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:
- 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.