical test at the 5% level of significance.

RESULTS

In this study, 25 original studies conducted in 17 countries in Africa and Asia that fulfilled the eligibility criteria were included in the review. The overall pooled prevalence of dental caries in Africa and Asia among children with cerebral palsy was 55.6% (95% CI: 42.4, 68.8). The pooled prevalence of dental caries among children with cerebral palsy in Africa was 42.43% (95% CI: 30.39, 54.58), and it was slightly higher in Asia with 64% (95% CI: 48.32, 79.72). In the random effect model analysis, the pooled mean DMFT of dental caries in children with cerebral palsy was 2.25 (95% CI: 1.86, 2.64). The pooled mean DMFT in Africa was 1.47 (95% CI: 0.86, 2.09), and in Asia it was 3.01 (95% CI: 2.43, 3.60).

CONCLUSION

In this study, we found that children with cerebral palsy experienced an alarming rate of dental caries. In these settings, dental caries affected roughly more than half of the children with cerebral palsy. Hence, oral health promotion initiatives should target children with CP, and this group of children must receive early preventive dental care.

Detection and quantification of pathogens in saliva of adolescents with cerebral palsy: a cross-sectional study

Background

Elevated levels of inflammatory mediators in saliva have been described in individuals with cerebral palsy (CP).

Objective

The aim of this study was to detect and quantify the pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Prevotella intermedia in the saliva of adolescents with CP.

Methods

This is a cross-sectional study with adolescents with CP to detect periodontopathogens from saliva samples. Initially, saliva was collected from the CP (n = 34) and control groups (n = 31), followed by the gingival index (GI) for distribution of the groups of individuals with CP and control with gingivitis (bleeding on probing ≥ 10%) and without gingivitis. Bacterial DNA was extracted from saliva samples for detection of periodontopathogens by quantitative PCR (q-PCR). Data were analyzed by Mann-Whitney and Kruskal-Wallis tests, analysis of variance t-test (ANOVA) with Tukey-Kramer post-hoc tests (p < 0.05).

Results

The quantification of DNA of periodontopathogens in saliva samples showed that adolescents with CP present a variability (22.93-39.56) in the detection of P. gingivalis and that some subjects with CP and gingivitis (n = 4) present high quantification of P. gingivalis (ranging 39.56-37.65), although no significant difference was found between the groups (p > 0.05). A significant contrast was observed for the pathogen P. intermedia when comparing the difference in the control group (p = 0.0396). No major differences were detected in the quantification of periodontopathogens evaluated between the control group and CP.

Conclusion

Adolescents with CP showed variability in the detection of DNA of periodontopathogens, especially a great variation in the detection of P gingivalis in saliva of CP with gingivitis.

Factors associated with dental caries experience of Thai preschool children with cerebral palsy

AIM

To investigate the factors association with dental caries experience in the primary dentition of Thai preschool children with cerebral palsy.

METHODS AND RESULTS

A cross-sectional study was conducted among sixty Thai preschool children with cerebral palsy, aged 3-6 years old. Caries experience was determined by identifying decayednon-cavitated and cavitated lesion, missing, and filled surfaces of deciduous teeth(dmfs). Sociodemographic data, CP motor types, dietary habits, oral health behaviors and dental plaque index were collected. Multiple linear regression analysis was carried out to identify the strength of the association between factors and dental caries experience. The prevalence of dental caries was 91.66%. The average dmfs was 20.30 ± 21.63 surfaces/individual. The multiple linear regression indicated that dmfs was significantly associated with snacking carbohydrate between meals more than two times/day (β ± SE = 0.372 ± 0.125; p = 0.004), spastic type of cerebral palsy (β ± SE = 0.309 ± 0.124; p = 0.015) and one-time daily tooth brushing (β ± SE = 0.306 ± 0.124; p = 0.017).

CONCLUSIONS

Nine out of 10 preschool children with CP experienced dental caries. Spastic type of CP had more risk to develop dental decay. Caries prevention for preschool children with CP should emphasis on controlling the frequency of carbohydrate snack no more than two times/day and reinforcing tooth brushing at least twice daily.

Evaluation of salivary parameters and Streptococcus' Mutans count in children with cerebral palsy in Egypt: a case control study

BACKGROUND

Children with cerebral palsy (CP) are at high risk for dental caries. Alteration of some salivary properties encountered among them compared to healthy children, could play a role in this elevated risk.

OBJECTIVES

The aim of the present study was to assess salivary physicochemical properties; including total antioxidant (TAC), flow rate, viscosity, pH and buffering capacity, as well as Streptococcus mutans level among children with CP, also to correlate these variables to their caries experience.

MATERIALS AND METHODS

This case control study included 80 children with CP, study group (SG) and matched number of healthy children for control group (CG). Interview-based questionnaire, clinical examination, salivary biochemical and microbiological investigations using MALDI-TOF were done.

RESULTS

In SG, the caries experience in primary teeth dmft and S. mutans log value were significantly higher than CG (P = 0.039, P = 0.002) while unstimulated salivary flow rate, buffering capacity and salivary TAC were significantly lower (P < 0.0001). Multivariate linear regression showed that the presence of CP was significantly associated with the greatest variation in caries experience in the primary teeth and permanent teeth. Higher unstimulated salivary flow rate, or an increase in buffering capacity by 1 ml of acid/ml of saliva were associated with lower number of the affected primary and permanent teeth. On the other hand, One-unit increase in S. mutans log count and higher salivary TAC were associated with higher caries experience.

CONCLUSION

Children with CP have higher caries experience (dmf) due to lower salivary protective factors and higher S. mutans counts.

The prevalence of dental caries and associated factors among students living with disability in the Amhara region, Ethiopia

OBJECTIVES

People living with disability are more vulnerable to dental caries and have a high decayed, missed, and filled permanent teeth (DMFT) index and untreated dental disease than nondisabled individuals. In Ethiopia, there is a dearth of information on the oral health status of the disabled population. Hence, this study aimed to determine the prevalence of dental caries and its predictors among special needs school students in the Amhara region, Ethiopia.

