Improving Oral Health Outcomes: Cerebral Palsy and Dentistry

Cerebral palsy is a neurological disorder caused by brain damage that happens either before birth, or in the first few years of life. The condition affects muscle coordination and results in uncontrolled body movement, seizures, problems with balance, and sensory dysfunction. There may also be intellectual impairment.[1]

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Cerebral palsy (CP) does not, in and of itself, cause dental health problems. But conditions that arise from it do. Dr. Zeyad Mady, who practices at the Center for Dental Anesthesia in Alexandria VA, says that people with CP develop more dental problems than the general population. “In addition to the poorer oral health outcomes,” he explains, “patients with special needs are more likely to have limited access to dental care services.”[2]

The symptoms associated with CP can make people more prone to a range of dental problems, including:

  • Tooth decay
  • TMJ disorders
  • Bruxism
  • Oral hygiene
  • Malocclusion
  • Traumatic dental injuries[3]

There are different types of CP. The severity of the disorder is generally grouped as mild, moderate, and severe. Those with mild or moderate forms can often be treated by a general dentist in an ordinary setting. But those with more severe forms are likely to present challenges that a general practice is not equipped to meet. The Center for Dental Anesthesia has made special needs dentistry central to its operation since 2015.[4]

Dental Care at Home

Everyone needs a good dental hygiene routine. In-home caregivers know the challenge of providing it to someone with a disability. It takes planning, time, and patience. Establishing a regular, unchanging routine can help.

“Caring for a special-needs patient is a full-time task,” Dr. Mady says. “We understand that. We commonly get questions about how to improve their home care, how to prevent problems, how to identify problems and what to do in case any dental issues arise.”[5]

“All patients with special needs
must have equal access and high-
quality treatment that focuses on
patient safety, patient-centered care
and treatment of all dental needs.”

Dr. Zeyad Mady, DDS, FAGD, FICOI

At-home dental care comes down to regular brushing and flossing, but it doesn’t necessarily need to be done in the bathroom. Wherever the patient feels most comfortable is probably the best place. Many home caregivers say the kitchen table works very well. The table allows you to keep everything you need – toothbrush and paste, dental floss, and water – close at hand. A bowl to spit in, of course, is also a good idea.

Whatever place you choose, make sure it is well-lit. You need to see inside the person’s mouth to make sure you get every area you need to get.

Some people with CP can brush on their own. That doesn’t mean it will be easy for them; a customized toothbrush with a wide handle may make brushing easier. An electric toothbrush may also be a good choice.[6]

For those unable to brush on their own, caregivers should wash their hands and wear disposable gloves. Beyond that, brushing teeth is about the same as for anyone else.

  • Use a soft-bristle brush (manual or electric)
  • Brush all teeth, making sure to get the front, side, back, and chewing surfaces
  • Use a small, pea-sized amount of fluoridated toothpaste
  • Brush the tongue
  • Help the person rinse
  • Replace the toothbrush every three months

Some people with cerebral palsy have difficulty swallowing. In cases like that, it may be better to skip toothpaste. Just use water.[7]

In the Office

All kids should see the dentist when their first tooth comes in, or by their first birthday – whichever comes first. After that, they should see the dentist for a checkup every six months.[8]

Caregivers should know the dental and medical history of the patient and be able to provide it. They should bring all relevant insurance, billing, and legal information to their appointments.

No matter the type of cerebral palsy, people with CP have problems with movement and posture. Some cannot be moved from their wheelchairs and must be treated there. Certain adaptations, such as a sliding board for support, can make the appointment go easier.[9]

For those who can be moved to the dental chair, the patient or a caregiver may be able to help with the best way to make the transfer.

Since uncontrolled body movements are common, dentist appointments can be challenging. A general dentist treating a CP patient should remain calm and supportive. A relaxing atmosphere can help. It won’t prevent uncontrolled movement, but it can reduce its frequency and intensity.

As the appointment begins, explain each procedure. Take as much time as necessary. Dentists should never assume that someone with CP is below normal intelligence. Check with a parent or caregiver.

In addition:

  • Keep the appointment short
  • Minimize distractions, like noises or sudden movement
  • Taking breaks can help
  • Consider sedation for longer appointments[10]

Prevention and Maintenance

Regular six-month checkups are as important to dental health as daily brushing and flossing. And yet it remains difficult for people with cerebral palsy to find dental practices able to treat them. “Despite remarkable progress in medicine and dentistry,” Dr. Mady says, “there are very few dentists nationwide who deal with special needs patients.”

