Cerebral Palsy Research Paper

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Disabilities Research Paper

Audrey Noonan

Dental Hygiene IV
In the dental field we encounter all kinds of patients, ranging from normal healthy

individuals to those who possess physical or mental disabilities. It is our job to

accommodate every type of patient we encounter and cater to their specific needs. For

my research paper I chose to take a closer look at patients with cerebral palsy and the

oral implications it has on those affected by it. Cerebral palsy is a condition that is

caused when part of the brain has been injured causing paralysis or disfunction of motor

functions throughout the body. Cerebral palsy has been proven to “affect movement and

posture caused by disturbances to the developing brain” (Kabani, 2015).

Cerebral Palsy was first documented in 1853, by Dr. William John Little, however

it was called Little’s Disease or Cerebral Paralysis at that time. The name “Cerebral

Palsy” did not come about until 1887 when Sir William Osler conducted his own

research while also referencing Little’s work. While initial research was conducted in the

1800s, there are signs that the earliest case of cerebral palsy was actually much earlier.

A medical examination of a mummified Egyptian Pharaoh found the body had extremely

deformed feet, making it the oldest physical evidence of cerebral palsy in history,

existing between 1196 to 1190 BC.

As previously stated, cerebral palsy is acquired when the brain has been injured.

The most common occurrence is during pregnancy or after birth. It can also be acquired

due to an accident, abuse, hypoxia, or infection. When looking at the population, it is

more common to see African American infants having a higher risk of cerebral palsy

than Caucasian infants. The cause of this statistic is unknown. It is believe that low birth

weight, prenatal care, and maternal education could be contributing factors. The earlier
a baby is born, the lower their birth rate will be, and this will put them at a higher risk of

developing cerebral palsy. In the United States of America, the rate of babies being

diagnosed with cerebral palsy is 3 to 1,000 babies and approximately 764,000 children

and adults are living with cerebral palsy.

Cerebral palsy effects how a person is able to move their body. The symptoms

can range from minimal to severe. For example, the paralysis can include one side of

the body, or it can be paralysis of certain parts of the body. And while cerebral palsy is

affecting the physical state of the person possessing it, it is also affecting the cognitive

state of the person as well. Patients with cerebral palsy may experience a delay in

language skills, ability to comprehend reading and writing, and difficulty focusing or hold

attention for long periods of time. Cerebral palsy is not a disease or syndrome. It has no

cure, but luckily it is also not progressive, meaning that it will not get worse over time.

People with cerebral palsy are most likely taking a regimen of medications to

treat or relieve symptoms. The four main drug types you may see a patient with cerebral

palsy taking are anticholinergics, anticonvulsants, antidepressants, and anti-

inflammatory medications. The anticholinergic drugs help control muscle spasms. The

anticonvulsants help with epileptic episodes. The antidepressants are used for

depression but also have shown that they can treat muscles spasms as well. The anti-

inflammatory medications help relieve a cerebral palsy patient of their pain. These

medications are most often used together to help treat multiple symptoms at once. Side

effects of these drugs may include constipation and urinary incontinence. While these

medications are very beneficial in treatment of a patient with cerebral palsy, they do
have side effects that effect a patient’s oral health. The side effects include xerostomia,

gingival hyperplasia, and bruxism.

When it comes to the oral care of a patient with cerebral palsy, special

accommodations may be needed in order for the patient to receive the best care.

Patients may present with worn down teeth due to grinding, fractured teeth due to

accidental falls, and dental decay due to their restricted ability to chew and the nature of

their diet being mostly soft foods (Hebl, 2022). Soft diets cause patients to be at a

higher risk for tooth decay because food is more easily trapped and packed in the teeth.

Patients with cerebral palsy are also more prone to having malocclusion or a misaligned

bite.

These patients also have a higher risk of caries, gingivitis, and periodontal

disease. This increased risk is due to uncontrolled biofilm, little to no motor function,

mouth breathing, GERD, medication side effects and lack of proper dental care. Another

reason periodontal disease is so present in patients with cerebral palsy is because

caretaker’s knowledge of the disease is limited, which makes it difficult to identify. It is

also difficult for them to perform oral care due to the limited or restricted function of

facial muscles of the patient. Phenytoin is a medication that some cerebral palsy

patients take to control seizures. This medication has been proven to cause gingival

overgrowth which can increase risk of periodontal disease because the areas affected

have become so much hard to clean at home due to excessive gingival tissue and

limited access with a toothbrush and floss, meaning plaque and bacteria become

trapped at deteriorate the mouth.


