Caring for Adults With Cerebral Palsy
Cerebral palsy (CP) is a disorder caused by encephalic damage that occurs during fetal development or infancy; it impairs motor coordination, cognitive function, sensation, perception, and communication abilities.
Cerebral palsy (CP) is a disorder caused by encephalic damage that occurs during fetal development or infancy; it impairs motor coordination, cognitive function, sensation, perception, and communication abilities. A lifelong disability, CP increases the risk for oral health disparities and comorbidities in adulthood. The disabilities presented by CP are not progressive, but they are permanent, and they impact health and well-being. As treatment has improved, life expectancies of those with CP have continued to grow, which has increased the demand for inclusive oral-systemic healthcare to enhance quality of life.
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Classifying CP
Cerebral palsy (CP) is a disorder caused by encephalic damage that occurs during fetal development or infancy; it impairs motor coordination, cognitive function, sensation, perception, and communication abilities. A lifelong disability, CP increases the risk for oral health disparities and comorbidities in adulthood. The disabilities presented by CP are not progressive, but they are permanent, and they impact health and well-being. As treatment has improved, life expectancies of those with CP have continued to grow, which has increased the demand for inclusive oral-systemic healthcare to enhance quality of life.
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Increased Risk
Dental hygiene assessment of risk factors impacting oral health is imperative for prevention and management of oral diseases among adults with CP. This patient population is at elevated risk for caries and periodontal diseases due to difficulty with biofilm control, loss of motor function, and decreased access to oral healthcare. The combination of high biofilm indices, mouth breathing, and infrequent dental visits are contributing factors for both diseases.
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Medication Usage
Medications taken by adults with CP may also impact oral health. Five main drug classes are commonly prescribed to control CP symptoms:
- Anticholinergics to control muscle spasms, sialorrhea, and urinary incontinence
- Anticonvulsants for epileptic episodes
- Antidepressants for depression; antispastic/muscle relaxant for muscle spasms
- Anti-inflammatory medication for pain
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Ensure Successful Appointments
To effectively care for adults with CP, dental hygienists should be prepared to collaborate with other healthcare providers, caregivers/family members, and social workers. In addition, dental hygienists should support autonomy of adults with CP to make their own oral healthcare decisions. Determining what type of modifications may be needed to increase the success of the dental appointment is a prudent strategy. Inquiring about what time of day and how long the patient can remain in the dental chair should inform appointment scheduling. Depending on the level of motor function and potential cognitive impairment, scheduling short morning appointments at the beginning of the week may be beneficial to ensure the individual is best able to tolerate the appointment.
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Modifications
Dental hygienists may also need to modify the dental hygiene appointment and patient education to the patient’s level. Adults with CP may have sensory issues related to textures, scents, and sounds. This may make the use of ultrasonic scalers and slow-speed handpieces and implementation of polishing and fluoride agents challenging. In addition, oral health professionals will need to consider the cognitive, sensory, and functional status of patients when recommending a self-care regimen. A thorough interview with the patient and caregiver before delivering dental hygiene care or developing a self-care regimen may increase the success of the dental appointment and improve patient compliance.
