Cerebral palsy is a group of disorders that affect a person's movement, balance and posture. Cerebral brain palsy means difficulty and problems using muscles. It occurs when the person's muscle control is affected due to damage to the brain as a result of abnormal development of the brain, trauma or infection.
It is the most common motor disability in childhood. Cerebral palsy is seen in 1-4 out of 1000 live births in the world and 4.4 out of 1000 live births in Turkey. It is more common in children with premature birth and low birth weight. While it was previously thought to occur only due to the brain being deprived of oxygen during birth, it is now known that very few of these occur for this reason and that brain damage causing cerebral palsy can occur at any time before, during or after birth while the brain continues to develop. Cerebral palsy occurs at or before birth in 85-90% of cases and is called “congenital cerebral palsy”. Premature birth (<32 weeks), low birth weight (<2500 gr), severe neonatal jaundice and long-term untreated, multiple pregnancies, infections during pregnancy, and the mother’s medical history (such as thyroid problems, epilepsy) are among the causes of congenital cerebral palsy.
Cerebral palsy that occurs within the first 28 days after birth is called "acquired cerebral palsy" and is usually caused by a brain infection such as meningitis or head trauma.
Symptoms of cerebral palsy vary from person to person, but what is common to all is movement and posture disorders. Other symptoms that can be seen frequently are mental retardation, seizures (epilepsy), vision, hearing and speech problems, spinal problems such as scoliosis and joint problems.
There are 4 types;
- Spastic cerebral palsy (80% of them are of this type, muscles are stiff, there are subtypes according to the affected muscle groups),
- Dyskinetic cerebral palsy (person cannot control their movements),
- Ataxic cerebral palsy (poor balance and movement ability)
- Mixed (spastic-dyskinetic) cerebral palsy.
There is no specific treatment and it does not get worse over time. Applications can be made to improve the person's life based on the symptoms, and the earlier the treatment is started, the greater the chance of success. The same treatment is not applied to every person with cerebral palsy, a multidisciplinary approach to symptoms and needs is important.
Oral and Dental Problems and Treatment Options in Cerebral Palsy;
People with cerebral palsy often experience high rates of caries, teeth clenching and grinding, erosion and wear on teeth, enamel problems, gum disease, mouth and teeth injuries, jaw joint disorders and delays in tooth eruption.
Flow of saliva out of the mouth;
While saliva flow out of the mouth is normal in infants and young children, it is considered pathological after the age of 4. The reason for saliva flow out of the mouth in children with cerebral palsy is not an excess of saliva, but a dysfunction in the swallowing mechanism. The severity usually decreases as age progresses and muscles develop.
Oro-facial rehabilitation, drug therapy (anticholinergic drugs), botox, surgical interventions on the salivary glands, speech therapy and strengthening of the tongue and lip muscles are some of the treatments applied.
As a result of exercises and massages aimed at strengthening the tongue, lip and cheek muscles, it is observed that the amount, frequency and intensity of saliva flow out of the mouth decreases; however, since children with cerebral palsy who have mental retardation have difficulty obeying commands, positive results cannot be obtained from such treatments.
In addition to exercises, various oral appliances used in dentistry can be used to correct tongue, lip and cheek muscle functions. With the regular use of the appliances as recommended, the tongue and lips are adjusted to their correct positions, thus improving nutrition, speech problems and saliva flow out of the mouth.
Clenching and grinding of teeth;
Clenching and grinding of teeth is seen in 36-51% of people with cerebral palsy and the exact cause is unknown. It is thought that factors such as reflux, neurological medications used, uncontrolled mouth and jaw muscles, and stress may be the cause. Severe teeth clenching and grinding can cause teeth to wear down, existing fillings to break/wear down, and joint disorders. Treatment options are determined by the dentist according to the needs of the person.
Risk of caries, tooth and gum problems;
Due to the effects of neurological drugs used, gum growth may occur. Tooth brushing becomes even more important in these cases.
Oral and dental care recommendations for people with cerebral palsy should be conveyed to the person, their parent or the person responsible for their care, according to their skills, and should be taught correctly and in practice.
People with cerebral palsy have a high risk of cavities. Mouth breathing, eating habits (food forms, eating times, etc.), medications used, disorders in the enamel structure, inadequate oral hygiene and saliva structure are the main factors that increase the risk of cavities.
Abrasions may occur on teeth due to reflux and teeth grinding.
Recommendations for oral and dental health;
A personalized oral care and treatment program should be created by the dentist for each individual with cerebral palsy. The risk of decay and needs should be carefully determined, necessary treatment plans should be made, and the awareness of the family and/or caregiver responsible for the person's care should be increased regarding the continuation of oral and dental health.
According to the American Association of Pediatric Dentists (AAPD) guide;
- To prevent cavities and gum problems, teeth should be brushed at least twice a day with fluoride toothpaste.
- For effective cleaning, electric toothbrushes, or when they cannot be used, three-dimensional toothbrushes that clean all surfaces of the teeth at the same time should be preferred over traditional toothbrushes.
- Eating habits should be adjusted, foods containing sugar should be restricted, calcium, grains and protein group foods and drinks in amounts appropriate for developmental age should be included in the diet, and food intake should be stopped one hour before sleep.
- The family and/or the person responsible for care should be informed about medications that may cause gum enlargement and dry mouth, and sugar-containing medications that increase the risk of caries.
- The use of chlorhexidine-containing mouthwash should be recommended for people with gum problems (for people at risk of swallowing, application can be done with a toothbrush).
- Preventive treatments such as fissure sealants and fluoride should be applied.
- In order to detect problems early and maintain the current situation, it is important and necessary to have a general dental check-up at least twice a year according to the dentist's recommendations.
Pediatric Dentist Cansu Uzun Önalan