The Center for Dental Anesthesia in Alexandria is committed to treating patients with many different special needs, including cerebral palsy. “There are an array of tips and tools to help maintain good oral health for patients with special needs,” Dr. Mady explained. “Primarily it is prevention and maintenance. We have an amazing team of professionals that help elaborate at their visits.”[11]

No matter their physical or intellectual condition, no one should be without professional dental care. Each member of the CDA team has years of experience in providing dental healthcare to people with cerebral palsy, Down syndrome, and many other special needs. Please call our office to schedule an appointment.



[1] Cerebral Palsy: A Dental Update. Referred to hereafter as “Dental Update”

Practical Oral Care for People with Cerebral Palsy (referred to hereafter as “Practical”)

Oral Health Fact Sheet for Medical Professionals: Children with Cerebral Palsy. Referred to hereafter as “Fact Sheet.”

Why Are Children with Cerebral Palsy At Risk for Oral Health Issues? Referred to hereafter as “Why?”

[2] Interview, March 2019. Referred to hereafter as “Interview.”

[3] Dental Update.

[4] Mild or moderate forms in a general practice: Practical.

[5] Interview.

[6] “Customized Toothbrush Can Improve Cerebral Palsy Patients’ Oral Hygiene, Study Shows.”

[7] Dental Care Every Day: A Caregiver’s Guide.

[8] Dental Health Guidance for Parents and Caregivers of Children with Cerebral Palsy.

[9] Practical.

[10] Practical.

[11] Interview.


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Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia

Center for Dental Anesthesia Has A Solution For Dental Anxiety

Oral Conscious SedationAt the Center for Dental Anesthesia in Alexandria, we understand that some people have severe anxiety when they go to the dentist. With sedation dentistry, it is possible to relax during a checkup instead of being tense and fearful.

In some cases, people with dental anxiety avoid dentist appointments altogether. This, in turn, puts their dental health at risk.

You may want to consider sedation dentistry if you have any of the following issues:

  • Strong gag reflex
  • Fear of needles
  • Sensitive teeth
  • Fear and anxiety associated with dental treatment
  • Difficulty getting numb
  • A history of negative dental experiences
  • Trouble controlling body movement due to Parkinson’s disease, Cerebral Palsy or related condition
  • Need extensive dental treatment requiring lengthy dental visits

If you have avoided dental treatment due to any of these reasons, schedule an appointment with the Center for Dental Anesthesia in Alexandria. Sedation dentistry is our specialty. We offer a wide range of services, from family dentistry to special needs dentistry. Call our office today!

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 611

Call Them What You Will, Just Keep Them Healthy

Alexandria Top Cosmetic dentist

Chompers. Pearly Whites. Dents. Gnashers. Grill. While you can switch up what you call them, the dentist at the Center for Dental Anesthesia in Alexandria VA remind you to never switch up a well-engrained oral health routine.

Practicing proper oral hygiene daily with pay off throughout your life. You’ll prevent tooth decay, plaque, and gum disease, not to mention bad breath (something friends, family, and coworkers will also appreciate).

  • By brushing your teeth twice every day, you remove the plaque that causes cavities. Plaque is that soft and sticky film that builds up on your teeth, a process that happens around the clock. It’s caused by food debris and bacteria.
  • It’s just as important to floss at least once a day. Flossing gets the plaque between your teeth, where your toothbrush cannot reach.
  • Scheduling twice-yearly checkups at our office is also very important. Regular checkups can prevent cavities and gum disease. Each checkup also includes an oral cancer screening.

Your teeth are meant to last a lifetime! At The Center for Dental Anesthesia in Alexandria VA, we want the best possible dental health for each of our patients. Our services include family dentistry, and special needs dentistry. Schedule your next checkup today!

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 4556

Change Your Life In 4 Steps

cosmetic dental and implants

There is no question that dentures are preferable to a toothless mouth, but they are not issue free. An increasingly popular alternative is state-of-the-art implant dentures from the Center for Dental Anesthesia in Alexadnria.

Traditional dentures can make it difficult to chew and taste food. It’s embarrassing to talk when they are slipping around in your mouth and laughing can dislodge them entirely. They can even make it hard to breathe – and it doesn’t get more basic than that.

Even if you have had dentures for many years, you may be a candidate for implant dentures. Mini dental implants (also called denture-stabilization implants) allow us to securely attach an appliance so that it won’t slip or irritate gums. Small titanium posts are implanted into the jawbone and fuse with the surrounding bone, building a substantial base for an over denture.

Here is the process:

1. Examination and Assessment
During your first visit, we will take x-rays and assess your mouth and the condition of your teeth, gums, and jawbone. We will assess options with you and together you will design a treatment plan.

