Dental treatment in children with cerebral palsy, epilepsy, Down syndrome

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Dental treatment in children with cerebral palsy, epilepsy, Down syndrome

Modern medicine is constantly improving. Today, children with disabilities and health features have more and more opportunities to receive quality medical care. For such children, centers are being created where the child can receive all the necessary treatment and undergo rehabilitation. Such circumstances have a positive effect on the general quality of life of the patient himself, as well as his parents, guardians.

Children “diagnosed”: common problems

A visit to the dentist for children with physical or mental abnormalities can be a real challenge. The main problem is not only fear of the doctor and manipulation.

Special children have communication problems, they sometimes cannot be in a static position for a long time, especially with an open mouth. By the way, even ordinary children cannot always adequately withstand the reception.

This greatly complicates the doctor’s work in detail, interferes with the performance of even standard manipulations. Just a couple of decades ago, dentists in pediatric practice refused such patients, and treated children only with acute pain, and then, more often radically, under general anesthesia, with the removal of a diseased tooth (or teeth). There was no talk at all about the prevention of oral diseases.

Meanwhile, children with diagnoses such as cerebral palsy, epilepsy, autism spectrum disorders, Down syndrome have some features of the condition of the teeth and gums, as well as the development of bite.  

And today, dental treatment for children with such diagnoses is not cloudless. But, nevertheless, dentists have modern equipment, materials, and also means that make the treatment of special patients comfortable for both the children themselves and the doctor.

Cerebral palsy: features of the dental status

Caries is recognized as the most common dental pathology in children. In children diagnosed with cerebral palsy, caries and its course have a number of significant features, in addition, such patients need a special approach.  

Statistics show that the prevalence of cerebral palsy is 3-9 children per 1000. It is sad that the mass incidence of cerebral palsy over the past 30 years has increased significantly and continues to grow.

Children with cerebral palsy often suffer from a decompensated form of caries, when almost all of the teeth in the oral cavity are affected. Such a wide manifestation of the pathological process is associated with underdeveloped enamel and dentin, low mineralization, poor hygiene skills, improper diet and, to some extent, taking medications.

At the same time, caries in children with a diagnosis takes a lightning-fast course. Dentists note that from the moment the initial forms of caries are diagnosed to the complete destruction of the tooth and its loss, it can take only a few months, when in children without a diagnosis, it may take years for complete tooth decay.

In addition to dental caries, 80% of children are diagnosed with non-carious lesions of the teeth – hypoplasia, aplasia and other disorders of the development of enamel and dentin of both primary and permanent teeth.

In addition, in children with a diagnosis in 50% of cases, various speech disorders, contractures of the temporomandibular joint are found. Various periodontal diseases are often diagnosed – gingivitis, periodontitis.

Treatment of small patients

Dental treatment of children with cerebral palsy is often carried out in the offices of specialized centers or in a hospital setting. The main feature of the treatment will be the involvement of numerous related specialists – pediatrician, neurologist, anesthesiologists, etc.  

The main task of the treatment is to carry out as many medical procedures as possible in one visit: treatment of caries and its complications, tooth extraction and preventive measures. Modern dentists and specialists in pediatric practice dealing with such children recommend treatment under anesthesia, since sedation is less effective.

Parents should carefully choose a clinic that can provide treatment. She must have all the necessary equipment for the treatment: documents, certificates, equipped intensive care unit, staff anesthesiologist, intensive care unit. Parents and doctors must first discuss all the features of the treatment.

Before treatment, dentists study the small patient’s card, features of his condition, the course of the disease, the presence of accompanying patients. The treatment includes a specialist who guides the child on the underlying disease. Before the day of treatment, the child undergoes a number of laboratory tests.

Expert commentary

Mahmuthodzhaev Askar Saitkamilovich , Anesthesiology -reanimatolog, Moscow

Anesthesia, which is used in patients with cerebral palsy, has its own characteristics. This can be explained by concomitant diseases: heart defects, epilepsy, asthma and much more. Therefore, the clinics where such children are treated must have all the necessary equipment, first aid equipment for any development of events. The process of preparing for treatment itself takes more than one day, parents must answer many questions and provide a number of medical documents.

Dental treatment for children under anesthesia is literally associated with anxiety among parents. And we are talking not only about the fact that something will go wrong, but also with the possibility of “rollback”. According to parents, anesthesia and such complex procedures can lead to the loss of the achieved success in treatment. Such results are costly, both materially and morally. But personal long-term practice (over 20 years) shows that these fears are not justified. And there has not yet been a single case of any deterioration in the well-being of a child with concomitant pathologies. We are talking about an anesthetic treatment that lasted more than 3 hours.

Prevention of dental diseases

Prevention of dental diseases begins with nutritional correction: reducing the proportion of fast carbohydrates in the diet of children and increasing the amount of solid fiber foods. Particular emphasis is placed on foods high in vitamins and minerals. Children must strictly adhere to the diet: eat at the same time, in small portions, avoiding starvation.

For children with a diagnosis, additional hygienic care products are recommended, which the dentist chooses. Parents should be involved in daily hygienic manipulations. Therefore, dentists conduct a series of conversations about the rules for brushing teeth.

For preventive examinations and manipulations in the chair, it is necessary to visit the dentist every 2-3 months. Ideally, if it will be a doctor who works specifically with children diagnosed in rehabilitation centers.

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