Oral health and oral motor function in children with cerebral palsy

Acceptance of the use of silver fluoride among Brazilian parents of children with special health care needs

Background

Children with special health care needs including Down Syndrome, Autism Spectrum Disorder and Down Syndrome experience difficulties in receiving dental treatment. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) are a minimally invasive treatments options to arrest dental caries without sedation; local or general anaesthesia (GA).

Aim

Evaluation of Brazilian's parents' acceptance of the use of SF in CSHCN.

Methods

After receiving education on SF, 100 Parents of CSHCN completed a questionnaire concerning their acceptance of SF, in different dental situation.

Result

Majority of parents (74,5%) agreed to the use of SF for their children. SF was more acceptable on posterior teeth (74,5%) when compared to its use on anterior teeth (43,1%). Parents accepted to use SF in order: to reduce infection and pain (82,4%); to avoid dental injection (72,5%) and treatment under GA (84,3%). The Majority of parents accepted the properties of SF (82,4%) and Silver (80,4%).

Conclusion

Silver Fluoride was accepted as a treatment option for caries, by Brazilian parents of CSHCN. SF should be considered as a treatment option for caries limited to dentine for CSHCN, taking into consideration the individual needs and opinions with regard to aesthetics and exposure to fluoride and silver.

Oral health of individuals with cerebral palsy in Saudi Arabia: A systematic review

OBJECTIVE

This systematic review aimed to comprehensively summarize and critically assess studies conducted on oral health outcomes among individuals with cerebral palsy (CP) in Saudi Arabia.

METHODS

This study followed the Participants, Exposure, Control and Outcomes (PECO) framework to formulate a focused research question. We conducted an extensive literature search across multiple databases, including PubMed, Medline, Scopus and Embase, in addition to clinical trial registers. Inclusion criteria encompassed clinical studies conducted in either English or Arabic, focusing on CP as defined by the International Classification of Diseases 10 (ICD10), and examining various oral health conditions and parameters. Nonclinical studies, commentaries, other systematic reviews and letters to the editor were excluded. Data extraction included comprehensive information about the study characteristics, oral health outcomes (dental, oral or periodontal disease; changes in standardized indices; dental trauma and other types of oral diseases) and an assessment of the risk of bias using the Appraisal Tool for Cross-Sectional Studies (AXIS).

RESULTS

The initial search yielded a total of 879 articles, ultimately resulting seven studies that met our stringent inclusion criteria. All of these studies were conducted as cross-sectional investigations in different cities within Saudi Arabia. The sample sizes ranged from 46 to 400 participants, all falling within the age range of 2-18 years. Notably, the prevalence of dental caries among individuals with CP in these studies varied significantly, with rates ranging from 52.9% to as high as 98.6%. Additionally, a substantial portion of CP patients exhibited poor oral hygiene, with figures ranging between 34.6% and 66.2%, and dental trauma was reported in 47.5% of the cases. Moreover, these studies underscored the influence of motor function and intellectual disabilities on the oral health status of CP individuals. Furthermore, various secondary outcomes, including periodontal parameters and oral health-related quality of life, were also assessed. However, it is essential to acknowledge that several sources of bias were identified within these studies, raising questions about the generalisability of their findings.

CONCLUSION

In conclusion, the systematic review revealed a concerning pattern of high dental caries prevalence and other oral health issues among individuals with CP in Saudi Arabia. Nevertheless, the need for comparative studies between CP patients and those without CP is evident to establish a definitive understanding of the oral health status of CP individuals. Initiating early interventions such as oral hygiene education, preventive dentistry programs, and orthodontic interventions could potentially contribute to improved oral health outcomes for individuals with CP in Saudi Arabia.

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.

Parental acceptance of silver fluoride as a treatment option for carious lesions among South African children with special health care needs

Providing dental care for children with neurological special health care needs, including Down syndrome, Cerebral palsy and Autism spectrum disorders, is challenging. They often require repeat exposure to sedation or general anaesthesia for routine dental care. 51 parents of children with special needs completed a questionnaire regarding the acceptance of Silver Fluoride as a treatment option.

Background

Silver Diamine Fluoride has become popular as a minimally invasive treatment option for providing oral health care to young or uncooperative children. Silver Fluoride (SF) is a newer development with similar but improved properties. The aim was to determine the acceptance of SDF/SF as treatment option for Children with Special Health Care Needs (CSHCN), including Down Syndrome, Autism Spectrum Disorder and Cerebral Palsy.

