Supporting Oral Health in Patients With Spina Bifida
Spina bifida is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors.
Spina bifida is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. It is part of a larger group of congenital birth defects termed neural tube defects. These congenital birth defects affect various parts of the central nervous system, such as the brain, spine, and spinal column. Spina bifida, the most common neural tube defect, is a largely preventable, noncommunicable, and permanently disabling congenital condition that results in the incomplete development of the brain, spinal cord, and/or meninges. Health disparities continue to exist for individuals with neural tube defects in both racial/ethnic and sex distribution. Hispanic individuals are at higher risk than non-Hispanics. Non-Hispanic whites are at higher risk than non-Hispanic blacks. In all racial and ethnic communities, women are at higher risk than men.
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Bowel and Bladder Problems
Patients with impaired autonomic nerve function can manifest with neurogenic bowel and bladder. There are multiple oral health considerations for populations affected with neurogenic bowel and bladder, including attentiveness to scheduling appointments, provider sensitivity to patients’ needs to use the restroom, and xerostomia management. Patients with neurogenic bowel and bladder should be encouraged to use the restroom before the appointment and clinicians should frequently suggest restroom breaks during lengthy appointments. Oral health professionals should suggest methods to mitigate decreased salivary flow, such as using over-the-counter glycerin-based mouthrinses and toothpastes with a neutral pH, saliva substitutes, and oral lubricants. Patients with xerostomia are also at an increased risk for dental caries and, therefore, need close monitoring and, if indicated, topical fluoride therapy.
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Many patients with spina bifida have orthopedic concerns such as clubfoot, dislocated hips, spinal dysplasia, and atypical musculoskeletal contractures. Patients with significant abnormal spinal curvatures undergo surgical rodding procedures that attempt to align the spinal column to a near-normal curvature. Some orthopedic surgeons require patients to obtain medical clearances from other clinicians, including the patient’s oral health professional, prior to spinal instrumentation. As such, patients who are candidates for spinal surgery need to complete oral health care treatment as soon as possible. Oral health professionals need to maintain communication with the patient and his/her orthopedic surgeon regarding the medical necessity for prophylactic antibiotic premedication for routine and invasive dental procedures post-spinal instrumentation.
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Patients with spina bifida are at increased risk for orofacial musculoskeletal concerns, such as Angles Class II malocclusions. Patients with malocclusions and crowding have difficulty maintaining adequate oral hygiene and are at an increased risk for developing both dental caries and periodontal diseases. Patients with complex malocclusions may want to see an orthodontist for therapeutic realignment. Oral health professionals need to help patients minimize their incidence of oral diseases by stressing oral hygiene education, increasing preventive dental hygiene visits, placing dental sealants, frequently applying topical fluoride, and providing referrals to dental specialists, as necessary.
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Patients with spina bifida are at an increased risk for a compromised vertebral column; thus, affected patients often experience a permanent altered sensory function. Most patients with spina bifida are limited in ambulation and are likely to use assistive devices, such as wheelchairs. There are multiple oral health care considerations for patients with limited ambulation and insensate skin. Clinicians need to identify if the patient, based on comfort and safety, should remain in the wheelchair or transfer to the dental chair for treatment. If the patient remains in the wheelchair, then oral health professionals will need to use adaptive ergonomics to complete the necessary treatment. Alternatively, if a patient transfer scenario is indicated, clinicians need to ensure that the patient’s receiving platform is at a lower height than the initial platform to minimize risk for patient injury.
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Patients with impaired sensory function are at increased risk for developing sores, calluses, blisters, and bruises. Due to localized spatial areas of insensate skin, patients with spina bifida are likely to be unaware of their pressure-based wound. Affected dental patients can benefit from the use of an intermediary device placed between the patient and the firm dental chair, such as a soft beanbag. A beanbag adapts to the patient’s musculoskeletal structure and redistributes the bodily pressures. Patients placed on soft beanbags are seated both on adaptive, more secure structures, reducing their risk for pressure wounds. Oral health professionals should ideally schedule short appointments to minimize these concerns.
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Patients with spina bifida are at increased risk of latex sensitivity. Oral health professionals need to note that many products used in dentistry may contain latex, including, but not limited to adhesive bandages; blood pressure cuffs; personal protective equipment, such as gloves and masks; nitrous oxide reservoir bag; orthodontic bands/elastics; rubber cup polish; rubber dams; and saliva ejectors. An adequate supply of nonlatex alternatives for commonly used armamentarium should be maintained. Early morning clinical appointments are ideal for patients with latex sensitivity to minimize aerosol exposure.