These are my notes from Dr. Bunza’s lecture on oral health in CP during the Weinberg CP Center Conference on May 18, 2013.

*This information is provided as educational material and not medical advice. Be sure to consult with your dental professional about your or your child’s unique situation.

Dr. Bunza is an Assistant Professor of Clinical Dental Medicine at the Columbia University College of Dental Medicine, section of Adult Dentistry, Division of Operative Dentistry. He is also an Assistant Attending at the NewYork-Presbyterian Hospital/Columbia University Medical Center where his responsibilities include directing the General Practice Residency Program. This program provides dental care for developmentally disabled, geriatric, and medically compromised patients. Dr. Bunza also is on the Medical Staff of the Isabella Geriatric Center.

Oral Health issues in CP:

-Plaque development-people with CP may have difficulty chewing and swallowing so they may eat starchier food leading to increased susceptibility to tooth decay

-Food sometimes remains in mouth and calcifies

-Sometimes people with CP take medications that can cause dry mouth. This can mean less saliva to wash out remaining food particles and bacteria in the mouth. Also, less saliva means less antimicrobrial benefits found in saliva that protect the teeth.

-Decay issues are so prevalent especially since it can be difficult to access and brush the individual’ posterior teeth.

-Reflux wears away enamel and this makes the teeth more vulnerable to more cavities

-Bruxism-TMJ or dysfunctions are very painful-this can affect teeth and wear away enamel exposing dentin

-It can be difficult to determine cause of pain in patients with CP. It could be gingervitis, bruxism, or decay.

Challenges to maintaining dental health in CP:

-It can be difficult to remove decay and fill cavities in the patient with CP. This can be due to:

-Oral hypersensitivity

-Positioning

-Hyper or hypo active gag reflex. Having a hyper or hypo active gag reflex can also make it difficult to remove fluids or to cough to clear fluids.

-Bite reflexes can make it hard to brush teeth as well.

Products and strategies to help dental hygiene for people w/ CP:

-Toothpastes that are gels are more water-soluble and may be tolerated better and work better because they clear out of mouth easier

-Brushes to consider: rotating head, wide handle, use tennis ball on end to modify regular brush so that it is easier to hold

-Rinsing to remove debris is one of the most important strategies in maintaining oral health

-Brush and floss as much as possible to maintain a more neutral PH in the mouth; a more acidic oral PH leads to susceptibility to dental decay and cavities

-Use a dry mouth spray

-Use a flouride varnish-consult with your dentist to see if this is appropriate

Get someone with CP to a dentist!  Even if there are problems present dental disease can be treated and the teeth can be remineralized.

Practical Oral Care for People with Cerebral Palsy from NIDCR

The American Academy of Developmental Medicine and Dentistry-AADMD

Here is a link to a comprehensive clinical report about oral hygiene and people with developmental disabilities. It is from the American Academy of Pediatrics.