METHODS

An institution-based cross-sectional study was done on special needs school students in the Amhara region from November 2020 to April 2021. The study participants were recruited using a simple random sampling technique using a computer random generator. Data collection was done using the World Health Organization oral health survey tool. Data entry was done using Epi-data 4.6 and analyzed using SPSS 26. A logistic regression model was used to identify the possible predictors of dental caries.

RESULTS

Four hundred and forty-three students with a mean age of 15.8 ± 3.8 were included in the study. The prevalence of dental caries was 41.5% (95% confidence interval [CI]: 36.3, 46.0) in permanent dentition with a mean DMFT score of 1.3 ± 1.6. The prevalence of dental caries in primary dentition was 23.1% (95% CI: 11.9, 32.1) with a mean decayed, missed, and filled primary teeth (dmft) score of 1.9 ± 0.2. Being 7-12 years old (adjusted odds ratios [AOR] = 3.6, 95% CI: 1.6, 8.3), lower grade level (AOR = 2.4, 95% CI:1.3,4.4), poor oral hygiene status (AOR = 2.5, 95% CI: 1.3, 4.8), and lack of parental support during tooth brushing (AOR = 2.2, 95% CI: 1.2, 4.1) were independent predictors of dental caries.

CONCLUSIONS

A significant amount of special needs school students in the study area had dental caries. Age, grade level, oral hygiene status, and lack of parent support during tooth brushing were independent predictors of dental caries.

Detection of periodontal disease activity based on histatin degradation in individuals with cerebral palsy

Objectives

This proof-of-concept study aimed at evaluating the proteolytic profile of histatin 1 and 5 in saliva of adolescents with spastic cerebral palsy (CP) with gingivitis.

Methods

This cross-sectional study included 24 individuals allocated into three groups: G1 (CP with gingivitis; n = 8), G2 (without CP and without gingivitis; n = 8), and G3 (without CP and with gingivitis; n = 8). The gingival index (GI) and simplified oral hygiene index (OHI–S) were evaluated. Whole saliva was collected and used to assess the rate and mode of histatin 1 and 5 at different times. The degradation products were visualized after cationic PAGE and the protein band densities (BDs) were compared with a protein standard. Fragmentation products were collected from the gel, pooled by group and characterized by mass spectrometry. BDs and gingival health parameters were analyzed by One-Way ANOVA or Kruskal Wallis tests, whereas poisson multilevel regression was used to the factors that influenced histatin degradation (α = 5%).

Results

Groups G1 and G3 differed significantly on OHI–S, visible biofilm, oral calculus and GI (p < 0.001). Poisson Regression showed that: 1) CP and gingivitis influenced the degradation of histatin 1 and 5 (p < 0.05); 2) The degradation of histatin 5 was influenced by age and male sex (p < 0.05); and 3) GI influenced significantly the degradation of histatin 1 (p < 0.001). Unique histatin degradation peptides were identified in individuals with gingivitis.

Conslusions

These data demonstrated that both the kinetics and pattern of histatins degradation differ according to the gingival health or disease conditions.

Risk Factors for Dental Caries Experience in Children and Adolescents with Cerebral Palsy-A Scoping Review

Cerebral palsy is a developmental motor disorder which has far-reaching impacts on oral health. This scoping review examined the extent of research undertaken regarding the risk factors affecting dental caries experience in children and adolescents with cerebral palsy. Data were obtained from the electronic databases Web of Science and PubMed, using 10 search strings, for studies published between 1983 and 2018. Eligible studies were required to have investigated caries in children under 18 with cerebral palsy, as well as be written in English. 30 papers published were identified for inclusion in the review. These included 23 cross-sectional, 6 case-control, and 1 longitudinal study. Studies were categorized into six domains of risk factors: socioeconomic status (SE); cerebral palsy subtype (CPS); demographics (D); condition of oral cavity (OC); dental habits (DH); nutrition and diet (ND). This review was conducted and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The most significant risk factors were caregiver-related education levels, oral health literacy, and sugar intake; this underlines the important role of special education and dental awareness in reducing dental caries incidence in CP children. Other factors showed divergent findings, highlighting the need for standardization and culturally specific studies in future literature.

From Mouth to Brain: Distinct Supragingival Plaque Microbiota Composition in Cerebral Palsy Children With Caries

Children with cerebral palsy (CP) present a higher prevalence and severity of caries. Although researchers have studied multiple risk factors for caries in CP, the role of microorganisms in caries remains one of the critical factors worth exploring. In order to explore the differences in the supragingival plaque microbiota (SPM), supragingival plaque samples were collected from 55 CP children and 23 non-CP children for 16S rRNA sequencing. Distinct SPM composition was found between CP children with severe caries (CPCS) and non-CP children with severe caries (NCPCS). Further subanalysis was also done to identify if there were any differences in SPM among CP children with different degrees of caries, namely, caries-free (CPCF), mild to moderate caries (CPCM), and severe caries (CPCS). After selecting the top 15 most abundant species in all groups, we found that CPCS was significantly enriched for Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, Porphyromonas endodontalis, Catonella morbi, Alloprevotella tannerae, Parvimonas micra, Streptobacillus moniliformis, and Porphyromonas canoris compared to NCPCS. By comparing CPCF, CPCM, and CPCS, we found that the core caries-associated microbiota in CP children included Prevotella, Alloprevotella, Actinomyces, Catonella, and Streptobacillus, while Capnocytophaga and Campylobacter were dental health-associated microbiota in CP children. Alpha diversity analysis showed no significant difference between NCPCS and CPCS, but the latter had a much simpler core correlation network than that of NCPCS. Among CP children, CPCM and CPCF displayed lower bacterial diversity and simpler correlation networks than those of CPCS. In summary, the study showed the specific SPM characteristics of CPCS compared to NCPCS and revealed the core SPM in CP children with different severities of caries (CPCF, CPCM, and CPCS) and their correlation network. Hopefully, the study would shed light on better caries prevention and therapies for CP children. Findings from the current study offer exciting insights that warrant larger cohort studies inclusive of saliva and feces samples to investigate the potential pathogenic role of oral microbiota through the oral-gut-brain axis in CP children with caries.

