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

Navigating Oral Hygiene Challenges in Spastic Cerebral Palsy Patients: A Narrative Review for Management Strategies for Optimal Dental Care

In the realm of well-being, the essence of maintaining optimal oral health is gaining more recognition. This quantifying quotient is being compromised in cerebral palsy (CP) patients due to multitude variations. Spastic CP predominantly impacts bodily motions, muscle synchronization, command, muscle tone, reflexes, stance, equilibrium, and can additionally influence both delicate and large-scale motor abilities. For individuals with spastic CP, the rigidity extends its influence over both their upper and lower limbs. When this stiffness takes hold in the upper limb, it poses significant challenges in executing everyday activities, causing issues with precise grasping and coordination of muscle movements. Consequently, using a toothbrush effectively becomes a formidable task resulting in widespread caries and periodontal diseases in spastic CP patients. The central focus of this review is to explore the oral health challenges of spastic cerebral palsy patients and mapping out a path towards the most efficient time-tested and innovative dental management approaches for preserving oral health in these patients.

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.

Management of Traumatic Fibroma in a Patient with Cerebral Palsy Using 810nm Diode Laser

There are several treatment options for hyperplastic gingival lesions. Among these, diode lasers have the advantages of less bleeding, which is an important characteristic in mucosal lesions, a shorter procedure time, better healing, and less complications. We present the case of a 48-year-old male patient with a history of cerebral palsy and a presumptive diagnosis of traumatic fibroma. The entire lesion was removed in one session with no complications. No recurrence was observed at 3 months follow up. This procedure can be considered a good modality especially for physically challenged patients.

Orthodontic management of a patient with cerebral palsy: six years follow-up

AIM

Cerebral palsy (CP) is a disorder that affects muscle tone, movement and motor skills. CP can also lead to other health issues, including vision, hearing and speech problems, as well as learning disabilities and dental problems. A case report describing the successful orthodontic treatment of a 10-year-old boy with the dyskinesia type of CP and severe malocclusion is presented.

MATERIALS AND METHODS

A 10-year and 2-month old boy was presented by his parents for orthodontic treatment, complaining of his unsatisfactory occlusion and poor chewing efficacy. An extraoral examination showed a convex profle. An intraoral examination showed the patient to be in mixed dentition with a class II molar relationship, 10 mm overjet and 4 mm overbite. In addition, his maxillary and mandibular arches were severely crowded. Cephalometric analysis indicated a severe skeletal class II discrepancy, which was confrmed by an ANB of 12°. The frst phase of treatment involved the use of twin blocks with a headgear tube to attempt some growth modification and reduce the overjet. Once it was clear that the appliance was being well tolerated and the oral hygiene was satisfactory, the fxed appliance was used.

RESULTS

Because of the good participation of the patient and his parents, orthodontic treatment was successful in the patient, achieving a normal overjet in combination with successful orofacial therapy.

CONCLUSION

As demonstrated in our case report, the success of the treatment was dependent on the cooperation of the patient and his parents. Furthermore, this case illustrates the importance of the treatment by a dental team in patients with CP.