PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

1146H


Fig. 17.13 Loose calculus deposits in a child with chromosome 4p-syndrome.


1147H


Fig. 17.14 The dental effects of frequent medication in a child with a cleft of the lip
and palate.


17.3 PHYSICAL IMPAIRMENT⎯CEREBRAL PALSY


17.3.0 Introduction


The common physical impairments the dentist will encounter are: developmental
neuromuscular disorders, for example, cerebral palsy, spina bifida, scoliosis, and
osteogenesis imperfecta; and degenerative neuromuscular disorders, for example,
muscular dystrophy and juvenile forms of arthritis. Included in this general category
of physical impairment are children with clefts of the lip and/or palate (1148HChapter 14),
where there may well be an associated syndrome in up to 19% of cases.


17.3.1 General considerations


Cerebral palsy occurs in 1-2 children per 1000 of school age, a figure which has been
relatively stable because of the improved quality of survival of premature babies. This
is a group of non-progressive neuromuscular disorders caused by brain damage,
which can be pre-, peri-, or postnatal in origin, and is classified according to the type
of motor defect:



  1. Spasticity⎯impaired ability to control voluntary movements. There is the
    appearance of severe muscle stiffness and the planned movement of an affected limb
    results in a hypotonic tendon reflex, especially with rapid movements. Spasticity
    occurs in about 50% of cases of cerebral palsy.

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