Orthodontic treatment of an adolescent with cerebral palsy - A case report

Cerebral palsy is a common cause of chronic motor neuron impairment. A constant prevalence of 2 to 3/1000 births in industrialized countries has been described. This case report describes the treatment of a 9 year old boy presenting this form of motor neuron impairment and class II malocclusion with an overjet of 14 mm, hyperdivergent growth pattern and various habits. Orthodontic treatment consisted mainly of a two-phase treatment. The first phase was treated with removable appliances and followed by a phase with fixed appliances. Treatment duration with removable appliances was 4 years and 5 months and for the fixed appliance phase, 1 year and 7 months. A class I occlusion could be achieved in this case by removable and fixed orthodontic appliances combined with adjunctive treatment for the hypotonic orofacial musculature.

Dental health status and hygiene in children with cerebral palsy: A matched case-control study

BACKGROUND

Children with cerebral palsy (CP) are at risk for oral pathology and parafunctional habits, and are reliant on caregivers for oral hygiene.

AIM

To evaluate oral hygiene habits and oral examination findings among a group of children with CP and a healthy age- and gender-matched control group.

DESIGN

A comparative, cross-sectional study, consisting of a questionnaire component and a standard dental examination component, each applied to both groups.

RESULTS

Eighty-three children with CP and 84 healthy children were included. Parents of children with CP were more likely to be of low educational level and lack a professional line of occupation (P < .05). Children with CP were less likely to be responsible for oral hygiene maintenance, adhere to toothbrushing, or receive procedural dental care (P < .001). Food packing and drooling were significantly more likely in children with CP. Malocclusion type III was more prevalent among children with CP, as was higher gingival index and gingival enlargement index-horizontal component (P < .001). There were no differences in caries experience between the CP and control groups.

CONCLUSIONS

Children with CP have suboptimal oral hygiene habits, limited access to procedural dental care, higher parafunctional habits, and increased periodontal pathology.

Upper Gastrointestinal Disorders in Adult Patients with Intellectual and Developmental Disabilities

The purpose of this literature review is to address the diagnosis and treatment of upper gastrointestinal (GI) disorders in patients with intellectual and developmental disabilities (IDD). Manifestations of upper GI dysmotility and disorders include dysphagia, pulmonary aspiration, malnutrition, gastroesophageal reflux, and gastritis, all of which can impact a person’s quality of life and lead to chronic, life-threatening conditions. This article will explore the existing diagnostic methods and treatments for gastrointestinal disorders as they relate to patients with IDD.

The Impact of Oral-Gut Inflammation in Cerebral Palsy

Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy.

Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis.

Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292).

Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.

Prevalence of dental caries and associated risk factors in children living with disabilities in Rwanda: a cross-sectional study

Introduction

several studies have been done on children with disabilities, and the results have shown that these particular individuals are more prone to developing various abnormal oral conditions. However, little is known about the oral health conditions among children with disabilities in Rwanda. This study aims to determine the prevalence of dental caries and associated risk factors among children with disabilities.

Methods

a cross-sectional study conducted among 226 randomly selected children living with physical disabilities; learning, intellectual and developmental disabilities; deafness, blindness and hearing impairment disabilities aged between 7 and 20 years old, who live and/or are under the care of NYANZA Home de la Vierge des Pauvres (HVP) GATAGARA. Bivariate and logistic regression analyses were done using SPPS version 20 at 95% confidence interval. The significance level was set at p<0.05.

Results

the prevalence of dental caries found in children with disabilities is 42.4%. In bivariate analysis age (p=0.003), frequency of sugary food consumption (p=0.001) and oral hygiene status (p=0.000) are respectively significantly associated with dental caries. In logistic regression model, children who take once or more times per day sugary food like biscuits, cake, chocolates and sweets are almost 6 times higher at risk of developing dental caries [OR: 5.945, CI: 1.187; 29.774, P=0.03) while a good oral hygiene status was protective against dental caries [OR: 0.296, CI: 0.159; 0.550, P=0.000].

Conclusion

dental caries is a reality among children living with disabilities. Appropriate measures should be taken to protect these children and these measures should mainly focus on identified factors.

Oral hygiene and oral status of institutionalized children with motor and intellectual disabilities

The oral hygiene and oral status of children with severe disabilities with both nutritional and respiratory complications who were institutionalized at Karugamonoie (KNI), a facility for children with disabilities, were investigated in this study. Their oral hygiene management was solely dependent on caregivers and nurses at the institution. Thirty children (13 females, 17 males; average age, 7.6 years) who had a tracheotomy and feeding tube (gastrostomy, nasogastric, or jejunostomy feeding tube) were included in the study. As for oral characteristics, poor control of tongue movement, anterior open-bite, abnormal strain of facial muscles, dry mouth, and swallowing dysfunction were found in 63.3%, 63.3%, 13.3%, 20.0%, and 100.0%, of the children, respectively. The mean ± standard deviation Decayed, Missing, Filled Teeth score was 0.13 ± 0.57. The Gingival Index (GI) showed that the children had mild (53.3%) to moderate (46.7%) gingivitis. The Simplified Oral Hygiene Index was excellent in 50.0% of the children, good in 23.3%, fair in 20.0%, and poor in 6.7% of the children. These indices were satisfactory in general except for GI management, which may have been hampered by abnormal oral functions and anterior open-bite. In conclusion, oral hygiene management of children with nutritional and respiratory complications at KNI was shown to be of high quality even without on-site intervention by dental specialists.

Constipation, antiepileptic drugs, and gingivitis in children and adolescents with cerebral palsy

BACKGROUND

Cerebral palsy (CP) individuals present with epilepsy, which requires the use of antiepileptic drug (AED).

