Oral Health Strategies for Cerebral Palsy and Other Neuromuscular Disorders

Information in this article was made available from a guide for parents and dental providers of children with special needs developed by the Oklahoma Dental Foundation in partnership with several funders.  The entire guide is available for download at: Oral Health Care For Children With Special Health Care Needs.

The following is an excerpt from page 15 of the guide.

Cerebral palsy is a complex group of motor issues and functional impairments that affect
muscle control and coordination. Children with this type of disorder can experience uncontrolled
body movements, stiffness, weakness in parts or all of their bodies, seizures, sensory problems,
balance and mobility problems and in many cases different levels of mental retardation.
Typical symptoms of cerebral palsy fall into many categories. This section intends to cover only
those medical issues that are unique to this disorder. Other conditions and/or behaviors will be
covered in other sections of this guide and the resource section.

Oral Effects
There are no specific oral effects, however, there are symptoms that can affect how a person is positioned and handled for dental treatment.

Once passed, comfort the child and ensure they understand to the best of their ability that they are ok and the treatment will go on or stop as determined beforehand

Physical/Behavioral Concerns Strategies for Care
Uncontrolled body movements • Do not force limbs into unnatural positions, allow the
child to settle comfortably in the chair
• Do not attempt to stop movements. However, firm,
gentle pressure can calm a shaking limb. Anticipate
movements and work around them, keeping equipment
out of the area of movement
• Tone down lights and prevent sudden unexpected
sounds as these may increase movements
• Take breaks and consider muscle relaxants or sedation
• If a wheelchair is used, the child may do better staying
in it rather than being transferred
Primitive reflexes • Often triggered by movement of the head and neck or
sudden sounds. See the resource section
Hyperactive bite and gag reflexes • Place dental instruments slowly into the mouth
• Schedule appointments early before eating and drinking
• Place child’s chin in a downward position
• Use a mouth prop if tolerated well
Dysphagia (difficulty swallowing) • Rinse mouth frequently to remove food particles
• Keep airway open by placing the child in a slightly
upright position, head turned to one side
• Use suction frequently or as tolerated
• In some cases a rubber dam might be tolerated