Child Dental Patient with CEREBRAL PALSY

Clinical cases

Clinical case 1


D.A, female, age 19 y

(Dr. Mihaela Tanase)

General dg:

    Spastic paraparesis
    Infantile encephalopaty
    Bilateral hearing impairment
    Severe ophtalmic disorder
    Autoimmune thyroiditis
    Mitral valve prolapse

Oral features

    Unilateral cheilognatopalatoskizis on the left side
    Hypodontia – 2.2 agenesis
    Persistence of 6.2, 6.3
    Multiple uncomplicated caries

Due to patient’s non-compliance, initial treatment was done under GA:

  • Extractions: 62, 63
  • Conservative treatment of caries using silver amalgam / GI

2 years after (age 21)

Previous treatments were in place, but new problems occured

Clinical aspects at age 21

Patient allows herself to be treated in-office. Composite restorations, endodontics and even prosthetic restorations are now accepted.

 

 

Clinical case 2


CAN, male, age 26 y

(Dr. Mihaela Tanase)

General dg:

  • Spastic paraparesis
  • Mild intellectual impairment

Oral findings:

  • Multiple caries (treated/untreated, with/without periapical involvement)
  • Multiple previous extractions
  • Periodontal disease
  • Malocclusion; deep bite
  • TMD signs and symptoms
  • Severe masticatory disfunction;
  • Impaired appearance

 

Dental history

  • Previous attempts of conservative treatment, mostly failed due to lack of compliance
  • The patient was referred for extractions of compromised teeth under GA
  • After the GA session, the patient was referred to the Pedodontics Department for conservative treatment
  • Cooperation was initially very poor, but improved with time and patience – patient gradually accepted treatment in dental office

Treatment plan

Under the given circumstances, an ideal full-mouth rehabilitation was regarded as non-feasible.
Patient and family requested an improvement of appearance and finally agreed with:

  • Direct restorations on:       17,16,23,26,33,31,37,41,42,43
  • Endodontic treatment on 13,11,21,22.
  • Post and core on 11,21,22
  • Metalo-acrylic bridge 13-22

TELL-SHOW-DO technique was used during all phases of treatment

Clinical aspects during treatment

 

Clinical case 3


GS, male, age 12 y 8 m

(Dr. Arina Vinereanu)

General dg: cerebral palsy
Reason for dental visit:seeking a second opinion on the management of fractured 21; previous recommendation: extraction

Anamnesis:   

  • recurrent trauma due to poor stability
  •  fractured fragment was found and stored dry for 4m (clinical appearance: white, dehydrated)  

Oral findings:

  • 21 crown fracture (without pulp involvement)
  • Brown extrinsic discoloration
  • Gingivitis; poor oral hygiene
  • Incipient cervical demineralization

Professional cleaning is done using regular suction and power suction simultaneously  in order to avoid choking.
Patient’s mom is holding his head.
Despite difficulties in controlling movements, patient is willing to cooperate
21 responds to vitality test
Decision to attempt reattachment of fractured fragment is taken

Fractured 21 is restored by fragment reattachment
White discoloration of reattached fragment to be noted

Patient is very happy with the result.

 

Follow-up:
3 m recalls are scheduled for check-ups, professional cleaning and prevention; topical fluoridation (Voco Profluorid Varnish) is applied with every visit
6 m after 1st visit the reattached fragment regained initial colour (photo)
Trauma re-occurred twice during the following 4 years and the fragment was retrieved and reattached every time.

4y7m years after the first reattachment, brown discoloration of the crown occurred
21 was non-vital
X-ray  revealed periapical radiolucency
Endodontic treatment is initiated
Calcium hidroxyde dressing is applied, followed by ZnO-eugenol root canal filling (chosen for the antimicrobial properties of eugenol)

3 ½ months later the tooth is asymptomatic and periapical healing is in progress.

Decision is taken to carry on with a composite crown restoration without a Titanium post → reduce risk of vertical root fracture in case of recurrent trauma.

 

 

  • Treatment is performed in patient’s wheelchair.
  • A travel pillow is used as a head rest.
  • The mum helps minimize uncontrolled moves.

Close power suction is used while rinsing the acid in order to avoid choking.

 

Video