HYPOTHESIS

Since an inflammatory response may contribute to epileptogenesis, the hypothesis tested was that constipation would be associated with gingivitis and the use of AED in children and adolescents (CA) with CP.

DESIGN

A comparative study was conducted with 101 CA aged 5-17 years (10.8 ± 4.9), classified as constipated (G1; n = 57) or not constipated (G2; n = 44). Clinical patterns, AED used, body mass index (BMI), fluid intake, toilet transfer, and gingival condition were evaluated. Student's t test, chi-squared test, and logistic regression analysis were performed (α = 0.05).

RESULTS

There were no differences between groups regarding gender (P = 0.531), age (P = 0.227), BMI (P = 0.437), and fluid intake (P = 0.346). G1, however, presented a higher percentage of quadriplegic individuals (P < 0.001), dependency for toilet transfer (P < 0.001), the presence of gingivitis (P = 0.020), and the use of AED polytherapy (P < 0.001) compared to G2. Constipation was associated with quadriplegic CA, using GABA as AED (P = 0.002).

CONCLUSIONS

Mucosal inflammation evidenced by constipation and gingivitis is associated with the most neurologically compromised CAs under the use of GABA AED.

Dental caries and related risk factors in Saudi cerebral palsy children

Objective:

To determine caries experience and related risk factors in cerebral palsy (CP) children.

Methods:

Random sample of CP children was examined for dental caries and oral hygiene. Questionnaire was utilized for information about caries risk factors. This cross-sectional study was conducted in Riyadh from December 2014 to May 2015.

Results:

Fifty-two CP children were examined with mean age of 6.3±2.7 years. Only one (1.9%) child out of the 52 had no clinical caries. Combined (dmft plus DMFT) mean caries score among study sample was 9.98±3.99. Older children had significantly higher mean caries scores (11.5±3.34) than younger children (8.86±4.1, p=0.017). The CP children with good oral hygiene had lowest mean caries score (5.8±7.32) as compared to those with fair (9.72±3.3) and poor (11.55±3.05) oral hygiene (p=0.012). Those children whose first dental visit was for routine check-up had significantly (p=0.02) lower mean caries scores (7.33±4.65) than those who made their first visit due to dental problem (11.57±4.15). Similarly, those who had topical fluoride applications by dentist had significantly (p=0.003) lower mean caries scores (8.67±4.14) than those with no topical fluoride application (11.9±2.89).

Conclusion:

The studied CP children had very high caries experience and poor oral hygiene. There was strong association between the high caries experience and poor oral hygiene.

A comparative study on oral health status in Greek preschool children with neurodevelopmental disorders with movement limitations

AIM

To assess the oral health status of preschool children with neurodevelopmental disorders (NDD) in Greece and compare it to that, of healthy children of the same age.

METHODS AND RESULTS

The sample consisted of 146 preschool children with NDD and movement limitations attending the rehabilitation centers of ELEPAP and 165 healthy children matched for age and maternal origin. Caries prevalence, dmft index, precavitated carious lesions (WSL) prevalence Visual Plaque Index (VPI), Restorative Index (RI), Mutans Streptococci (MS) levels, saliva buffer capacity, gingival hyperplasia, tooth wear and developmental dental defects were assessed. Data were analyzed using parametric and nonparametric tests (P ≤.05). The NDD group, compared to the healthy controls, had significantly lower caries prevalence (P <.001), dmft index (P <.001), VPI (P <.001) and MS levels (P = .027), significantly higher WSL prevalence (P <.001), and visited the dentist at an older age (P <.001). Significant determinants of WSL in the NDD group was the VPI (P = .009) and the presence of MS (P <.028).

CONCLUSION

Preschool children with NDD had lower prevalence of manifested caries but higher prevalence of WSL. However, most oral health parameters need improvement for both groups indicating the need for proper early interventions especially in the NDD group.

A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a permanent neurological disorder accompanied by secondary musculoskeletal masticatory disorder, with repercussion on chewing and deglutition functions. In these conditions, the liquids ingestion is compromised resulting in salivary osmolality alteration. The objective of this study was to compare salivary osmolality, caries experience and caries risk between normoreactive individuals and patients with CP.

MATERIAL AND METHODS

The participants were 4-20 years old: 52 patients with CP treated at a reference rehabilitation centre (study group, SG), and 52 normoreactive individuals (control group, CG). Saliva was collected for five minutes using cotton rolls. Following centrifugation, salivary osmolality was determined by freezing point depression osmometry. Evaluations included caries experience (DMFT index), and caries risk based on a caries-risk assessment tool (CAT). Descriptive and inferential statistics (Chi square and Student t tests) were used to compare the groups. Receiver operating characteristic (ROC) analyses were performed and the area under the ROC curve (Az) was calculated. The level of significance was set at 5%.

RESULTS

The groups were homogeneous for sex (p=0.843) and age (p=0.128). In the SG, spastic type CP was the most prevalent (80.8%), and patients showed significantly higher salivary osmolality values compared with the CG (p<0.001). No significant differences in caries experience (p=0.159) or caries risk (p=0.297) were observed. ROC curve analysis determined a salivary osmolality cutoff point of >74 for the SG and >54 for the CG in the presence of dental caries. A significant correlation was verified between salivary osmolality and the DMFT index for the SG (p≤0.05).

CONCLUSIONS

Although patients with CP showed higher salivary osmolality values, higher caries experience and caries risk were not observed compared with normoreactive individuals.

Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial

Introduction

Individuals with cerebral palsy (CP) often present with oral alterations that impact oral health and require dental treatment.

Aim

This study aimed to evaluate the use of conscious sedation with nitrous oxide (N₂O) to control stress during dental treatment in individuals with CP using as parameters: Venham score (VS), heart rate (HR), and respiratory rate (RR).

