Dental management of Cerebral palsy patients

What is cerebral palsy disorder?

Cerebal palsy is a group of disorders that affect a person’s ability to maintain his posture and movement.

Types and forms of cerebral palsy:

There are few types of cerebral palsy : spastic, athetoid, ataxia and mixed combination.

Spastic cerebral palsy  is the commonest form of cerebral palsy disorder.  Cerebral palsy patients will have very stiff and tense muscles. The range of movement can be very limited in the severe form of spastic cerebral palsy.

Ataxia cerebral palsy is the less common type of cerebral palsy disorder. Patients with ataxia cerebral palsy have lack of balance and coordination.

Mixed cerebral palsy:  Mixed cerebral palsy patients might have combination symptoms of the above illness.

Here are some of the causes of cerebral palsy:

Damage to the brain (the motor control center) during pregnancy, childbirth or during infancy can cause cerebral palsy in children. Infection, premature birth, lack of oxygen during birth and etc are the risk factors of cerebral palsy.

Dental problems in cerebral palsy patients

1)      Dental malocclusion: Malocclusion will be present in cerebral palsy patients due to the abnormal orofacial neuromuscular tone. Cerebral palsy patients may have maxillary protrusion (which means the protrusion of your upper jaw) and open bite ( the teeth of the upper jaw cannot meet the teeth of the lower jaw). Presence of open bite and spacing in between teeth causes cerebral palsy patients to drool excessively.


2)      Dental caries: Most of the cerebral palsy patients exhibit poor oral hygiene. Dental caries may develop as a result of sweetened medications, mouth breathing and lack of oral hygiene maintenance.  Physical limitations may hinder oral hygiene procedures and most of the cerebral palsy patients are dependent on their care takers to clean their teeth.


3)      Periodontal disease:  Up to 36% of children with cerebral palsy will have onset of epileptic attacks. Thus they are often prescribed with anti epileptic drugs. Usage of anti epileptic drugs is one of the causes of gingival enlargement. For more information on drug induced gingival enlargement, please click: Dental plaque build up can also contribute to formation of periodontal disease.


4)      Self mutilation: Cerebral palsy patients may exhibit self mutilation habit by chewing on the soft tissues around their mouth.

Dental management of cerebral palsy patients

1)       Dental practitioner might need to perform dental treatment under sedation or general anesthesia if patient is uncooperative/ the patient requires extensive dental treatment.

2)      Most of the cerebral palsy patients are brought in to the dental clinic in a wheelchair. Hence, basic dental examination and simple dental procedures can be performed while patient is on a wheelchair.

3)      Basic dental examination and simple dental procedures can be performed on patient’s wheelchair. Remember to stabilize patient’s head to avoid unwanted movement and gag reflex.

4)      Mouth prop can be used while performing dental examination and simple dental procedures. However, there are not suitable for patients with impaired swallowing.

5)      Introduce instruments from the side of the mouth to prevent cerebral palsy patients from biting your finger.

6)      Discuss with the medical practitioner to change/modify drug prescription if the usage of specific drug is the main cause of gingival enlargement.

7)      Dental practitioner can place fluoride varnish to protect and reduce dental demineralization.

8)      Dental practitioner should achieve cooperation from the care takers or parents and implant the importance of oral hygiene maintenance. Care takers should also modify patient’s dietary habits and reduce sugar consumption.

9)      Modify regular tooth brush holders to allow cerebral palsy patients to grip their toothbrush. However, for patients with severe cerebral palsy, care takers may need to help with their daily tooth brushing.

10)   Dental practitioner should perform regular checkups on cerebral palsy patients to monitor their dental condition.

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