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.

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Sources

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212167/

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

https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-cerebral-palsy.pdf

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

http://www.thecenterforpediatricdentistry.com/intranet/special_needs_fact_sheets/medical_providers/CP-Medical.pdf

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

https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/oral-health-issues/

[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.”

https://cerebralpalsynewstoday.com/2018/11/02/customized-toothbrush-can-improve-cerebral-palsy-patients-oral-hygiene/

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

https://www.nidcr.nih.gov/sites/default/files/2017-09/dental-care-every-day-caregiver.pdf

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

http://dental.washington.edu/wp-content/media/sp_need_pdfs/CP-Parent.pdf

[9]      Practical.

[10]     Practical.

[11]     Interview.

________

Contact Center for Dental Anesthesia:

703-379-6400

Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia
22311