Materials and methods

A total of 77 CP patients >3 years of age with a mean age of 11.8 (± 6.4) years were evaluated in a rehabilitation center. Stress control was measured at the following time points: T1 (presedation), T2 (induction), T3 (sedated patient), and T4 (end). Student's t-test, the Chi-squared test, analysis of variance (ANOVA), and the McNemar test were used. The significance level was 5%.

Results

Sedation ranged between 10 and 60% N₂O, with an average of 35.6% (± 10.4). The RR did not vary among the times (p = 0.12). The HR and VS varied significantly between times (p < 0.001), as significantly higher values of HR were observed at T1.

Conclusion

Conscious sedation with N₂O during dental care controls stress in CP patients, as verified by a decrease in HR, and does not promote respiratory depression. Higher concentrations of N₂O are recommended for CP patients with tachycardia.

Clinical significance

Sedation modifies behavior during dental procedures, facilitating patient collaboration.How to cite this article: Baeder FM, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2017;10(4):384-390.

Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control

AIM

To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1β, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study.

DESIGN

Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation.

RESULTS

The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79.

CONCLUSIONS

Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.

Risk factors for dental caries among children with cerebral palsy in a low-resource setting

AIM

To describe the oral health status and investigate factors affecting dental caries experience among children with cerebral palsy (CP) in rural Bangladesh.

METHOD

A cross-sectional study was conducted among children with CP who are part of the Bangladesh Cerebral Palsy Register (BCPR) study. Caries experience was measured by identifying decayed, missing, and filled teeth for deciduous and permanent teeth (dmft/DMFT). Clinical periodontal index, body mass index, oral hygiene behaviour, masticatory ability, and dietary habits were recorded. CP motor types and severity of functional mobility (Gross Motor Function Classification System [GMFCS]) were assessed.

RESULTS

Of 90 children with CP (mean age 9y 7mo, range 2-17y, 37.8% female and 62.2% male), 35% of 2 to 6 year olds, and 70% of 7 to 11 year olds (p=0.014) experienced caries (dmft+DMFT>0). The mean values (standard deviation [SD]) of dmft and DMFT were 2.46 (3.75) and 0.72 (1.79) respectively. After adjusting for age and sex, binary logistic regression analysis showed a significant relationship with dental caries for children who had quadriplegia (odds ratio [OR] 5.56, p=0.035), tooth cleaning less than one time/day (OR 0.08, p=0.016), using toothpowder or charcoal for cleaning (OR 7.63, p=0.015), and snacking between meals more than one time/day (OR 6.93, p=0.012).

INTERPRETATION

Early oral health preventive care is required for children with CP because dental caries is highly prevalent in these children.

The Greek version of the Gagging Assessment Scale in children and adolescents: psychometric properties, prevalence of gagging, and the association between gagging and dental fear

BACKGROUND

No studies assessing the association between gagging and dental fear are available in pediatric samples.

AIM

To assess the psychometric properties of the Greek version of the Gagging Assessment Scale (GAS), to explore the prevalence of gagging, and to evaluate the relationship between gagging and dental fear in a pediatric sample.

DESIGN

A total of 849 8- and 14-year-old children filled out a questionnaire consisting of demographic items, the Greek version of the GAS, and the Greek Children's Fear Survey Schedule Dental Subscale (CFSS-DS); the older children also completed the Greek version of the Modified Dental Anxiety Scale (MDAS). The short form of dentist part of the Gagging Problem Assessment (GPA-de-c/SF) was used to objectively assess gagging.

RESULTS

A total of 51 children (6.0%) demonstrated gagging on the GPA-de-c/SF. Children rated as gaggers on the GPA-de-c/SF had significantly higher GAS scores. There were no relationships between GPA-de-c/SF and the CFSS-DS or MDAS. The GAS ratings were significantly correlated with the CFSS-DS (rho = 0.420, P < 0.001) and MDAS (rho = 0.429, P < 0.001). The internal consistency was good (Cronbach's alpha = 0.697).

CONCLUSIONS

The GAS demonstrated good psychometric properties. Dental fear was correlated with the self-report gagging assessment, but not with the objective gagging assessment.

Gingivitis and salivary osmolality in children with cerebral palsy

AIM

To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP).

DESIGN

A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed.

RESULTS

Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P < 0.001). The cutoff value of 84.5 for salivary osmolality presented good sensitivity and specificity, both higher than 77%. The proportion of children presenting salivary osmolality ≤84.5 mOsm/kgH₂ O and gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH₂ O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%.

CONCLUSION

Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality.

Use of different oral hygiene strategies in children with cerebral palsy: A comparative study

Background:

Cerebral palsy (CP) is described as a group of conditions usually occurring in childhood, where children have motor dysfunction and are unable to adequately master the necessary techniques of plaque control, which ultimately leads to dental caries and periodontal problems.

Aims:

The objective of this study was to educate the parents/caretakers/institution staff and children with CP about the different preventive home care measures and to evaluate the oral hygiene and gingival health status of these children before and after the institution of different preventive home care measures.

Materials and Methods:

A total of 64 individuals with CP, aged between 6 and 18 years, were examined for their oral hygiene and gingival health status, after which the parents/caretakers received a health education program. The children were then randomly divided into four groups. Each group was administered a specific preventive home care measure (mechanical and chemotherapeutic) to be followed for a period of 6 weeks, and the oral hygiene and the gingival health status were recorded at the end of 1 week, 2 weeks, and 6 weeks. The data were then subjected to statistical analysis.

Results:

In the sample of 64 children diagnosed with CP, the mean OHI(S) score among the groups of children who were given different preventive home care measures was compared at baseline, 1 week, 2 weeks, and 6 weeks. Group 4 showed a marked reduction in the OHI(S) score measured from baseline to 6 weeks, when compared to the other three groups which wa statistically very highly significant (P < 0.001) The mean MGI score was compared at baseline, 1 week, 2 weeks, and 6 weeks home, Group 4 showed a marked reduction in the MGI score measured from baseline to 6 weeks, when compared to the other three groups. When the mean MGI score was compared from baseline to 6 weeks, there was a gradual decrease in the MGI score, which was statistically highly significant between baseline and 1 week (P < 0.05) and statistically very highly significant between 1 and 2 weeks (P < 0.001). However, this improvement was not statistically significant between 2 and 6 weeks (P > 0.05).

