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Oral health care considerations for patients with cerebral palsy:

  • Document available support networks.
  • Address increased prevalence of periodontal diseases, possibly due to poor oral hygiene, increased mouth breathing, and medications.
  • Address increased prevalence of caries, possibly due to poor oral hygiene, increased mouth breathing, medications, enamel hypoplasia, and food pouching .
  • Be aware of increased incidents of trauma the face and mouth, which may be due to self-injury. Consider protective oral appliances.
  • Address possible:
    • bruxism – clenching and grinding of teeth
    • rumination – regurgitation, re-chewing and re-swallowing
    • pouching – placement of food and medication between the cheek and the teeth for extended periods
    • pica – compulsive eating of non-edible substances.
  • With increased vomiting and presence of rumination, palatal enamel erosion may be present.
  • Recognize gingival overgrowth that may be present in patients taking anticonvulsants.
  • Determine each patient’s communication skills and apply a tell-show-do approach and positive reinforcement with patients with impaired intellectual capacities.
  • Increased verbal communication with visually impaired patients.
  • Increase nonverbal communication techniques in patients with hearing impairments.
  • Be aware of increased involuntary movements of facial muscles, lips and tongue.
  • Be aware of increased incidence of a severe gag reflex.
  • In case of swallowing difficulties, coughing, gagging, choking and risk for aspiration, place the patient in a slightly more upright position and turn the patient’s head to one side. Use high evacuation suctioning.
  • Considering using a mouth prop.
  • Recognize possible abuse and neglect.
  • Use sedation or general anesthesia when appropriate.
  • Address patient’s ability to perform proper oral health care independently.
  • Instruct care providers in proper oral hygiene practices.
  • When appropriate, recommend a power tooth brush, or adopt existing tooth brush to enhance the grip and usability, and use of daily antimicrobial mouth rinses, or local application of antimicrobial agents.

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