Frequent dental appointments are crucial in maintaining good oral care for

patients with cerebral palsy. There are several factors to take into account when

preparing for a dental appointment with a cerebral palsy patient. Patients may

experience a difficulty opening their mouth or holding their mouth open. A bite block

may be useful during treatment. And since they have little control over their mouth,

operators should be cautious about placing fingers and other objects in the patient’s

mouth because patient’s uncontrolled movements may lead to them suddenly closing or

biting down on fingers or other objects. It wouldn’t be a bad idea to have bite block in

this instance as well to protect from injury to the patient and operator. It may also be

recommended that a care giver be present to hold the patients head, arms, or legs still

during the appointment. Gag reflex may also be an issue, so placing the patient in a

neutral position should minimize this. It is also important to not force patient into a

position that is unnatural or uncomfortable for them. Performing treatment on these

patients may need to be done standing up in order for the patient to remain comfortable.

During the oral hygiene instruction, it is important to show the patient and caretaker

what you are talking about as well as having the patient show you what they understood

from your teachings. Without this confirmation of understanding, it is very possible that

caretakers and patients are sent home with little understanding or misguided

understanding. This is an issue with normal healthy patients as well, which is why

confirmation through replication and repeating back is key.

Home care may also be difficult for them. These people are being subjected to

constant uncontrollable movement, making it very difficult to maintain a proper and

successful oral hygiene routine. It is my recommendation that patients who are


struggling with their oral care should be aided by another person to help them brush and

floss daily to prevent dental disease. However, I know that there are some patients who

feel like their independence is being stripped away if they ask someone for help, so for

the few patients who are able I would recommend an auxiliary aid to help them brush

their teeth. A larger handle added to the patient’s toothbrush would help them hold the

toothbrush and maintain a little bit more control. An electric toothbrush may also be

beneficial. The mechanical movements will do a majority of the work, all the patient has

to do it get the toothbrush into their mouth. When it comes to flossing, patients will most

definitely need assistance. Floss is too flimsy and tedious for patients to perform care

on their own. A caretaker may also find a water flosser to be beneficial for the patient

instead of floss but that isn’t always possible. Regardless of which method is chosen,

the patient’s dental hygienist should educate them about how to clean their mouth. Now

obviously the proper bass technique will not always be possible due to the spastic

muscle movements and limited access. The biggest thing that we want to convey to the

patient is the importance of brushing twice a day, brushing every tooth, and getting any

and all food out of the mouth. Caretakers should also be educated in proper brushing

and flossing because there is such a disconnect between the medical and dental needs

of patients, and sometimes dental needs get swept under the rug.

In conclusion, cerebral palsy takes an effect on the patients physical, oral, and

mental health. It is our duty as dental hygienist to make proper accommodations,

provide thorough oral education to the patient and to their caretaker, provide any aids or

materials that may be needed for efficient home care, and make sure to keep these

patients on a tight schedule for routine dental care.


References

Hebl, L. June 7th, 2022.

Kabani, F. (2015). Understanding cerebral palsy. Dimensions of Dental Hygiene,

13(12), pg. 52-55.

Kim, S. (2020). The history and origin of cerebral palsy. Cerebral Palsy Foundation:

Discovery for Disability.

Koerber, K. N., Reibel, Y. G., Drake, M., & Arnett, M.C. (2020). Successful

management of adult patients with cerebral palsy. Dimensions of Dental

Hygiene, 18(4), pg. 38-41.

Mordini, L. (2018). Maintaining oral health in patients with special needs. Dimensions

of Dental Hygiene, 16(2), pg. 37-42.

Waldman, H. B., Perlman, P. P., & Perlman, S. P. (2011). Periodontal care for

patients with special needs. Dimensions of Dental Hygiene, 9(9), pg. 78-80, 83.

Wu, Y. W., Xing, G., Fuentes-Afflick, E., Danielson, B., Smith, L. H., & Gilbert, W. M.

(2011). Racial, ethnic, and socioeconomic disparities in the prevalence of

cerebral palsy. Pediatrics, 127(3), pg. 674-681.

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