2. Implant Placement
A complete tooth implant and restoration consists of the actual implant or root replacement, an abutment, and final restoration. The first step is to insert the titanium alloy implant into your jawbone. This is not as difficult or painful as it sounds. Most patients are surprised at how speedy and easy the procedure is.

3. Integration
Implant surgery would not be successful if your jawbone did not welcome an artificial and non-biological tooth root. Amazingly, in the vast majority of cases, the jawbone tightly fuses with the implant to design an extremely durable foundation for the final restoration. It takes from three to six months for your jawbone to work its extraordinary magic.

4. Final Restoration
The implant dentures are secured to the titanium posts. Dental implant restorations are virtually indistinguishable from initial teeth.

At The Center for Dental Anesthesia in Alexandria, we offer dental implants, including implant dentures. We also offer family dentistry, and many other services. Schedule an appointment with us today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 7170

Cavity Fighting Chewing Gum?

Alexandria Oral DentistryAt the Center for Dental Anesthesia in Alexandria, we are sometimes asked if gum sweetened with xylitol is an effective substitute for brushing your teeth, and regular dental exams.

Before answering that question, let us tell you a little bit about xylitol:

Xylitol is a natural sweetener that was first discovered in birch tree bark but is also found in many fruits and vegetables. Unlike most other sweeteners (natural or synthetic), xylitol is actually useful for your teeth.

Numerous clinical studies have demonstrated that xylitol prevents the growth of the bacteria that initiates decay. It also lessens plaque and strengthens tooth enamel.

Xylitol has other benefits, as well. Because it is low on the glycemic index, many of my patients with diabetes enjoy it as a healthy alternative to sugar. For our patients that notice frequent dry mouth, we recommend xylitol gum or mints to stimulate saliva production while safeguarding against cavities.

Now, back to the golden question. Is xylitol gum just as effective as brushing your teeth and seeing your family dentist regularly? Absolutely not! If you cannot brush your teeth after a meal, chewing xylitol gum for five or ten minutes is probably a good idea. However, you should still brush your teeth thoroughly (with a soft brush) after meals and get twice-yearly exams and dental cleanings.

At the Center for Dental Anesthesia in Alexandria, our goal is to keep your smile healthy and beautiful for life by preventing dental problems before they start. We offer a wide range of servicers, from family and cosmetic dentistry, to special needs dentistry. Schedule an appointment today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 1368

Think It’s Not Necessary To Replace Missing Back Teeth?

dental implants Alexandria

Some people who lose a back tooth question whether to replace it. After all, it doesn’t show when you smile and there are other teeth to take over the chewing functions. Why not avert the cost to replace it and save some money? At The Center for Dental Anesthesia in Alexandria, we have several very good reasons to replace a back tooth with a dental implant:

1. The adjacent tooth (or teeth) may start shifting.

If a tooth tips, moves, or rotates, it can affect the bite. The unopposed tooth can also move, though it generally moves outward from the bone (over-eruption). Teeth that are displaced can become more vulnerable to gum disease, decay, and other problems.

2. The underlying bone will eventually loosen.

Without the tooth root, the jaw bone recedes. This changes the shape of the face and gives it a sunk-in look due to a decrease in supporting bone. The vertical shortening advances and becomes more pronounced as you get older.

3. There will be extra stress on the teeth that take over the chewing functions.

This can lead to excessive wear, fracture, or pain.

If you have a missing back tooth and want to learn about dental implants, call the Center for Dental Anesthesia in Alexandria. We offer family dentistry, and a wide range of other services. Schedule an appointment today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 7768

4 Oral Ailments To Discuss With Your Dentist

Bad Breath Treatment Alexandria

We all go to the dentist for cleanings and check-ups, but there are other, less-obvious issues that we can help you with. In this post from the Center for Dental Anesthesia in Alexandria, we look at some common conditions you can discuss with us.

  1. Bad Breath. Sure, nobody wants to admit that they have bad breath, but bad breath can be treated. It is usually associated with bacteria build-up in the mouth. This means that it might be a symptom of accelerating dental caries. Discuss it with your dentist who can help you overcome this condition. (Your friends will appreciate it.)
  2. Dry Mouth. Also known as xerostomia, this lack of saliva is very irritating and can predispose dental patients to a host of troubles such as dental caries and gum disease. Some people experience it because of prescription medications or chronic diseases, so make sure to bring a list of current prescriptions with you to your appointment
  3. Jaw Issues. If you notice inexplicable jaw pain or notice a clicking sound, be sure to schedule an appointment with your dentist right away! These symptoms can be signs of a serious condition called temporomandibular disorder or TMD.
  4. Teeth Grinding. If you’ve been stressed out and find that you’ve been grinding your teeth (or if your partner tells you that you’re doing it in your sleep), discuss it with your dentist. A simple appliance can guard your teeth. If you have sufferred damage from grinding such as fractured or chipped teeth, we will give you information about restorative dentistry.

