Study Questions     

1. What may be the cause of increased DMF scores in patients with cerebral palsy?

2. Which is likely the most serious of the oral disease problems in cerebral palsy, and what might prove to be the best strategy for its management?

3. Describe the possible causes of malocclusion and dental attrition.

4. Comment on the importance of practitioners looking for signs and symptoms of prior trauma associated with falls.

Periodontal and Dental Status 

Reports indicate the presence of increased DMF (decayed, missing, and filled) scores and increased periodontal disease in the CP population as compared to non-CP controls.  The increased DMF scores are the result of more decayed and missing teeth rather than filled teeth and probably reflect the tendency to extract teeth rather than to perform restorative procedures. 

Periodontal disease is probably the most serious of the oral disease problems. Historically, the caretakers of persons with CP did not see oral hygiene as a priority.  Antimicrobial coverage such as that provided by fluoride rinses and chlorhexidine ultimately may be the best strategy for management of periodontal disease. 

Other oral problems that may require management in the dental patient with CP are malocclusion, most likely a consequence of severe chronic tongue thrust during the developmental years that persists into the adult years, maintaining the malocclusion.  The problem of malocclusion may become significant in the management of periodontal problems or in the provision of reconstructive restorative care. 

Dental attrition is due to the constant bruxing and clenching that occurs in these individuals.  The attrition is often so extensive that the teeth are worn through the primary dentin and the pulp chamber can be seen through the secondary dentin.  There is no therapy that will reduce the movement, and management must be directed toward protection of the existing tooth structure. 

The practitioner also should be alert for signs and symptoms of prior trauma from falls that occur as a consequence of the neuromuscular component of the disability.  A record of these may appear in the dental history, but the presence of dental fractures, jaw fractures, intruded teeth and facial scarring are cues to prior injury.  Appropriate consultations are indicated. 

Click here to read an article entitled Cerebral Palsy and Dentistry: A Brief Review, by Dr. Thomas W. Stanford (2000).