Oral and Dental Health with Cerebral Palsy

Cerebral palsy is a group of disorders that affect a person’s movement, balance and posture. Cerebral refers to the brain, while palsy means difficulty or problems using the muscles. It is caused by abnormal development of the brain, damage to the brain as a result of trauma or infection, which affects a person’s muscle control.

It is the most common motor disability in childhood. Cerebral palsy is seen in 1-4 out of 1000 live births on average in the world and in 4.4 out of 1000 live births in Turkey. The incidence is higher in children with preterm birth and low birth weight. While it was previously thought to occur only due to oxygen deprivation of the brain during birth, it is now known that a very small proportion of cases occur for this reason and that brain damage causing cerebral palsy can occur at any time before, during or after birth when the brain continues to develop. Cerebral palsy occurs at or before birth in 85-90% of cases and is called “congenital cerebral palsy”. Preterm birth (<32 weeks), low birth weight (<2500 g), severe newborn jaundice and prolonged untreated jaundice, multiple pregnancies, infections during pregnancy, medical history of the mother (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 common to all are movement and posture disorders. Mental retardation, seizures (epilepsy), vision, hearing and speech problems, spinal problems such as scoliosis and joint problems are other common symptoms.

There are 4 types;

Spastic cerebral palsy (80% of cases are of this type, muscles are stiff, there are subtypes according to the affected muscle groups),

Dyskinetic cerebral palsy (the person cannot control their movements),

Ataxic cerebral palsy (poor balance and mobility)

Mixed (spastic-dyskinetic) cerebral palsy.

There is no specific treatment and it does not get worse over time. Symptom-oriented interventions can be used to improve the person’s life and the earlier treatment is started, the better the chances of success. The same treatment is not applied for every person with cerebral palsy, a multidisciplinary approach to symptoms and needs is important.

Oral and Dental Problems and Treatment Options in Cerebral Palsy;

Cerebral palsy is a disease characterized by muscle weakness. As a result of the involvement of mouth, cheek, tongue and swallowing muscles; problems such as feeding and swallowing problems, saliva flow out of the mouth, parafunctional habits (such as teeth clenching and grinding, biting, finger sucking…) and inability to perform oral and dental care are observed.

People with cerebral palsy often have high caries rates, clenching and grinding of teeth, erosion and wear of teeth, enamel problems, gum diseases, oral and dental injuries, jaw joint disorders and delayed eruption of teeth.

Saliva flow out of the mouth;

While saliva flow out of the mouth is normal in infants and young children, it is considered pathological over the age of 4. In children with cerebral palsy, the reason for saliva flow out of the mouth is not the excessive amount of saliva, but the dysfunction in the swallowing mechanism. Generally, its severity decreases with advancing age and muscle development.

Oro-facial rehabilitation, drug therapy (anticholinergic drugs), Botox, surgical interventions for salivary glands, speech therapy and strengthening of tongue and lip muscles are some of the treatments applied.

Exercises and massages aimed at strengthening the tongue, lip and cheek muscles can reduce the amount, frequency and intensity of saliva flow out of the mouth; however, children with cerebral palsy who have mental retardation have difficulty following commands and therefore do not get positive results from such treatments.

In addition to exercise, tongue, lip and cheek muscle functions can be improved with various oral appliances applied in dentistry. With the regular use of the appliances as recommended, it is aimed to adapt the tongue and lips to their correct positions, thus improving nutrition, speech problems and saliva flow out of the mouth.

Teeth clenching, teeth grinding;

Teeth clenching and grinding is observed in 36-51% of people with cerebral palsy and the cause is not known exactly. It is thought to be caused by factors such as reflux, neurologic drugs used, uncontrolled mouth and jaw muscles, and stress. Severe clenching and grinding can cause tooth wear, fracture/abrasion of existing fillings and joint disorders. Treatment options are determined by the dentist according to the needs of the individual.

Risk of caries, tooth and gum problems;

Enlargement of the gums can be seen due to the effect of neurological drugs used. 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, parent or caregiver according to the person’s skills and should be taught correctly in practice.

People with cerebral palsy have a high risk of caries. Mouth breathing, eating habits (forms of food, duration of eating…) medications, defects in enamel structure, inadequate oral hygiene and saliva structure are the main factors that increase the risk of caries.

Dental abrasions can be seen due to reflux and teeth clenching.

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. Caries risk and needs should be carefully identified, necessary treatment plans should be made, and the awareness of the family and/or caregiver responsible for the care of the person should be increased about the maintenance of oral and dental health.

According to the American Association of Pediatric Dentists (AAPD);

Teeth should be brushed with fluoride toothpaste at least twice a day to prevent caries formation and gum problems.

For effective cleaning, electric toothbrushes should be preferred to traditional toothbrushes, and when they cannot be used, three-dimensional toothbrushes that clean all surfaces of the teeth at the same time should be preferred to traditional toothbrushes.

Eating habits should be adjusted, sugar-containing foods should be restricted, calcium, cereal and protein group foods and beverages should be included in the diet in amounts appropriate for the developmental age, and food intake should be stopped one hour before sleep.

The family and/or caregiver should be informed about medications that may cause gingival overgrowth and dry mouth and sugar-containing medications that increase the risk of caries,

People with gingival problems should be advised to use chlorhexidine-containing mouthwash (application can be done with a toothbrush in people at risk of swallowing).

Protective treatments such as fissure sealant and fluoride should be applied.

It is important and necessary to have a general dental check-up at least twice a year according to the recommendations of the dentist for early detection of problems and to maintain the current situation.