Chelsea Litton

DH222 Special Care Client

May 13, 2016
Cerebral Palsy (CP) is a term used to describe a group of neurological chronic conditions
affecting muscle coordination and body movement. This condition is caused by damage to the brain
before, during, or shortly after birth. (UCPF, 2016).
In my patients case, his cerebral palsy was caused due to complications from a premature
birth. He was born when his mother was 7 months pregnant and suffered from oxygen deprivation
immediately after he was born. Because of this, they kept him for 42 days in the hospital after he was
born. The patient was not able to walk until the age of 5, and needs a walker to move around. The
patient has hemiparesis indicating that one arm and one leg are affected by his CP. His right leg is the
most affected by this and he had extensive surgery in 2003 for a bilateral adductor release, bilateral
psoas release, and bilateral achilles lengthening, and bilateral distal medial hamstring release. The
patient reports having physical therapy, but is no longer seeing a therapist and does not take any
medications for his condition.
The prognosis of CP is very good. In most cases, CP does not affect life expectancy. People with
CP often have an above average intelligence, and as children attend the same schools as other children
their age. While there is no cure for cerebral palsy, early treatment and intervention such as physical
therapy, occupational therapy, speech therapy and medications, can improve their capabilities and help
alleviate some pain and muscle spasms they may have. (NINDS, 2016).
People with mild to moderate CP can be seen successfully in a general dentist office. No premedication or medical consult is needed for this chronic condition, but modifications need to be made
for treatment. Patients with CP may have uncontrolled reflexes. Tonic Labyrinthine Reflex occurs if their
neck isnt supported. This causes their body to stretch into full extension and their arms and legs to

stiffen. Prevention of this is to keep the head and neck supported and flexed, and to maintain the chair
in an upright position. The other common reflex is asymmetric Tonic Neck Reflex. This is stimulated
when the head is turned to one side. The Tonic Neck Reflex causes the arm and leg on the side that the
person is facing to extend and the opposite arm and leg to flex. To prevent this, the clinician should sit in
the twelve oclock position and stabilize the head in a midline position. Lastly, the clinician should
always inform the patient with CP when they are lowering, raising or tilting the chair to prevent the
startle reflex. (National Institute of Dental and Craniofacial Research, 2016)
Startle reflex can also occur when surprising stimuli, such as noises, lights or sudden movement
occur. This can cause the patients whole body to react with forceful involuntary movement. To prevent
this, providing stress reduction techniques and a calm environment can be helpful to the patient.
(National Institute of Dental and Craniofacial Research, 2016)
Cerebral Palsy is not a direct cause for oral abnormalities. However, some conditions including
malocclusion, attrition, erosion, oral injury, dental caries and periodontal infections are more commonly
seen in patients with CP. Malocclusion often occurs from the abnormal function of the facial,
masticatory, and lingual muscles. Another cause for malocclusion can be from the patients oral habits
such as tongue thrusting, mouth breathing and faulty swallowing. The attrition can be caused by the
patients involuntary bruxism, which can be common. Gastroesophageal reflux is common with CP
patients and can lead to erosion of the oral tissues. Oral injuries can occur if the patient has fallen or had
a seizure (between 25% and 30% of these patients have had seizures related to their drug therapy).
(Wilkins, 2013).
Dental caries and periodontal infections are likely because of the difficulty for the patient to
maintain biofilm control, mouth breathing and increased food retention due to problems with
mastication. Because of this, many patients with CP also have heavy calculus deposits. Determining the

patients dexterity is important to create an appropriate oral self-care plan. A powered tooth brush, as
well as a floss holder, may be indicated. Fluoride and chlorhexidine rinses can also be recommended but
rinsing may need to be monitored by a caregiver. (Wilkins, 2013).
Seeing this patient was an incredible learning experience and I am so glad I had the opportunity
to work with this patient. The patient presented with heavy deposits of subgingival and supragingival
calculus which was expected due to his difficulties to properly care for his teeth. I explained to the
patient the importance of using his electronic toothbrush and I taught him how to use a floss-holder
which he reported that it worked well for him because he previously had difficulty flossing his back
teeth.
Taking a panoramic image was difficult because the patient was unable to stand completely
upright but we managed and were still able to receive a diagnostic image. My biggest difficulty with
seeing this patient was his startle reflex. I did not anticipate that the patient would be unable to even
close his mouth over the suction without jumping and would often be startled when I scaled in his
mouth. To combat this, I didnt have him close on the suction and I would tell him everything I was going
to do before touching him. This seemed to minimize the startle reflex and even worked when I gave him
local anesthesia. When administering the local anesthetic, I had an assistant place their hands on top of
his so he wouldnt move as much. Even with some difficulties, overall it was a successful two
appointments. I would be happy to see this patient or a patient like this again because once I got
familiar with what modifications I needed to make, it was not that difficult.

Resources

National Institute of Dental and Craniofacial Research. (2014, August). Practical Oral Care for
People With Cerebral Palsy. Retrieved May 12, 2016, from
http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCare
PeopleCerebralPalsy.htm#2
National Institute of Neurological Disorders and Stoke (NINDS). (2016, March). NINDS
Cerebral Palsy Information Page. Retrieved May 12, 2016, from
http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm
United Cerebral Palsy Foundation (UPCF) San Diego County. (2016). Retrieved May 13, 2016,
from

http://ucpsdfoundation.org/whatiscp.html

Wilkins, E. M., & Wyche, C. J. (2013). Clinical practice of the dental hygienist (11th ed.). Pages
897 to 899. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.