D Dis (Special Needs) Research Paper Criteria Sheet

Poin Possible (/

Research in ty that has oral implications. The disability can be one studied in
lecture or you are interested in leaming more about.

This research paper should be typed, double-spaced in written form. The paper should be 3-5
pages in length,with a cover page...Include rubric. Can also be sent electronically

Site a minimum of 3 references.

Limit of 1 reference from the Internet (.org or hospital website). Source must be a
professional organization. 1 source must come from a professional, peer reviewed dental or
health joumal. Make sure all resources are professional and credible.

CONTENT TO IN
Topic:
*What is the
choice (3 points/question) cl
*History of ty: it ?By6+
*Predisposing ,u"@q
*Whom does the disability (Male/female, ethnicity?)
*When is population ?

Effects on the body (3

*How does disability affect
*Medications prescribed to di or symptoms.
*Do medications ad body?
*Is the disease VE, does it have a state of remjssidn, is it a lifelong

Effects on the oral

*How the
considerations.
*Medications on the oral cavity.

Dental T r eatmenlf,x{p o ln modifications (2 points/question) 8 POINTS

*Need for carel#er
*Tooth
*Dental
*Appointment
^oaiA,
Format of paper
*Spelling/
*Documentation of references
*Required length, 3-5

References
See APA style research paper references

DUE DATE: JULY 3rd

€*

ere and
its Dental
r

Cerebral Palsy (CP) is a neuromuscular disorder of nervous system. This

disorder is caused by damage to the brain which prior to, during, or shortly

after birth. It may also after a brain injury later in life but much less common. It is

chxacterized by movement, coordination, and posture disorders. Alopg with these motor
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disorders, those with CP may also experience a lack of sensation,'frception and communication.
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William John Little was the first to describe Ol ir, 1843. He later coined the term

Cerebral Palsy in 1889. Long before William Little, drawings done by ancient Egyptians

have been found and are thought be of CP. Because CP is due to incidents of
brain damage, it makes sense that this disorder have occurred throughout history all over

the world.

CP is not i@a,nor is it able to be passed from person to person. Unfortunately, it is

,/
not qrfit". According to the Centers for Disease Control and prevention, is also not a
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progressive py{rder,meaning it will not worsen as the person ages. However, as a person ages

their physical functioning naturally deteriorates. Since physical functioning is already

compromised in an individual with CP, it may seem deterioration of their physical

functioning is exasperated or happening more , making CP seem like a progressive

disorder.

In one study done by the Cerebral Palsy Research Foundation" it was found

that women of all ethnicities who received no care were twice as likely to have a baby

with CP. Increased risk of CP in certain areas or among different races was found to be related to
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a combination of low birth rates, young gepgdnilage (younger than l8), old gestational

(older than34), and lack of prenatal education. The Risk factors for Cp are other
 but broken down into when they may occur and th cause the disorder. Risk factors to the fetus

prior to birth include gene mutations, hypoxia of oxygen to the brain), intrauterine

infections of the mother, fever of the mother. in the structure of the brain, growth

restrictions while in utero, trauma and toxins. Risk factors happening during birth

include hypoxia, premature birth, infections, and an of the fetus within the

birth canal. Risk factors shortly after birth include seizures, cerebral infarction

(fetal stroke), hyperbilirubinemia, sepsis, lung meningitis, shaken baby syndrome and

head injuries

There are different levels of CP, levels 1-5. These levels take into account the individuals

ability to walk, handle objects communicate. Those with CP may have varying degrees of
deficits relating to hearing, sensory perception, motor function, epilepsy,

cognitive function, muscle imbalances, muscle spasms, muscle and tendon deformities, joint

subluxation, contractures and/or scoliosis.

Depending on the severity of the disorder, medica may not be necessary

Medications may be prescribed to patients to help treat symptoms seen with Cp, but not the

disorder itself. These include muscle r432dand

tr/ medications to help with spasti c ffients
like Botox andDiazepam. AnticholinergicsgrGssen involuntary movements, seizure

medications such as Dilantin or Phenytoin, Tofranil, an incontinence medication, Omeprazole for

acid reflux and behavioral disorder medications such as Adderall. medications can have

multiple side effects. Common side effects of most of are lethargy, loss of
appetite, nausea and dizziness. Some have more specific side effects on the oral cavity. The

seizure medication Dilantin causes gingival leading to additional problems in the

mouth. The enlarged tissue inhibits adequate oral care, provides additional areas for
 I

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bacterial to live and contributes to periodontal disladand decay. Tofranil has

been found to cause dry sores in the mouth and on the tongue, taste ai"gh#"r, dental

caries and an increased risk ofbone fracture. A person taste disturbances may form

a habit of choosing foods and drinks high in salt. These are typically high-risk

cavity causing foods. Many of these medications also causes A d.y mouth with an

increase in cariogenic foods again, creates an ideal en for the decay process. Sores in

the mouth or on the tongue may also be seen medication. These areas may be painful

and result in oral home care that is less tlaan adequate or nonexistent. This medication has the
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potential to weaken bones causing &/ctures. Your teeth and jaw are also comprised of many of

the same components seen in the skeletal system, throughout the body. A weakened jaw and

teeth would also be a consideration fbr improper an inadequate barrier to decay

and compromised oral home care. These side alone greatly increase ones' risk of

developing periodontal disease. Add in the potential lack of adequate oral home care and that

puts these patients at an even greater risk.