At the Center for Dental Anesthesia in Alexandria, we provide a wide range of services: from family to special needs dentistry. Schedule your next checkup with us today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 4795

Dental Healthcare and Muscular Dystrophy

Muscular dystrophy is a group of degenerative diseases that cause weakness and the loss of muscle mass. It occurs mainly in boys, and can appear as early as age three. Patients who are not treated are usually unable to walk by the time they’re about ten. While advances in medicine have extended the lifespans of some patients, muscular dystrophy is often fatal by the late teens because of respiratory or heart problems.[1]

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The term muscular dystrophy (MD) refers to more than thirty conditions, the most common of which is Duchenne muscular dystrophy (DMD). It isn’t known how common other forms are, in part because symptoms can vary so much from one patient to the next. This article mainly describes Duchenne MD, but also considers Becker (BMD). BMD is similar to DMD, but the symptoms are not as severe, and it progresses more slowly.[2]

Muscular dystrophy brings on a host of life challenges, including proper dental care. The Center for Dental Anesthesia in Alexandria is equipped to treat patients with MD and other special needs.

A Cruel Disease

Muscular dystrophy is a particularly cruel disease. Children who are diagnosed with it gradually lose their ability to walk, move their arms and hands, and even to breathe easily. In about a third of all cases there is no family history of the disease. While medication and physical therapy can slow its progress there is currently no cure, nor can it be prevented or reversed.[3]

Suzan Norton’s son Mike was diagnosed with DMD when he was four years old, and the news devastated her. “I spent the next six months in chronic sorrow,” she recalls. “But one day I woke up and knew we could be OK.” She and her family got involved with the Muscular Dystrophy Association and learned to have hope. “MDA and all its resources are there to help.”[4]

In 1986, research supported by MDA identified a gene on the X chromosome that, if it mutates, leads to DMD. Women are DMD carriers, but carriers don’t usually have any signs or symptoms.[5]

MD and Dentistry

MD patients and their loved ones face challenges every single day, and the disease remains a grim subject. “I can fight with it,” one MD patient said bluntly, “but I can’t beat it.”[6]

The effects of MD do not spare the muscles of the face and mouth. Consequently, it can have a major impact on dental health, leading to these common issues:

  • Chewing difficulties
  • Swallowing difficulties
  • High rates of malocclusion (improper bite alignment)[7]

People with DMD are also more likely to have poor dental hygiene. Even with help from caregivers, it may be difficult for the patient to open his jaw or move his tongue out of the way. It is common to find higher than ordinary rates of tooth decay, plaque buildup, poor gum health, and poor dentition.[8]

At home, most patients will eventually need help brushing and flossing their teeth. Whoever has this responsibility must understand that patience and skill are necessary so that their efforts are successful. In order to maintain the patient’s dental health, caregivers should make sure that:

  • Teeth are brushed daily
  • Teeth are flossed daily
  • The patient has regular dental checkups[9]

Many of the issues that make everyday life a challenge for MD patients are present in the dentist’s office. Since many are in a wheelchair by the age of ten, just getting into the office may be a challenge. The Center for Dental Anesthesia is fully wheelchair accessible, and many dental practices throughout the United States follow that example. Some patients, of course, are able to walk but may be more likely to fall. Dental professionals should take appropriate precautions.[10]

Never Give Up Hope

New and better treatments for DMD and other forms of muscular dystrophy are developed all the time, and Suzan Norton tells people like herself, whose loved ones have the disease, to remain optimistic. “Surround yourself with inspirational and positive people,” she advises. “Let your love for your child give you strength. Never give up your hopes and dreams.” Her son has graduated from high school and has many friends, including a girlfriend. “He’s taught me more than I’ve taught him.”[11]

Dr. Mady is always here to provide
honest and gentle dental care … and
would be happy to speak with you
soon and help you design a treatment
plan that’s right for you.

Caregivers and the loved ones of people with MD must be proactive in the management of their dental care. The combined effects of the progression of the disease and the weakening of the facial muscles means there must be constant vigilance.

No matter your age or physical condition, good dental health is important. It should never be viewed as some kind of bonus. At the Center for Dental Anesthesia in Alexandria, we believe that no one should be without quality dental care because of a physical limitation. Our entire facility is wheelchair accessible and provides specialized dental chairs and equipment. Each team member is familiar with relevant protocols, and has years of experience in providing dental healthcare to patients with DMD and other special needs. Please call our office to schedule an appointment.

