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

Alterações sialoquímicas e sialométricas de pacientes com paralisia cerebral: uma revisão de literatura

TEMA: paralisia cerebral e alterações salivares. O paciente com paralisia cerebral é acometido por diversas desordens no Sistema Estomatognático, sendo muitas delas expressas sob a forma de alterações no fluxo e composição salivar. A variação da concentração de constituintes da saliva está diretamente relacionada com sua capacidade tampão, antioxidante, imunológica, digestiva e lubrificante, além de sofrer variações em função da velocidade do fluxo salivar, o qual está intimamente relacionado à eficiência dos estímulos mecânicos e neurais do trato salivar. Alterações na deglutição, da percepção gustativa, do processo de mineralização dos dentes e da propriedade protetora da saliva contra lesões cariosas, infecções e inflamações, freqüentemente observadas em pacientes com paralisia cerebral, podem ser avaliadas pelo exame da saliva. OBJETIVO: realizar uma revisão de literatura relacionando as principais alterações sialométrica e sialoquímica de pacientes com paralisia cerebral e seus efeitos na saúde bucal. CONCLUSÃO: a análise sialométrica e sialoquímica oferece informações extremamente úteis no diagnóstico e no direcionamento do tratamento desses pacientes, e pode ser considerada uma indicadora prática e objetiva dos processos de doença e disfunções.

Clinical and microbiological evaluation of the use of toothpaste containing 1% chlorhexidine and the influence of motivation on oral hygiene in patients with motor deficiency

Patients with motor deficiency have variable difficulties with mechanical plaque control, and as a consequence, the incidence of dental caries and periodontal disease can be higher in these patients. The objective of this study was to evaluate the clinical and microbiological efficacy of a toothpaste containing 1% chlorhexidine, which was used by patients with motor deficiency for 14 days. The reduction in plaque and gingival index and the impact on salivary microorganisms was evaluated. We conclude that the motivation of caregivers to carry out oral hygiene for patients with mental and motor deficiency is of great importance and is effective in reducing the formation of plaque as long as it is continuously reinforced. The use of chlorhexidine-containing toothpaste significantly reduced the plaque index and microorganism count between days 0 and 14. A reduction was also observed in the group that used a dentifrice without the chlorhexidine, but this difference was not significant.

Caries prevalence in patients with cerebral palsy and the burden of caring for them

The aim of this study was to investigate the correlation between caries prevalence in individuals with cerebral palsy (CPG) and the burden on their caregivers (CGCP) compared to nondisabled individuals (CG) and their caregivers (CGCG). In a cross-sectional assessment, 65 subjects with cerebral palsy were evaluated for their caries prevalence. The CGCP answered the Caregiver Burden Scale (CBS) questionnaire. Using the same methodology, 58 CG were evaluated and CGCG replied to the questionnaire. The CGCP had statistically significant higher scores on general strain, isolation, disappointment, environment, and total scores using the CBS questionnaire. The CPG had significantly higher values using the Decayed, Missed and Filled (DMF) index than the CG. Values for the CBS domains in general strain and disappointment and DMF index were found to have a statistically significant correlation. Taking care of an individual with CP is a potential source of continual burden for caregivers, and there is a positive correlation between caries prevalence in individuals with CP and the burden on their caregivers.

Effect of spastic cerebral palsy on jaw-closing muscles during clenching

The motor effort of jaw-closing muscles during maximal voluntary clenching (MVC) was compared between individuals with spastic cerebral palsy (CP) and nondisabled control subjects (CG). Bilateral electromyographic (EMG) activity of the anterior temporalis (AT) and masseter (MS) muscles was obtained during MVC in 22 subjects with CP and 29 nondisabled subjects. The oral functional status of the group with CP was evaluated using the Orofacial Motor Function Assessment Scale. The group with CP presented lower bilateral EMG activity during MVC compared to the control group for both AT and MS muscles. Comparisons of AT and MS EMG activity showed no difference in muscular effort. Subgroups with CP who were only slightly and very slightly orally impaired had a higher bilateral AT EMG activity compared to individuals with CP who were severely and moderately compromised. A statistically significant positive correlation was found between the oral motor function and EMG activity of the group with CP in all the muscles evaluated. Individuals with CP had motor weakness in the jaw-closing muscles, a condition that may compromise their masticatory function.

