Cerebral palsy: Dental implications

My three year-old daughter was born prematurely with mild cerebral palsy. As her teeth continue to erupt, the enamel seems absent and there has been extensive decay within the past three months. We have always brushed, flossed, and limited candy. What can we do to help?

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Premature birth and cerebral palsy both have dental implications. The tooth decay your daughter is experiencing is because the enamel layer is absent from her teeth. Healthy enamel forms a natural barrier against tooth decay.

Neglect or bad oral hygiene on your part did not cause the present decay. You should not feel guilty.

Prematurely born children can have hypocalcemia (decreased calcium), delayed tooth eruption and lack of enamel development. Hyperbilirubemia is a condition that may lead to green staining of the teeth. Prematurely born children may also have intubation trauma, which causes irregular enamel formation.

Dental effects of cerebral palsy may depend upon the etiology (the cause or origin) and type of cerebral palsy. Cerebral palsy can be caused by a variety of prenatal (before birth), perinatal (during birth), and postnatal (after birth) factors.

Prenatal causes include infections such as rubella, prematurity, and developmental defects. Perinatal factors include lack of oxygen or damage to the nervous system during delivery. Postnatal factors include tumors, stroke, trauma, infection and other central nervous system problems.

Different types of cerebral palsy are defined by the type of motor activity shown, including spasticity, athetosis (uncontrolled and uncoordinated random movements of body and face), tremors and/or rigidity.

Many patients with cerebral palsy have malocclusions -- an abnormal bite relationship between upper and lower arches -- due to muscular imbalances. This is most common in athetoid patients who constantly grimace. Severe bruxism (teeth grinding) is also quite common. Some patients have an underdeveloped enamel of the primary teeth.

The disruption of enamel formation begins when the central nervous system damage occurs in the fetus. Your daughter's teeth were probably damaged sometime during the middle of their development in-utero. This scenario would explain why your daughter's teeth appeared normal during early eruption. However, as the teeth erupted completely, the damage became evident.

I currently treat two patients that have cerebral palsy. Treating these patients in a dental office requires some modification. They may need help getting into the dental chair and may need pillows or props to make them comfortable in the chair. Gagging, coughing, biting and swallowing reflexes may be impaired or abnormal in children with cerebral palsy.

I applaud your oral hygiene efforts and diet control. Continue these aspects of your daughter's oral care. The extensive dental work your daughter faces to correct her existing decay does not necessarily have to be a recurring event. Fluoride supplements and/or dental sealants may offer additional protection from cavities. Discuss these options with your dentist.

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