DEVELOPMENTAL DISABILITIES
syndromes have an intellectual component that make adaptation to activities of daily living a challenge. In most cases, the cause of an intellectual disability is unknown (Patel et al., 2020). Neurological disorders are caused by a disturbance in structure and function of neurological systems. This disturbance can be the result of disease, injury, or environmental toxin. Seizure disorder is one example of a neurological developmental disability. It has been estimated that 15% of children ages 3 to 17 years in the U.S. have at least one type of developmental disability (Zablotsky et al., 2019). Given the prevalence of these conditions, oral health providers should be aware of the challenges and needs of this patient population to help ensure long-term oral health. The four broad categories of developmental disabilities will be discussed here. The spastic classification is the most prevalent form of CP, with 70% to 80% of cases presenting in this group. Spasticity is caused by upper motor neuronal damage that leads to an increase in muscle tone that is usually isolated to the limbs (CDC, 2023d). Patients with spastic CP tend to have contractures (muscles become fixed in a rigid, abnormal position) of the limbs that make positioning in the dental chair problematic. Athetoid CP falls under the classification of extrapyramidal disorders and is representative of 10% to 15% of cases. This type of CP, also called dyskinetic CP (CDC, 2023d), results from damage to deep motor neurons or trauma to the basal ganglia. This group of patients present with hypotonia (decreased muscle tone); slow, writhing movements; and abnormal postural control, including involuntary movements. Oromotor issues are found in these patients, causing speech and swallowing difficulties. It is important to be aware of the airway management issues with this type of CP in order to avoid salivary or foreign body aspiration during treatment. The least common type of CP is called ataxic , and it is present in about 5% of cases (CDC, 2023c). Typically, these patients present with problems of voluntary movement, balance, and depth perception. for appropriate dental management via the caries risk assessment tool. The increased colonization of the oral cavity by respiratory pathogens means that the risk of pneumonia is very high. Dyskinetic movements (abnormal voluntary muscle movements) and pathologic oral reflexes can make it difficult for patients to self-manage their oral hygiene. The dentist and hygienist are important members of the healthcare team for patients with CP. Salivation, gastroesophageal reflux, and motor control issues related to eating and oral hygiene affect the caries risk assessment, making it important for the dental team to educate parents about the specific needs of each child. To prevent joint trauma during dental treatment, postural maintenance should be of concern. Providers should be vigilant about suctioning excessive saliva. Hospital dentistry should be considered only as a last resort when ventilator capacity is affected, there is a severe compromising gag reflex, or behavioral issues prevent treatment in a typical dental setting.
Developmental disabilities are a group of disorders generally defined as “ a lifelong disease state due to mental or physical impairment occurring before age 18 “ (National Institute of Child Health and Development, 2021). This patient population presents with conditions affecting at least three of the four following activities of daily living: ability to live independently, mobility, self-hygiene, and learning capabilities. Developmental disabilities can be grouped according to various classification systems, including musculoskeletal, neurological, and neuromuscular, all of which can have genetic components. Musculoskeletal disorders include spinal stenosis (narrowing of the spinal column that causes pressure on the spinal cord) and polychondritis (recurrent episodes of inflammation of cartilaginous tissues). Neuromuscular disorders include cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Genetic conditions such as Down and fragile X Cerebral palsy According to the CDC (2023d), the most common motor disorder affecting children is cerebral palsy. This group of disorders affects movement and posture and limits children’s daily activities. It is nonprogressive in nature, meaning the condition will not worsen over time. Cerebral palsy (CP) results from damage that occurs in the developing fetus or infant brain. Cerebral palsy involves disturbances of motor function and may be associated with sensory function, cognition, communication, and perception, as well as behavioral components. Seizure disorders can often be found in patients with cerebral palsy. A prenatal cause of CP is found in 85% to 90% of cases (CDC, 2023d). Prenatal causes include trauma, poor maternal nutrition, illicit drug use, and tobacco use. Cerebral palsy can also be induced perinatally and postnatally (at the time around or after birth), although it is much less common for damage to occur during these times. More than 1 million people in the U.S. are living with CP, and between 87% and 93% of these individuals live well into adulthood. It is important to understand the three subclassification of CP in order to understand the differences among patients with this condition (CDC, 2023d; Cerebral Palsy Guide, 2023). spasticity, joint contractures, hip dislocation, cognitive disability, and seizures. These patients often present with gastroesophageal reflux, which can erode the dentition. Temporomandibular joint disorders have been found in 37.5% of children with cerebral palsy, in addition to higher rates of tooth wear and dental trauma compared to patients without cerebral palsy (Cerebral Palsy Guide, 2023). Frequently, an anterior open bite is encountered due to hypotonia of the orofacial musculature. Mouth breathing is also a common finding that can lead to increased inflammation of the gingival tissues. Inadequate motor function may result in pouching or pocketing of food in the buccal vestibule as a result of inability to clear foods properly (Lansdown et al., 2022). Sialorrhea, or excessive salivation, is very common among patients with CP. Sixty percent or more of patients have an inability to swallow the normal output of saliva (Lansdown et al 2022). This problem can lead to angular cheilitis and chapping of the lips. If excessive salivation is treated, the concern is for hyposalivation, leading to the need Dental treatment implications Conditions typical of most patients with CP are
EliteLearning.com/Dental
Page 155
Powered by FlippingBook