Diagnóstico das condições de saúde bucal em portadores de paralisia cerebral do município de Pelotas, Rio Grande do Sul, Brasil

Paralisia cerebral (PC) é uma lesão encefálica estática, definida como uma desordem não progressiva dos movimentos e postura. Está comumente associada com epilepsia e anormalidades da fala, audição, visão e retardo mental. Embora os portadores de paralisia cerebral necessitem de cuidados especiais na prevenção de problemas bucais, no contexto da assistência odontológica, as informações da literatura são contraditórias quanto à incidência de doenças bucais em pacientes com paralisia cerebral. A fim de determinar as condições de saúde bucal e fatores associados, realizou-se um levantamento epidemiológico em 41 crianças portadoras de paralisia cerebral. As variáveis avaliadas foram: aspectos socioeconômicos, fatores de risco para o desenvolvimento de doenças bucais, acesso a serviços odontológicos, índice de cárie, doença periodontal, presença de má oclusão e fluorose dentária. As crianças examinadas apresentaram índices elevados de alteração gengival e experiência de cárie, principalmente na dentição decídua, e má oclusão severa, fatores que indicam a necessidade de intervenção precoce, seja com programas educativos e preventivos como de assistência curativa. O estudo mostrou que, além da necessidade quantitativa de atendimento, também se faz necessário melhorar a qualidade das consultas desses pacientes.

Assessment scale of the oral motor performance of children and adolescents with neurological damages

Among the conditions that classify individuals as special needs patients are those resulting from neurological sequelae, particularly cerebral palsy (CP), which is a disorder of high prevalence. Innumerable alterations can be found in individuals with CP but the inability to control striated muscles, due to damages suffered by the central nervous system, should be emphasized. Changes in tonus, speed and strength of oral muscles, reduction of mandibular mobility amplitude and difficulty to passively seal the lips are characteristics observed in such individuals. Categorization of the individual's mastication pattern is important in order to establish diagnosis and treatment protocols and prognosis. The aim of this study was to develop an Oral Motor Assessment Scale (OMAS) and evaluate its performance in terms of construct validity and reliability in a cohort of 53 children and individuals with CP. Two dentists examined the same patients on two different occasions. Good interexaminer (kappa > 0.85) and intra-examiner (kappa > 0.90) agreement was obtained for the majority of the OMAS items. This study shows that the OMAS is an accurate and valid method of assessment of oral motor skills in children and adolescents with neurological damages.

Dental caries in cerebral palsied individuals and their caregivers' quality of life

OBJECTIVE

To study the correlation between caries experience in individuals with cerebral palsy (CP) and the quality of life of their primary caregivers.

MATERIALS AND METHODS

Sixty-five non-institutionalized individuals, presenting CP, aged 2-21 years old, were evaluated for caries experience. Their respective caregivers aged 20-74 years old answered the Short Form 36 (SF-36) health survey and Independence Measure for Children. Fifty-eight non-disabled individuals (ND group), aged 2-21 years old, and their respective caregivers, aged 25-56 years old, were submitted to the same evaluation process as the CP group.

RESULTS

Primary caregivers of CP individuals exhibited significantly lower scores than the ND group in all subscales of the SF-36 health survey questionnaire: physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role and mental health. The CP group presented significantly higher values for the Decayed, Missed and Filled (DMF-T) index than the ND group and a significant negative correlation was obtained between the SF-36 and DMF-T index.

CONCLUSION

The results suggest that caregivers of CP individuals exhibited worse quality of life than those of the non-disabled. A negative correlation exists between caries experience of CP individuals and their caregivers' quality of life.

A review of cerebral palsy for the oral health professional

Individuals who have cerebral palsy (CP) face many physical challenges throughout their lifetimes in addition to societal barriers that can have an impact on quality of life. The ability to access appropriate dental care has long been an issue for people who have disabilities. Dentists should be integral members of teams of professionals involved in optimizing the health of individuals who have CP. As with all members of this interdisciplinary team, oral health care providers should have a thorough knowledge of the medical, cognitive, and rehabilitative issues associated with CP. With this knowledge the best possible health care can be provided.

Inequalities in oral health for children with disabilities: a French national survey in special schools

BACKGROUND

Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.

METHOD

Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.

RESULTS

DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25-4.86 for COHI; OR = 2.01, 95% CI = 1.77-2.28 for COCNI; OR = 5.25, 95% CI = 4.55-6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7-4.6 for COHI; OR = 1.52, 95% CI = 1.38-1.69 for COCNI; OR = 1.53, 95% CI = 1.39-1.69 for COPI).

CONCLUSION

Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.

Frequency of parafunctional oral habits in patients with cerebral palsy

Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs patients and it seems that parafunctional oral habits are often present in such individuals. The aim of this study was to investigate the frequency of occurrence of parafunctional habits in individuals with CP. Sixty-five patients with CP were evaluated through a questionnaire and clinical observation, regarding the following habits: pacifier-sucking, finger-sucking, biting objects, tongue interposition, and bruxism. The results showed that nine (13.8%) patients presented with pacifier-sucking, four (6.1%) showed finger-sucking, 12 (18.4%) had the habit of biting objects, 27 (41.5%) presented with tongue interposition, and 24 (36.9%) had eccentric bruxism. The significance of the presence of oral parafunctional habits in individuals with CP, revealed in this study, justifies the need to establish protocols for adequate prevention and clinical intervention in order to minimize the deleterious consequences that may result from such habits.