Methods

51 Parents of CSHCN completed a questionnaire on the overall acceptance of SF; aesthetic concerns related to the location of application; the use of SDF as an alternative to general anesthesia; and the composition of SF.

Results

The use of SF on posterior teeth were more acceptable (70.59%) as opposed to its application to anterior teeth (50.98%). Parents generally agreed/ strongly agreed to the use of SF to reduce infection and pain (82%); to avoid treatment under GA (26.70%); and to avoid an injection (78%). 64% of parents indicated their agreement in using SF because it has a reduced cost when compared to a conventional restoration. Majority of parents were in agreement to use SF even if it contains Fluoride (84%) and Silver (78%).

Conclusion

The use of SF, as treatment option for caries, was well accepted by South African parents of CSHCN. Shared decision making should be applied when considering SF as treatment option for CSHCN.

Biochemical and Microbiological Aspects of the Oral Cavity of Children and Young People with Neurological Impairment and Oropharyngeal Dysphagia

The components and the salivary flow have a direct influence on the composition of the oral microbiota of children and young people with oropharyngeal dysphagia, and studies have already demonstrated the excessive accumulation of supragingival dental calculus in individuals with enteral nutrition. This study aimed to compare the oral hygiene, biochemical, and microbiological aspects of the oral cavity of children and young people with neurological impairment and oropharyngeal dysphagia. Forty children and young people with neurological impairment and oropharyngeal dysphagia were enrolled and divided into two groups: group I, encompassing 20 participants fed via gastrostomy; and group II, encompassing 20 participants fed via the oral route. Oral hygiene and salivary pH and flow were assessed, and a polymerase chain reaction was performed to evaluate the messenger RNA expressions of Porphyromonas gingivalis, Tanerella forsythia, and Treponema denticola. In groups I and II, the mean Oral Hygiene Index-Simplified scores were 4 and 2, respectively, showing a significant difference; the mean Calculus Index scores were 2 and 0, respectively, showing a significant difference; and the mean pH was 7.5 and 6.0, respectively, showing a significant difference. Bacterial analysis indicated no association between the two groups. It can be concluded that children and young people who use gastrostomy had a poorer oral hygiene, greater dental calculus deposition, and higher salivary pH. The saliva of patients in both groups contained Porphyromonas gingivalis, Tanerella forsythia, and Treponema denticola.

Optical spectral diagnostics of the oxygenation level in periodontal tissues and photodynamic therapy using methylene blue in children with cerebral palsy

Dental diseases occur in children with cerebral palsy three times higher than in healthy children. Low values of the unstimulated salivation rate (<0.3 ml per minute), pH and buffer capacity, changes in enzyme activity and sialic acid concentration, as well as increased saliva osmolarity and total protein concentration, which indicates impaired hydration, are the factors in the development of a gingiva disease in case of cerebral palsy. This leads to increased bacterial agglutination and the formation of acquired pellicle and biofilm, leading to the formation of dental plaque. There is a tendency toward an increase in the concentration of hemoglobin and a decrease in the degree of hemoglobin oxygenation, as well as an increase in the generation of reactive oxygen and nitrogen species. Photodynamic therapy (PDT) with the use of photosensitizer methylene blue improves blood circulation and the degree of oxygenation in periodontal tissues, as well as eliminates a bacterial biofilm. Analysis of back diffuse reflection spectra makes it possible to conduct non-invasive monitoring determine tissue areas with a low level of hemoglobin oxygenation for precision photodynamic exposure.

Aim

To improve the effectiveness of phototheranostics methods using, namely PDT with simultaneous optical-spectral control, for the treatment of gingivitis in children with complex dental and somatic status (cerebral palsy).

Methods

The study involved 15 children (6-18 y.o.) with various forms of cerebral palsy, in particular, spastic diplegia and atonic-astatic form and with gingivitis. The degree of hemoglobin oxygenation was measured in tissues before PDT and on the 12th day. PDT was performed using laser radiation (λ = 660 nm) with a power density of 150 mW/cm² with a five-minute application of 0.01% MB. The total light dose was 45 ± 15 J/cm². For statistical evaluation of the results, a paired Student's t-test was used.

Results

The paper presents the results of phototheranostics using methylene blue in children with cerebral palsy. An increase in the level of hemoglobin oxygenation from 50 to 67% (p < 0.001) and a decrease in blood volume in the microcirculatory bed of periodontal tissues were shown.

