(1) poor oral hygiene, increased periodontal disease, and drug-induced gingival
enlargement;
(2) malocclusion (increased prevalence of skeletal class II with anterior open-bite);
(3) a tendency to bruxism;
(4) tongue thrust and mouth breathing;
(5) an increase in caries prevalence;
(6) increased prevalence of anterior trauma;
(7) enamel hypoplasia;
(8) heightened gag reflex and peri-oral sensitivity;
(9) drooling;
(10) decreased parotid flow rate.
Although not confined to children with cerebral palsy, gastric reflux is relatively
common (1151HFig. 17.16). There may be an obvious aetiology, for example, a hiatus
hernia, but quite often a cause for the erosion cannot be identified (1152HChapter 10).
1153H
Fig. 17.16 Palatal erosion on maxillary
incisors in a child with cerebral palsy.17.3.3 Operative procedures
Children who are severely physically impaired will probably be brought to the dental
surgery in a wheelchair or be carried. Care is required in the handling of such patients
(see 1154HSection 17.4.1).
Key Points
Oral features in cerebral palsy:
- gingival hyperplasia;
- increased caries prevalence;
- malocclusion;
- dental trauma;
- enamel hypoplasia;
- heightened gag reflex;
- dental erosion and abrasion (bruxism).
Altered gag and cough reflexes may complicate the delivery of dental care or the
provision of prostheses, as well as adding to the patient's anxiety. Plentiful
reassurance, efficient suction and skilled assistance are vital to success in these
situations. Impaired ventilation may accompany scoliosis and becomes an even more
important consideration if procedures involving a general anaesthetic are