Conclusion:

A combined mechanical and chemotherapeutic measure is highly recommended to maintain the oral hygiene and gingival health of these special children because of their difficulties and their limited abilities to control dental plaque.

Caracterização dos pacientes e procedimentos executados no serviço de atendimento a pacientes com necessidades especiais da Faculdade de Odontologia de Araraquara – UNESP

ResumoObjetivoCaracterizar os pacientes atendidos e os procedimentos realizados no Serviço de Atendimento a Pacientes com Necessidades Especiais da Faculdade de Odontologia de Araraquara (FOAr) – UNESP.MetodologiaA partir dos prontuários odontológicos dos pacientes atendidos em nível ambulatorial entre 2007 e 2013, foram obtidas informações em relação a idade no início do tratamento, tipo de deficiência, medicamentos usados, número de sessões de atendimento e número e tipo de procedimentos odontológicos realizados.ResultadoDos 232 prontuários analisados, observou-se que mais da metade dos pacientes (56,0%) apresentava deficiência mental, paralisia cerebral ou anomalias congênitas determinadas por agentes infecciosos, com deficiência mental associada. Entre as anomalias congênitas, a mais prevalente foi a Síndrome de Down (9,9%). Apenas 20% dos pacientes iniciaram o tratamento antes dos dez anos de idade e 62,0% faziam uso de anticonvulsivantes, antipsicóticos, ansiolíticos, antiepilépticos e antidepressivos. Foram realizados 4.506 procedimentos odontológicos, sendo 37,6% preventivos e 62,4% curativos (Restauradores, 28,0%; Periodontais, 13,9%; Endodônticos, 9,7%; Cirúrgicos, 9,1%; Protéticos, 1,7%). Observou-se também que, para a maior parte dos pacientes (63%), foram necessárias até dez sessões para a realização do tratamento.ConclusãoOs pacientes que procuraram tratamento odontológico no Serviço de Atendimento a Pacientes com Necessidades Especiais da FOAr apresentavam, na sua maioria, deficiências com envolvimento neurológico. Apesar de esse serviço priorizar os procedimentos preventivos, a maior parte dos procedimentos executados foi curativa, o que está diretamente relacionado com a procura tardia pelo tratamento odontológico.

Comparison of oral health status between children with cerebral palsy and normal children in India: A case-control study

Background:

The aim of the present research was to describe and compare the oral health of children with cerebral palsy (CP) with the normal children in India.

Materials and Methods:

Fifty children with CP of the age range 7-17 years and fifty normal children were selected for the study. An oral examination was carried out and decayed, missing, and filled teeth (dmft/DMFT) index, oral hygiene index-simplified (OHI-S) index, Angles malocclusion were charted along with other significant dental findings. Data were analyzed using Student's t-test and Kruskal–Wallis one-way ANOVA test.

Results:

The mean dmft/DMFT of the CP group was 4.11 ± 2.62, while that of controls was 2.95 ± 2.75, which showed higher caries prevalence in the CP group. There was a significant association between the dmft/DMFT (P = 0.03), OHI-S (P = 0.001), and Angles Class 2 malocclusion and CP.

Conclusions:

Cerebral palsy group had higher caries, poor oral hygiene and Class 2 malocclusion when compared to controls primarily because of their compromised general health condition and also less dental awareness. Effort should be made for better organization of preventive dental care and promoting dental health of this challenged population.

Avaliação da microdureza do esmalte de dentes decíduos de crianças com paralisia cerebral

INTRODUÇÃO: Em indivíduos com paralisia cerebral, ocorre redução do fluxo salivar, o que pode predispor à hipomineralização do esmalte e à cárie dentária. OBJETIVO: Comparar a microdureza do esmalte de dentes decíduos anteriores e posteriores de crianças com paralisia cerebral (PC) e crianças normorreativas (NR). MATERIAL E MÉTODO: Foram utilizados 58 dentes decíduos esfoliados/extraídos, que foram distribuídos em quatro grupos: (A) anteriores de PC (n=14); (B) anteriores de NR (n=16); (C) posteriores de PC (n=14), e (D) posteriores de NR (n=14). Os dentes foram seccionados, incluídos em resina acrílica, lixados e polidos. A análise da microdureza longitudinal foi realizada em microdurômetro com endentador do tipo Knoop, com carga estática de 25 g/f e tempo de 5 segundos. Foram realizadas três fileiras de 12 endentações, distanciadas entre si em 100 mm, com profundidade entre 10 e 180 mm. Foram obtidas as médias de cada profundidade para cada dente e, posteriormente, as médias de cada profundidade para cada grupo avaliado. O teste estatístico empregado foi o de Mann-Whitney (α=5%). RESULTADO: As médias de microdureza foram 253,5 ± 55,3 (A), 247,6 ± 45,7 (B), 284,4 ± 68,7 (C) e 252,2 ± 53,8 (D). Não houve diferença estatisticamente significante entre os grupos A e B e os grupos C e D, para cada profundidade e para a média global (p>0,05). CONCLUSÃO: Pôde-se concluir que a microdureza de esmalte de dentes decíduos anteriores e posteriores de crianças com PC foi semelhante à microdureza de esmalte de dentes decíduos de crianças normorreativas.

Cerebral palsy: a dental update

Special and medically compromised patients present a unique population that challenges the dentist’s skill and knowledge. Providing oral care to people with cerebral palsy (CP) requires adaptation of the skills we use everyday. In fact, most people with mild or moderate forms of CP can be treated successfully in the general practice setting. This article is to review various dental considerations and management of a CP patient.

How to cite this article: Sehrawat N, Marwaha M, Bansal K, Chopra R. Cerebral Palsy: A Dental Update. Int J Clin Pediatr Dent 2014;7(2):109-118.

