Special Needs Research Paper 1

(Special Needs) Research Paper Criteria Sheet

Dis

D

Poin

Possible

(/ ty that has oral implications. The disability can be one studied in you are interested in leaming more about.

Research in

lecture or

This research paper should be typed, double-spaced in written form. The paper should be 3-5 with a cover page...Include rubric. Can also be sent electronically

pages in length,

minimum of 3 references. Limit of 1 reference from the Internet (.org or hospital website). Source must be a professional organization. 1 source must come from a professional, peer reviewed dental or health joumal. Make sure all resources are professional and credible. Site a

CONTENT TO IN Topic: choice (3 points/question) *What is the *History of it ty: *Predisposing *Whom does the disability *When is population

cl

?By6+

,u"@q

(Male/female, ethnicity?) ?

Effects on the body (3 *How does disability affect *Medications prescribed to di or symptoms. *Do medications ad body? *Is the disease VE, does it have a state of remjssidn, is it a lifelong Effects on the oral *How

the considerations.

*Medications

on the oral cavity.

Dental T r eatmenlf,x{p o ln *Need for carel#er *Tooth *Dental *Appointment

modifications (2 points/question)

^oaiA,

Format of paper *Spelling/ *

Documentation of references *Required length, 3-5

References See APA style research paper references

DUE DATE: JULY 3rd

8 POINTS

€*

ere

its Dental

and

r of

Cerebral Palsy (CP) is a neuromuscular disorder

nervous system. This

disorder is caused by damage to the brain which

prior to, during, or shortly

after birth. It may also after a brain injury later in life but

much less common. It is

chxacterized by movement, coordination, and posture disorders. Alopg with these motor

/

disorders, those with CP may also experience a lack of sensation,'frception and communication.

I

William John Little was the first to describe Ol ir, 1843. He later coined the term Cerebral Palsy in 1889. Long before William Little, have been found and are thought be

of

drawings done by ancient Egyptians CP. Because CP is due to incidents

brain damage, it makes sense that this disorder

of

have occurred throughout history all over

the world. CP is not

,/ not qrfit".

i@a,nor

is

it able to be passed from person to person. Unfortunately, it is

According to the Centers for Disease Control and prevention, is also not a

,/

progressive py{rder,meaning it will not worsen as the person ages. However, as a person ages

their physical functioning naturally deteriorates. Since physical functioning is already compromised in an individual with CP, it may seem

functioning is exasperated or happening more

deterioration of their physical , making CP seem

like

a progressive

disorder.

In one study done by the Cerebral Palsy

Research Foundation"

that women of all ethnicities who received no

care were twice as

it was found

likely to have a baby

with CP. Increased risk of CP in certain areas or among different races was found to be related to a

-/'

combination of low birth rates, young gepgdnilage (younger than l8), old gestational

(older than34), and lack of prenatal education. The Risk factors for Cp are

other

but broken down into when they may occur and th

cause the disorder. Risk factors to the fetus

prior to birth include gene mutations, hypoxia

of oxygen to the brain), intrauterine

infections of the mother, fever of the mother.

in the structure of the brain, growth

restrictions while in utero, trauma and

toxins. Risk factors happening during birth

include hypoxia, premature birth, infections, and an

of the fetus within the

birth canal. Risk factors shortly after birth include (fetal stroke), hyperbilirubinemia, sepsis, lung

seizures, cerebral infarction

meningitis, shaken baby syndrome and

head injuries

There are different levels of CP, levels 1-5. These levels take into account the individuals

ability to walk, handle objects deficits relating to

communicate. Those with CP may have varying degrees

of

hearing, sensory perception, motor function, epilepsy,

cognitive function, muscle imbalances, muscle spasms, muscle and tendon deformities, joint subluxation, contractures and/or scoliosis. Depending on the severity of the disorder, medica

may not be necessary

Medications may be prescribed to patients to help treat symptoms seen with Cp, but not the disorder itself. These include muscle

r432dand tr/

medications to help with spasti c

ffients

like Botox andDiazepam. AnticholinergicsgrGssen involuntary movements, seizure medications such as Dilantin or Phenytoin, Tofranil, an incontinence medication, Omeprazole for acid reflux and behavioral disorder medications such as Adderall.

medications can have

multiple side effects. Common side effects of most of

are lethargy, loss

of

appetite, nausea and dizziness. Some have more specific side effects on the oral cavity. The seizure medication Dilantin causes gingival

leading to additional problems in the

mouth. The enlarged tissue inhibits adequate oral

care, provides additional areas

for

I

,/'

bacterial to live and been found to cause dry

contributes to periodontal disladand decay. Tofranil has sores in the mouth and on the tongue, taste

of choosing foods and drinks high in

dental

taste disturbances may form

caries and an increased risk ofbone fracture. A person a habit

ai"gh#"r,

salt. These

cavity causing foods. Many of these medications also causes

are typically high-risk

A d.y mouth with an for the decay process. Sores in

increase in cariogenic foods again, creates an ideal en

medication. These areas may be painful

the mouth or on the tongue may also be seen

and result in oral home care that is less tlaan adequate or nonexistent. This medication has the