For anyone with a loved one facing the challenges of muscular dystrophy, you can read about the latest in medical management, and find other useful information, on the Muscular Dystrophy Association website.



[1] Mayo Clinic website. Referred to hereafter as Mayo Clinic.

Lifespans: “Patients living longer with Duchenne muscular dystrophy pose new challenge for caregivers,” Science Daily website. Referred to hereafter as “Lifespans.”

[2] “Muscular Dystrophy.”

More than thirty forms: “All About Muscular Dystrophy,” Referred to hereafter as All About.

[3] Mayo Clinic.

[4] “Facts About Duchenne & Becker Muscular Dystrophies.” referred to hereafter as Facts.

[5] “Duchenne Muscular Dystrophy (DMD).” Referred to hereafter as DMD.

[6] Quote: “21 Truths People With Muscular Dystrophy Wish Others Understood.”

[7] Parent Project Muscular Dystrophy, referred to hereafter as Parent Project.

[8] Parent Project. Note: since most MD patients are male, this article forgoes gender-neutral language.

[9] Dental Care Every Day: A Caregiver’s Guide.

[10] Muscular Dystrophy – CDHO (College of Dental Hygienists of Ontario).

[11] Facts.


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia

Choosing A Toothbrush For Your Child

pediatric dental Alexandria

At the Center for Dental Anesthesia in Alexandria VA, we are sometimes asked how to select a toothbrush. Picking a toothbrush can be as hard as choosing a paint color, and there seems to be just as many choices.

If you have visited the dental section of your local grocery store, you know what we mean. To name just a few of the available types, there are brushes with bristles of varying lengths, brushes that massage your gums, and brushes that change color when they are used up.

Choosing a Toothbrush for a Child

When selecting a toothbrush for a child, it’s important to make sure the brush feels comfortable in his or her hand. If the size and angle feel awkward, the child will be less likely to use it long enough to clean all areas of the mouth. Children do not necessarily need a child-sized toothbrush. Some kids can manage an adult size brush better than a short, narrow child-size brush. If you are unsure, ask us.

Is your child’s toothbrush and brushing technique doing the job? Schedule an exam with us to find out. Our hygienists help our patients of all ages learn proper brushing techniques.

Beware of Firm Bristles

One crucial factor is the firmness of the bristles. Hard bristles may be more effective for cleaning burnt steak off a grill or hard water deposits off a shower floor. But this does not hold true for your teeth. Medium and firm brushes can weaken your gums. Soft and extra-soft bristles are plenty stiff enough to wipe plaque, food particles, and surface stains from your teeth. Soft bristles also offer more flexibility for hard-to-reach nooks and crannies.

Schedule a Dental Cleaning

At the Center for Dental Anesthesia in Alexandria VA, we recommend coming in for a dental cleaning every six months. Our services include family and cosmetic dentistry. Schedule an appointment with us today!

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 8098

Keeping You Comfortable

sleep dentistry Alexandria

At the Center for Dental Anesthesia in Alexandria, we make a conscious effort to help our patients feel comfortable. Though our chairs are cushy as can be, we mean more than physical comfort. We mean peace of mind, which may include sedation dentistry.

1. We don’t judge you. We have devoted our careers to promoting oral health and creating beautiful smiles.

We are here to help you, regardless of the state of your teeth. We have treated patients with severe tooth neglect, advanced gum disease, enamel erosion caused by eating disorders, tooth damage caused by illegal drug use, baby bottle tooth decay, tobacco-stained teeth: basically, every imaginable dental trouble. We don’t live in a bubble. We understand and empathize with our patients.

2. We protect you from pain. From topical analgesics to sedation, we will eliminate or minimize pain as best we can. We are a leader in sedation dentistry.

3. We help you with your dental anxiety. Fear of the dentist is far more common than you might think. The perceived loss of control, instruments poking in your mouth, and teeth being worked on is not pleasant. Some individuals get claustrophobic because they need to lie still in the chair for treatment.

Sedation dentistry not only assists in pain management, it allows you to relax through your appointment. We can review the different levels of sedation so you can select the one that is best for you.

4. We communicate with you.
 Procedures are thoroughly explained and all your questions will be answered prior to treatment. If you are not sure you want to initiate treatment, we are happy to let you think about it for a while. There is no rush.

If you have postponed dental treatment for any reason, we encourage you to give the Center for Dental Anesthesia a try. Neglecting your oral health has serious consequences. Our services include family and cosmetic dentistry. Make an appointment today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


ArticleID 7038