Impact of oral health behaviors on dental caries in children with intellectual disabilities in Guangzhou, China

Dental care is consistently reported as one of the primary medical needs of children with disabilities (IDC). The aim of the present study was to explore the influence of oral health behaviors on the caries experience in children with intellectual disabilities in Guangzhou, China. A cross-sectional study was carried out in 477 intellectually disabled children, 12 to 17 years old, who were randomly selected from special educational schools in Guangzhou. A self-administered parental questionnaire was used to collect data on socio-demographic characteristics and oral health behavior variables, and 450 valid questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dental caries. The average age of those in the sample was 14.6 years (SD = 1.3), 68.4% of whom were male, and the caries prevalence rate was 53.5% (DMFT = 1.5 ± 2.0). The factors significantly affecting the development of dental caries in IDC included gender, the presence or absence of cerebral palsy, and the frequency of dental visits and toothbrushing. In conclusion, the presence of cerebral palsy contributed to an increase risk of caries experience in intellectually disabled children, while toothbrushing more than twice a day and routine dental visits were caries-protective factors. Oral health promotion action may lead to a reduction in dental caries levels in IDC.

Association between anticonvulsant drugs and teeth-grinding in children and adolescents with cerebral palsy

The relation between teeth-grinding and the use of drugs acting on the central nervous system of cerebral palsy (CP) patients has not yet been described. The aim of this research was to evaluate the presence or absence of teeth-grinding (sleep and/or awake periods) in normal and in CP children and adolescents, as well as the association of teeth-grinding and use of anticonvulsant drugs. The sample consisted of 207 children and adolescents, divided into three groups: G1, individuals with CP who did not take anticonvulsant drugs; G2, individuals with CP administered medications on a regular basis; and CG, normal individuals. Logistic regression analyses were performed to evaluate the association of teeth-grinding with some variables. No significant statistical differences were observed regarding the presence or absence of teeth-grinding when G1 and G2 were compared. However, compared with the CG, a statistically significant difference was determined, with the CG showing fewer children presenting teeth-grinding (P < 0·001). Among those children/adolescents prescribed drug therapy, the barbiturate group showed a greater frequency of teeth-grinding. CP children and adolescents show a greater and significant presence of grinding of the teeth compared with normal individuals. Subjects taking barbiturate drugs showed greater presence of teeth-grinding, than those who were taking medications from the other groups of anticonvulsant drugs.

Children with central and peripheral neurologic disorders have distinguishable patterns of dysphagia on videofluoroscopic swallow study

To determine whether findings on videofluoroscopic swallow studies reveal different patterns of dysphagia between children with central and peripheral neurologic disorders, a retrospective study of 118 videofluoroscopic swallow studies was completed. There were 3 groups: cerebral palsy with only spastic features (n = 53), cerebral palsy with dyskinetic features (n = 34), and neuromuscular disorders (myotonic dystrophy I, n = 5; spinal muscular atrophy I-II, n = 8; Duchenne muscular dystrophy, n = 8; other neuromuscular disorder, n = 10). Interpretation of the videofluoroscopic swallow studies was not blinded. The video fluoroscopic swallow study findings were compared dichotomously between the groups. Children with cerebral palsy demonstrated dysphagia in 1 or all phases of swallowing. In neuromuscular disorder, muscle weakness results in pharyngeal residue after swallow. The underlying swallowing problem in neuromuscular disorder is muscle weakness whereas that in cerebral palsy is more complex, having to do with abnormal control of swallowing. This study serves as a first exploration on specific characteristics of swallowing in different neurologic conditions and will help clinicians anticipate what they might expect.

Assessing salivary osmolality as a caries risk indicator in cerebral palsy children

BACKGROUND

Salivary osmolality reflects the hydration status of individuals with cerebral palsy (CP) necessary for an adequate unstimulated salivary flow rate.

AIM

To investigate whether salivary osmolality could serve as a potential indicator of caries risk in children with spastic CP by displaying a stronger association with caries occurrence than salivary flow rate.

DESIGN

The convenience sample consisted of 65 children with CP aged 6-13 years old. Unstimulated whole saliva was collected using cotton roll, and salivary osmolality was measured using a freezing point depression osmometer. The children's oral motor performance was evaluated during the feeding process using the Oral Motor Assessment Scale. Caries occurrence was also evaluated according the World Health Organization criteria.

RESULTS

Motor skills were significantly associated with caries experience. Regarding the salivary parameters, osmolality presented a stronger association with caries experience than did the salivary flow rate. Children with worse oral motor performance presented a higher rate of caries occurrence.

CONCLUSION

Osmolality exhibited a stronger association with caries occurrence than did salivary flow rate. This parameter, therefore, could be a potential caries risk indicator for spastic cerebral palsy children.

Experiência de cárie e osmolaridade salivar em crianças com paralisia cerebral

INTRODUÇÃO: Estudos têm demonstrado que quanto maior a severidade do dano neurológico em crianças com paralisia cerebral (PC), maior é o risco de doenças orais. OBJETIVO: Correlacionar a experiência de cárie com a osmolaridade salivar em crianças com PC. MATERIAL E MÉTODO: Participaram do estudo 99 crianças (9,2±2,3 anos) com PC, em tratamento reabilitacional. A saliva de repouso foi coletada no período matutino, utilizando rolos absorventes (Salivette®) por cinco minutos. A osmolaridade salivar foi medida por depressão do ponto de congelamento em osmômetro. As avaliações incluíram a experiência de cárie pelo índice de dentes cariados, perdidos e obturados (CPOD), e o motor oral durante o processo de alimentação da criança. Foram utilizados os testes Qui-quadrado, t de Student, Correlação de Spearman e razão de chances (OR), com nível de significância de 5%. RESULTADO: O grupo 1 (G1) foi composto por 41 crianças livres de cárie e o grupo 2 (G2), por 58 crianças com cárie (CPOD=3,5±2,7). Os grupos foram homogêneos para gênero (p=0,884) e idade (p=0,174). Entretanto, diferiram significantemente com relação à motricidade oral, apresentando G2 maiores porcentagens de crianças com motor oral subfuncional (p<0,001) e tetraparéticos (p=0,001). O G2 apresentou valores significantemente maiores (p<0,001) para osmolaridade (99,6±36,7mOsml) quando comparado ao G1 (76,7±15,9mOsml). Observou-se uma correlação significante entre osmolaridade e experiência de cárie (p<0,001). Apresentar osmolaridade superior a 76,7 (OR=5,18; 1,85 a 14,83) foi determinante individual de maior probabilidade de apresentar risco de cárie (CPOD>0). CONCLUSÃO: Maiores valores de osmolaridade salivar aumentam o risco de cárie em crianças com PC.