CP itself can aflect the oral cavity causing an array of issues. Maloccl
'drrh among

CP patients, ranging from59o/o-92%o.The majority of the malocclusions are class 2 with overjet,

overbite, an anterior open bite and ytinability to close their lips together. It is thought this is due

to the low muscle tone of the n#muscles. This malocclusion incrfthe chances of these

patients mouth breathing, thus increasing the dryzess of their mqyfh and increasing the risk of

decay. Poor ability to swallow and a forward6ngue position may be seen along with this

malocclusion. This poor ability to swallow can lead to or drooling. Drooling increases

one's risk for angular cheilitis and irritation to and chin. The malocclusion seen in CP

patients also puts them at greater risk for developing TMJ problems. It is common for these
patients to have prominent maxillary incisors. All the factors in the malocclusion along with the

symptoms seen with CP such as increased seizure activity and spasms greatly increases

the risk of a traumatic dental injury to approximately 600/o CP individuals. A fracture in the

enamel and dentin was the most common type of injury fo/nd in one study. Enamel defects can
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also be seen in those with CP, most commonly on thehr4-ury dentition. This was found to have

a relationship to the increasedTrisk of premature births. Patients with CP also have a habit of
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bruxing or grinding theirHth. Some can be extreme bruxers which can lead to significant

abrasion to the teeth. Along with bruxism, a higher instance of thumb or pacifier sucking, and

habits of biting objects has been noted. It is thought these habits and the side effects seen

from them are increased in CP individuals due to dopamine function and not caused

by their malocclusion. Dental erosion is seen in of CP patients, likely due to acid

reflux, a symptom of CP.

It has been found that the more severe the neurological damage is to the CP individual,

the more likely they have a higher risk ofpoor oral hygiene and oral diseases. The caries

rate in CP high. Main influences to the increased caries risk include their

diet and their motor and neurological

Just like with all children, oral home care with CP should begin during infancy

with parents wiping the teeth daily with a soft infant toothbrush. If the CP is

advanced and the person cannot be taught to adequately care for their own oral hygiene, home

care from a parent or caretaker needs to be continued throughout their life. Some individuals can

be very reluctant to dental \y'me care. In these cases, it may be for an assistant or

helper to restrain the irrglidual. Restraint techniques sitting or reclining and cradling the

head while brushing. Extremely difficult patients may to have their limbs restrained in
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order to complete dental home care. Some patients sedation or general anesthesia in
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order for dental care to be completed.
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A dental visit for a CP patient should be scheduled in the fi^irgand long enough to

properly evaluate the patient as a whole and discuss treatment for that individual. These patients

may be inawheefrhair, so accommodations need to be made for the patent to maneuver into and
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within the buil#ng. The dental team should also be prepared to see the patient in their own chair

or be able to transfer to a dental chair. Sometimes those with CP are nervous about meeting new

people, being in a new environment and cooperating. It can be schedule one or a few

get to know you visits where everyone gets to know each the office and little to no

dental treatment is done. During dental treatments, extra precautions may need to be taken.

These patients have difficulty swallowing so keeping the mouth as empty and free of debris as

possible.will help reduce the risk of aspiration. These patients also have an increased risk of

clenching their teeth, uncontrolled movements and seizures. The dental team should use finger

guards, mouth props and extra caution when they have their hary/s and/or instruments in the

mouth to reduce the risk of injury to the patient the dental team member

It is recommended that electric be used in children and adults with a variety

of disabilities including CP. Electric toothbrusheyhre fast and can provide a better cleaning than
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hand/manual brushing. Horizontal brushing t\6t.t are focused on due to the likelihood of

circular motions being too difficult for the patients or their caregivers to complete. Some CP

patients are able to do their own dental an electric

brush or a manual but may need to better secure

the brush. Floss aids, floss reacher can be given to patients capable of doing this task
on their own or given to the parent or caregiver to aid in their ability to properly floss the patients

whole mouth while staying safe.

Cerebral Palsy has a wide variation of severity. One should not speculate a patient's

deficit(s) until they have an adequate relationship with that patient. Inadequate oral hygiene can

open any person up to a slew ofissues throughout the body. , regardless of the patient's

abilities, it is so important to keep an adequate level of maintained throughout an

individual's life.

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