Conclusion

Photodynamic therapy methods with application of methylene blue make it possible to assess the state of the gingival mucosa tissue diseases objectively in real time, and to provide effective targeted therapy for gingivitis in children with cerebral palsy. There is a prospect that they can become widely used clinical methods.

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.

Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.

Oral hygiene and oral microbiota in children and young people with neurological impairment and oropharyngeal dysphagia

This study compared the oral hygiene and oral microbiota in children and young people with neurological impairment and oropharyngeal dysphagia with and without gastrostomy. Forty children and young people participated in this study: 19 females and 21 males, aged 2 to 22 years (mean age 8.6 years). Participants were divided into two groups: group I (GI = 20) with gastrostomy and group II (GII = 20) without gastrostomy (with oral feeding). Oral hygiene was assessed using the Simplified Oral Hygiene Index (SOHI). Analysis of two bacteria, Streptococcus mutans and Streptococcus sobrinus, was performed by collecting saliva using an oral swab, then mRNA expression was evaluated using the polymerase chain reaction (PCR) technique. The oral hygiene index had a general median of 2.2, and the two groups were statistically different (Group I: median 2.9 and Group II: median 2.0) (p = 0.01751). Bacterial analysis indicated 13 individuals with S. mutans and none with S. sobrinus. Of the 13 individuals with S. mutans, 6 were from Group I and 7 from Group II. Those with gastrostomy had worse oral hygiene, and both groups harbored the bacterium S. mutans.

Oral health status and parental perception of child oral health-related quality of life among children with cerebral palsy in Bangalore city: A cross-sectional study

AIM

To assess and compare the oral health status and parental perception of child oral health-related quality of life (OHRQoL) among children with and without cerebral palsy (CP).

METHODS AND RESULTS

A cross-sectional comparative study was conducted among 300 children aged 5-15 years with and without CP in Bangalore city. Oral health status was assessed using WHO 2013 criteria, and malocclusion was assessed using Angle's classification of malocclusion. Parental perception of child OHRQoL was assessed using parental caregivers perceptions questionnaire. Chi-square test, Student's t-tests and logistic regression were applied. Majority of the study participants were males with a mean age of 10 years. Caries experience, gingivitis, dental trauma, and dental erosion were significantly higher among children with CP than the comparison group. Mean parental perception of child OHRQoL score among CP was significantly higher than that of comparison group (P < .001). Odds of having caries experience, gingivitis, dental trauma, and Angle's Class II/III malocclusion were significantly higher among CP children with poor OHRQoL compared to those without these conditions.

CONCLUSION

Oral health status among children with CP was poor than the children without CP. Parents perceived poor OHRQoL among children with CP when compared to those without CP. Hence CP has an impact on oral health necessitating preventive care.

Exploring the association of predisposing factors of Cerebral Palsy and developmental defects of enamel: a case-control study

AIM

To evaluate the occurrence of developmental defects of enamel (DDE) in children and adolescents with Cerebral Palsy (CP) and to analyze the effect of common factors in the etiology of CP on the occurrence of DDE.

METHODS

A case-control study was carried out using the modified DDE index to classify enamel defects. The study group (SG) consisted of 45 participants with CP aged between three and 14 years. The control group (CG) consisted of 88 normotypical schoolchildren, paired by gender and age group. Caregivers answered a questionnaire on their socioeconomic status and medical history. The Chi-square tests, bivariate and multivariate analysis were performed (level significance < 0.05).

RESULTS

The occurrence of DDE in SG and CG was 60% and 64.8%, respectively (p value = 0.726). The most frequent defect observed in SG was diffuse opacity (44.4%), followed by demarcated opacity (26.7%) and enamel hypoplasia (2.2%). No difference was observed in the defect's distribution among both groups (p value = 0.083). For SG, the bivariate analysis revealed a statically significant association between the presence of DDE and age group 7-14 years old and maternal schooling below 11 years. After adjusting for confounding variables, age, family income and maternal schooling were not associated with DDE.

CONCLUSION

In conclusion, the occurrence of DDE was high and similar in both groups. The pre, peri or post-natal factors associated with CP were not significant for the presence of DDE.

Prevalence of Malocclusions and Associated Factors inBrazilian Children and Adolescents with CerebralPalsy: A Multi-Institutional Study

Background

To assess the prevalence and factors associated with malocclusions in children and adolescents with cerebral palsy (CP).