/

potential to weaken bones causing &/ctures. Your teeth and jaw are also comprised of many

of

the same components seen in the skeletal system, throughout the body. A weakened jaw and teeth would also be a consideration fbr improper and compromised oral home care. These side

an inadequate barrier to decay alone greatly increase ones' risk

of

developing periodontal disease. Add in the potential lack of adequate oral home care and that puts these patients at an even greater risk. CP itself can aflect the oral cavity causing an array of issues. Maloccl

'drrh

among

CP patients, ranging from59o/o-92%o.The majority of the malocclusions are class 2 with overjet,

overbite, an anterior open bite and ytinability to close their lips together. It is thought this is due

to the low muscle tone of the n#muscles. This malocclusion

incrfthe

chances of these

patients mouth breathing, thus increasing the dryzess of their mqyfh and increasing the risk

of

decay. Poor ability to swallow and a forward6ngue position may be seen along with this

malocclusion. This poor ability to swallow can lead to one's risk for angular cheilitis and irritation to

or drooling. Drooling increases and chin. The malocclusion seen in CP

patients also puts them at greater risk for developing TMJ problems. It is common for these

patients to have prominent maxillary incisors.

All the factors in the malocclusion along with the

symptoms seen with CP such as increased seizure activity and the risk of a traumatic dental injury to approximately 600/o

spasms greatly increases

CP individuals. A fracture in the

enamel and dentin was the most common type of injury fo/nd in one study. Enamel defects can I also be seen in those with CP, most commonly on thehr4-ury dentition. This was found to have a

relationship to the increasedTrisk of premature births. Patients with CP also have a habit

bruxing or grinding

/

theirHth.

of

Some can be extreme bruxers which can lead to significant

abrasion to the teeth. Along with bruxism, a higher instance of thumb or pacifier sucking, and

habits of biting objects has been noted. It is thought

these habits and the side effects seen

from them are increased in CP individuals due to

dopamine function and not caused

by their malocclusion. Dental erosion is seen in

of CP patients, likely due to acid

reflux, a symptom of CP. It has been found that the more severe the neurological damage is to the CP individual, the more likely they rate in CP

have a higher risk

ofpoor oral hygiene and oral diseases. The caries to the increased caries risk include their

high. Main influences

diet and their motor and neurological Just like with all children, oral home care with CP

should begin during infancy

infant toothbrush. If the CP is

with parents wiping the teeth daily with a soft

advanced and the person cannot be taught to adequately care for their own oral hygiene, home care from a parent or caretaker needs to be continued throughout their be very reluctant to dental \y'me care. In these cases,

it may be

helper to restrain the irrglidual. Restraint techniques head while brushing. Extremely

difficult patients may

life. Some individuals can for an assistant or

sitting or reclining and cradling the to have their limbs restrained in

7

sedation or general anesthesia

order to complete dental home care. Some patients order for dental care to be

in

\

completed.

/

A dental visit for a CP patient should be scheduled in the fi^irgand long enough to properly evaluate the patient as a whole and discuss treatment for that individual. These patients may be inawheefrhair, so accommodations need to be made for the patent to maneuver into and

/

within the buil#ng. The dental team should also be prepared to

see the patient

in their own chair

or be able to transfer to a dental chair. Sometimes those with CP are nervous about meeting new people, being in a new environment and cooperating. It can be get to know you visits where everyone gets to know each

schedule one or a few

the office and little to no

dental treatment is done. During dental treatments, extra precautions may need to be taken. These patients have

difficulty swallowing

so keeping the mouth as empty and free of debris as

possible.will help reduce the risk of aspiration. These patients also have an increased risk

of

clenching their teeth, uncontrolled movements and seizures. The dental team should use finger guards, mouth props and extra caution when they have their hary/s and/or instruments in the

mouth to reduce the risk of injury to the patient

It is recommended that electric

the dental team member be used in children and adults with a variety

of disabilities including CP. Electric toothbrusheyhre fast and can provide a better cleaning than hand/manual brushing. Horizontal

/ brushing t\6t.t

are focused on due to the likelihood

of

circular motions being too difficult for the patients or their caregivers to complete. Some CP patients are able to do their own dental

an electric

brush or a manual but may need

to better secure

the brush. Floss aids,

floss reacher can be given to patients capable of doing this task

on their own or given to the parent or caregiver to aid in their ability to properly floss the patients

whole mouth while staying safe. Cerebral Palsy has a wide variation of severity. One should not speculate a patient's

deficit(s) until they have an adequate relationship with that patient. Inadequate oral hygiene can , regardless of the patient's

open any person up to a slew ofissues throughout the body.

abilities, it is so important to keep an adequate level

of

maintained throughout an

individual's life.

iP