Oral health and nutritional status of children with cerebral palsy in northeastern peninsular Malaysia

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.

Mid-upper arm circumference (MUAC) measurement usage among children with disabilities: A systematic review

Background: Anthropometric measurements, including mid-upper arm circumference (MUAC), are used for monitoring and evaluating children's nutritional status. Evidence is limited on optimal nutritional assessment for children with disabilities, who are at high risk for malnutrition. Aim: This study describes MUAC use among children with disabilities. Methods: Four databases (Embase, Global Health, Medline, and CINHAL) were searched from January 1990 through September 2021 using a predefined search strategy. Of the 305 publications screened, 32 papers were included. Data included children 6 months to 18 years old with disabilities. Data including general study characteristics, methods for MUAC measurement, terminology, and measurement references were extracted into Excel. Due to heterogeneity of the data, a narrative synthesis was used. Results: Studies from 24 countries indicate that MUAC is being used as part of nutritional assessment, but MUAC measurement methods, references, and cutoffs were inconsistent. Sixteen (50%) reported MUAC as a mean ± standard deviation (SD), 11 (34%) reported ranges or percentiles, 6 (19%) reported z-scores, and 4 (13%) used other methods. Fourteen (45%) studies included both MUAC and weight-for-height but nonstandard reporting limited comparability of the indicators for identifying those at risk of malnutrition. Conclusion: Although its speed, simplicity, and ease of use afford MUAC great potential for assessing children with disabilities, more research is needed to understand its appropriateness, and how it performs at identifying nutritionally high-risk children in comparison to other measures. Without validated inclusive measures to identify malnutrition and monitor growth and health, millions of children could have severe consequences for their development.

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.

Effectiveness of Apple Cider Vinegar and Mechanical Removal on Dental Plaque and Gingival Inflammation of Children With Cerebral Palsy

Background

This study was designed to evaluate the effect of apple cider vinegar (ACV) 5% and mechanical plaque removal with a manual toothbrush on dental plaque and gingivitis. The objective was to study available, natural, and inexpensive ways to improve oral health status among the studied group.

Materials and methods

A randomized clinical trial was performed on 50 children with cerebral palsy aged from three to six years. Participants were divided into two groups (n=25, apple cider vinegar, manual brushing without toothpaste). Plaque accumulation and gingival status were evaluated using Turesky of the Quigley-Hein plaque index (TQHPI) and modified gingival index (MGI) seven times: pre-intervention baseline (T0), post-intervention at one month (T1), two months (T2), three months (T3), four months (T4), five months (T5), six months (T6).

Results

Plaque accumulation and gingivitis decreased significantly for the ACV group between T0 and T6 (p<0.05) and demonstrated significantly lower plaque accumulation and gingivitis compared to the manual brushing group (p<0.05) at T5 and T6. The manual brushing group showed decreasing in TQHPI between T0 and T3, then TQHPI increased significantly (p<0.05) at T4, T5, and T6.

Conclusions

To sum up, this in vitro study has demonstrated the possibility of using apple cider vinegar to reduce plaque and gingivitis. In addition, without additives, apple cider vinegar has both mechanical and chemical effects on dental plaque, and it may be a natural, available, inexpensive, and harmless substance that can improve the quality of oral care for difficult groups of children and people with special needs. Unlike toothbrushes, especially electric toothbrushes, they are effective, but they may be expensive and not available to all children.

Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis

OBJECTIVES

This systematic review study and meta-analysis sought to estimate the prevalence of malnutrition and nutritional deficiencies in children with cerebral palsy (CP).

STUDY DESIGN

This is a systematic review and meta-analysis.

METHODS

The systematic review was conducted according to the PRISMA guidelines. The articles were chosen using the PubMed, Embase, Scopus, Web of Science, Cochrane Library, SciELO, and Lilacs databases and the bibliographical reference lists of the articles. No limitations were placed on the time of publication, but the articles had to include children from 0 to 18 years old with CP who presented the prevalence of malnutrition and nutritional deficiencies. The methodological quality of the articles was assessed using the verification list for analytical cross-sectional studies, the Newcastle-Ottawa scale, and the Cochrane Collaboration tool for randomized studies. The meta-analysis of proportions was conducted based on the prevalence data for malnutrition or nutritional deficiencies. The study is registered in PROSPERO under CRD number 42020175068.

RESULTS

Sixty-seven articles (N = 453,804) published between 1986 and 2019 were included. Most of the articles presented a low risk of bias and no publication was excluded for quality reasons. The most widely used anthropometric index for diagnosing nutritional status was weight-to-age and the estimated prevalence of malnutrition was 40% (95% CI = 28.0-53.0). Nutrient deficiency was investigated by nine publications, with hypocalcemia and reduced serum concentrations of zinc, copper, and vitamin D being reported the most.

CONCLUSIONS

We found a high rate of malnutrition in the population in this review, moreover, we suggest that some nutritional deficiencies are associated with food deficit and that the socio-economic and age factors of these children may relate with the poor nutritional outcome. This makes monitoring and personalized nutritional management necessary, in accordance with the characteristics and particularities of children with CP.

A scoping review of oral health outcomes for people with cerebral palsy

INTRODUCTION

Good oral health is important for good overall health. Studies have reported poorer oral health outcomes for people with cerebral palsy, but there has been no synthesis of the evidence surrounding this and, there are no clear oral health recommendations for people with cerebral palsy globally. This review synthesizes the existing knowledge base on oral health in people with cerebral palsy and provides recommendations for future research.

METHODS

A scoping review was conducted to assess the current literature. Databases were searched using relevant search terms. Study outcomes were synthesized according to their reported outcomes.

RESULTS

One hundred seventy three studies were included in this review. Children with cerebral palsy have an increased risk for dental caries and untreated caries. Higher saliva osmolality is a major contributor to increased dental caries. People with cerebral palsy are more likely to experience tooth wear and bruxism. Children and their care-givers have poor oral health related quality of life. There is a large unmet need for oral healthcare in this group. There is no suggested plan for the prevention of poor oral health for this group. A high number of studies included related to research is conducted in low- and middle-income countries, care should be taken in applying results outside this context. There is a lack of research conducted in people with cerebral palsy, 18 years and over.

CONCLUSION

There is a higher risk for poor oral health in people with cerebral palsy and there is a large unmet need to dental care in this group. This study highlights the need for further research to focus on adults with cerebral palsy and an of understanding the oral health care outcomes in the context of settings. The authors recommend the inclusion of classification systems and the integration of disability inclusive language in future studies.