Methods

The study included 134 subjects with CP aged 2-18 years enrolled in six rehabilitation institutions and their caregivers, which provided demographic, systemic, and behavioral data. A calibrated researcher held oral examinations with record of the following malocclusion indexes, DAI and DMFT. Poisson regression analysis was used (α < 0.05).

Results

About 85.8% (n = 115) of patients had malocclusion. In deciduous and mixed dentition (n = 99), increased overjet (75.8%), open bite (51.5%), posterior cross bite (19.2%), and anterior cross bite (3.0%) were identified. Increased overjet was associated with the age group of 2-5 years and mild communication impairment. Anterior open bite was more common in children who underwent tongue interposition, lip interposition, and pacifier sucking. Communication skills, mouth breathing, and tongue interposition were associated with posterior cross bite. Severe malocclusions (DAI > 30) were observed in 88.6% of patients with permanent dentition (n = 35) and were associated with liquid diet consistency and finger sucking.

Conclusion

The prevalence of malocclusion in individuals with CP was high and associated with demographic, behavioral, and systemic factors.

Oromotor dysfunction in minimally verbal children with cerebral palsy: characteristics and associated factors

AIM

To explore the characteristics and associated factors of oromotor dysfunction in minimally verbal children with cerebral palsy (CP) aged five to six years, recruited from a population-based registry. Methods: Twenty children with CP who were minimally verbal completed a standardised, observational oromotor assessment. Linear regression analyses examined the relationship between oromotor dysfunction and potential associated factors (e.g., fine and gross motor function, communication, and feeding). Results: Oromotor dysfunction affected every participant and was identified in all structures examined (i.e., face, jaw, lips, and tongue). Oromotor movements showed little dissociation among jaw, lip, and tongue movements. Oromotor dysfunction was univariately associated with the Manual Ability Classification System levels IV-V (p = 0.001), reduced communication skills (p = 0.002), and a prolonged eating duration (>45 min) (p = 0.006), even when non-verbal cognition served as a covariate. Interpretation: Oromotor dysfunction was highly prevalent in our sample of minimally verbal children with CP, having significant functional impacts on feeding and communication. Findings suggest that fine motor function (i.e., Manual Ability Classification System levels IV-V) is a stronger predictor than gross motor function for identifying children with CP who are minimally verbal and at risk of oromotor dysfunction.IMPLICATIONS FOR REHABILITATIONOromotor dysfunction was highly prevalent in our sample of minimally verbal children with cerebral palsy.Severe fine motor impairment strongly predicted oromotor dysfunction, indicating that fine motor function may provide an early indicator of impaired oromotor function for this clinical population.Robust, standardised measures of motor speech-related oromotor development suitable for children with cerebral palsy who are minimally verbal are lacking.Until such a measure is developed, formal evaluation may be achieved via oral motor assessments standardised for typically developing children, with the caveat one must interpret the results with caution.

Physiologic and behavioural signs during a dental appointment in children and teenagers with Cerebral Palsy: a comparative cross-sectional study

AIM

To evaluate the heart rate (HR) and behaviour of children and teenagers with Cerebral Palsy (CP) when having a dental appointment.

METHODS

A comparative cross-sectional study was carried out with 60 participants with CP, between 2 and 14 years old (study group-SG), and 60 normotypical individuals (CG). The sample was paired according to age, gender and socioeconomic status. Behaviour was evaluated during dental prophylaxis using the Frankl Scale, and HR was measured at five moments: before the appointment, when sitting in the dental chair, during the clinical examination, during prophylaxis and immediately after prophylaxis. Mann-Whitney, Friedman and Chi-square tests were applied at a significance level of 5%.

RESULTS

SG presented significantly higher HR (p < 0.001) and more participants with uncooperative behaviour (p < 0.001) than CG in all observational periods. Furthermore, SG participants with uncooperative behaviour presented higher HR values than those in SG who were cooperative in all observational periods (p ≤ 0.002).

CONCLUSIONS

Individuals with CP have a higher HR before and during the clinical session, and are frequently more uncooperative with the procedure than normotypical individuals.

Personalized Dental Caries Management for Frail Older Adults and Persons with Special Needs

Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.

Oral health-related quality of life in caregivers of individuals with Cerebral Palsy: a case-control study

AIM

The object of this study is to evaluate the oral health-related quality of life (OHRQoL) of caregivers of individuals with Cerebral Palsy (CP).