Association between executive/attentional functions and caries in children with cerebral palsy

The aim of the present study was to evaluate the existence of an association between attention/executive functions and the development of dental caries in individuals with cerebral palsy (CP). Seventy-six children with CP were selected from a physical rehabilitation center and a school serving children with disabilities. The control group was made up of 89 children without neurological impairment. Socioeconomic status, presence of teeth with cavities due to caries, degree of motor impairment and intellectual, executive and attentional functions were assessed. Mean age of participants was 8.9 years (SD=3.56). The CP group had a significantly lower performance (p<0.05, Mann-Whitney test) on the intelligence, attentional function and executive function tests in comparison to the control group. Controlling for the clinical diagnosis (CP or control group), motor impairment and intellectual function, the significant explanatory variables for the presence of teeth with cavities were performance on the Complex Rey figure test (OR=0.941) and the Digit Span subtest of the Wechsler Intelligence Scale for Children in backward order (OR=0.581). After controlling for intellectual function, clinical diagnosis and motor impairment, deficits in executive and attentional functions increased the odds of developing dental caries in children with cerebral palsy.

Infantile hemiplegia in pediatric dental set-up

Infantile hemiplegia refers to brain injuries that occur before or at birth and lead to hemiplegia/ total paralysis of one side of the body, including the face, arm and leg. The main purpose of this article is to provide valuable information to pediatric dentists about the review and treatment alternatives for patients with infantile hemiplegia. This article reports the case of a 12-year-old girl with a hemiplegia of left side of the body suffering with tooth ache and gum inflammation. The treatment performed was rehabilitation with oral prophylaxis and extractions of root stumps followed by thorough preventive regimen with periodic check-ups.

Does intellectual disability affect the development of dental caries in patients with cerebral palsy?

The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of these, 76 individuals had been diagnosed with spastic cerebral palsy and 89 had no neurological impairment. The subjects were matched based on age and gender and selected randomly by lottery. All patients were examined to determine the number of dental cavities, and tested for their intellectual functioning (Raven Test) and motor abilities. The study showed that children with CP who presented with intellectual disabilities had a larger number of dental cavities than children with CP without intellectual disabilities. Considering intellectual functioning and motor impairment in the multivariate logistic regression, only intellectual functioning was found to have a significant effect on the development of dental cavities. These results suggest that intellectual disability can be considered a contributing factor for the development of dental caries in patients with cerebral palsy.

Parental reports of the oral health-related quality of life of children with cerebral palsy

BACKGROUND

The severity of physical and mental impairments and oral problems, as well as socioeconomic factors, may have an impact on quality of life of children with cerebral palsy (CP). The aim of this research was to assess the impact of impairments and oral health conditions, adjusted by socioeconomic factors, on the Oral Health-Related Quality of Life (OHRQoL) of children with CP using their parents as proxies.

METHODS

Sixty children, between 6-14 years of age were selected. Their parents answered a children's OHRQoL instrument (5 domains) which combines the Parental-Caregivers Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS). The severity of dental caries, type of CP, communication ability, gross motor function, seizures and socioeconomic conditions were assessed.

RESULTS

Considering the total score of the OHRQoL instrument, only the reduction of communication ability and dental caries severity had a negative impact on the OHRQoL (p < 0.05). Considering each domain of the instrument, the severity of the type of CP and its reduction of communication ability showed a negative impact on oral symptoms and functional limitations domains (p < 0.05). Seizures have a negative impact on oral symptoms domain (p = 0.006). The multivariate fitted model showed that the severity of dental caries, communication ability and low family income were negatively associated with the impact on OHRQoL (p = 0.001).

CONCLUSIONS

The severity of dental caries, communication ability, and family income are conditions strongly associated with a negative impact on OHRQoL of children with CP.

Condições de saúde bucal e acesso ao tratamento odontológico de pacientes com paralisia cerebral atendidos em um centro de referência do Nordeste - Brasil

OBJETIVO: avaliar a ocorrência de cárie dentária e necessidades de tratamento em crianças com paralisia cerebral atendidas no setor de Odontologia de um centro de referência do Nordeste do Brasil (Associação À Criança Deficiente; Recife-Brasil); e conhecer suas principais dificuldades no acesso ao tratamento odontológico. MÉTODO: a amostra foi composta por livre demanda de 167 pacientes de seis a 12 anos. A experiência de cárie foi avaliada de acordo com os critérios da Organização Mundial de Saúde. RESULTADOS: a grande maioria das crianças (70,7%) apresentava paralisia cerebral do tipo espástica. Dos que tiveram dificuldades no acesso ao tratamento (46,1%), a maioria relatou a falta de profissional capacitado (34,1%). A prevalência de cárie foi de 61,1% na dentição decídua e 26,3% na permanente. Aproximadamente 60% dos pesquisados necessitavam de algum tipo de tratamento da cárie. Observou-se que, em comparação com estudos realizados em outras regiões do Brasil, as crianças pesquisadas apresentaram experiência de cárie mais elevada. CONCLUSÃO: verificou-se a necessidade de melhorar a assistência odontológica a esses pacientes, principalmente no interior do estado, de forma quantitativa, qualitativa e integrada com ações multidisciplinares.