METHODS

Ninety-eight caregivers of individuals with CP (SG) and 196 caregivers of individuals without special needs (CG) completed the reduced version of the Oral Health Impact Profile (OHIP-14). In addition, a questionnaire with demographic and socioeconomic questions was used. Groups were matched according to gender, schooling and family income. Fisher's exact tests, Chi square and Mann-Whitney, and bi/multivariate logistic regression were used (p < 0.05).

RESULTS

The impact on OHRQoL was similar for SG and CG (OHIP-14 total score). For SG, the high negative impact was in the following OHIP domains: "Functional limitation", "Physical disability", "Psychological incapacity" and "Disadvantages". For SG, a higher number of caregivers was single, unemployed, received government financial aid. There was a statistically significant association between the number of children a caregiver has and a negative impact on OHRQoL.

CONCLUSIONS

Being a caregiver of children with or without CP had a negative impact of similar magnitude on ORHQoL. The negative impact on OHRQoL of caregivers of children with CP was associated with having a high number of children; the higher the number of children, the greater the negative impact on their OHRQoL.

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.

Dental Decay and Oral Findings in Children and Adolescents Affected by Different Types of Cerebral Palsy: A Comparative Study

OBJECTIVE

To compare dental caries and oral findings in patients affected by different types of Cerebral Palsy (CP).

STUDY DESIGN

This cross-sectional study involved 120 children and adolescents with a diagnosis of CP. WHO diagnostic criteria were used to determine DMFT (caries diagnosis), the pocket depth and attachment level (periodontitis diagnosis). Additionally, the study evaluated dental erosion, traumatic dental injuries, treatment needs index (TNI), oral habits, malocclusions, gingival overgrowth, and dental fluorosis.

RESULTS

The most frequent CP type was spastic (62.5%), followed by mixed (18.3%), ataxic (10%), and athetoid (9.1). Patients affected by mixed CP showed a higher prevalence in decayed, DMFT index and TNI compared with the other types of CP (p<0.05). The frequency of malocclusion in the clinical evaluation was 87.5% and in plaster models was 49.2%.

CONCLUSIONS

Dental caries was an important issue in mixed and athetoid CP groups. Oral habits and malocclusions were the most significant oral health problems in individuals with CP.

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.

Mechanical control of biofilm in children with cerebral palsy: a randomized clinical trial

BACKGROUND

Dental biofilm removal is difficult and can be ineffective in individuals with cerebral palsy.

OBJECTIVE

Determine the effectiveness of brushing with an electric toothbrush on and off in comparison with manual brushing for the removal of biofilm in children aged four to 16 years with cerebral palsy.

METHODS

A crossover, randomized, simple-blind, clinical trial was conducted. The examiner was blinded to the brushing method (G1: manual; G2: electric toothbrush on; and G3: electric toothbrush off). The order was determined randomly. The participants (n = 40) were examined before and after brushing performed by caregivers using the Turesky-Quigley-Hein biofilm index. Statistical analysis involved the paired t-test, Wilcoxon, Kruskal-Wallis, and anova tests.

RESULTS

Biofilm was significantly reduced with the three brushing methods (P < 0.001) (mean reductions: 47.6% in G1; 47.4% in G2; 44.5% in G3). Significant differences were found between G1 and G3 (P < 0.001) and between G2 and G3 (P = 0.007). No significant difference was found between G1 and G2 (P = 0.06).

CONCLUSION

All methods reduced biofilm. Effectiveness was similar between manual brushing and with the electric toothbrush on, whereas both these methods achieved better results in comparison with the electric toothbrush switched off.

Dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy

The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.

Integrated approach to outpatient dental treatment of a patient with cerebral palsy: a case report

The large number of oral manifestations associated with motor disorders in patients with cerebral palsy (CP) makes the dentist an indispensable member of the multidisciplinary team caring for this population. This case report presents an 11-year-old girl with spastic CP who had severe motor impairment, and a description of her care illustrates the importance of integrated care for patients with CP who are receiving outpatient dental treatment. It was determined that the use of adaptations based on knowledge of CP supported the outpatient dental treatment. The integrated approach used during dental treatment enabled the application of knowledge from the fields of dentistry, physical therapy, and speech therapy to provide for a better quality of life for the patient and, consequently, the caregiver through the improvement in the patient's oral and general health.