Introduction
Our aims in this study were to compare the biopsychosocial aspects of patients with cerebral palsy and subjects in a control group, establish the severity of malocclusion, and identify determinant factors.
Methods
The group with cerebral palsy included 60 patients diagnosed with the spastic form of the disease. The control group included 60 randomly selected healthy subjects with various malocclusions. Data were collected through questionnaires, medical charts, and clinical evaluations. The criteria of the dental aesthetic index were used for the diagnosis of malocclusion. Comparisons between groups and between the independent variables and dependent variable (severity of malocclusion) were performed by using the chi-square test ( P ≤0.05) and multivariate logistic regression (forward stepwise procedure).
Results
Significant differences between the groups were found for these variables: tooth loss, overjet, anterior open bite, facial type, breathing pattern, drooling, difficulty in swallowing, and lip incompetence.
Conclusions
The main risk factors associated with the severity of malocclusion were cerebral palsy, mouth breathing, lip incompetence, and long face.
Editor’s comment
Cerebral palsy is an umbrella term for a group of conditions characterized essentially by motor dysfunctions that might be associated with sensory or cognitive impairment stemming from a nonprogressive brain lesion during development. Its prevalence is about 2 of every 1000 live births. Impairments range from mild, with little difficulty, to severe, in which the child is completely dependent on others for daily living activities. Have you taken the time to discuss with your staff what to expect when your next patient has cerebral palsy? In relation to oral health, patients with cerebral palsy are more prone to problems. They have a greater prevalence of enamel hypoplasia, higher frequencies of carbohydrate and pasty food intake, oral self-hygiene challenges, greater difficulty in chewing and swallowing, greater use of medication, and greater prevalences of periodontal disease and malocclusion. The main characteristics associated with the prevalence of malocclusion in patients with cerebral palsy are musculoskeletal abnormalities, altered cranial-base relationships, premature tooth eruptions, and lip incompetence. The aims of this study were to compare the biologic and psychosocial aspects of patients with cerebral palsy with those of a control group, establish the severity of malocclusion, and identify determinant factors.
Noted the authors, “Orthodontists must recognize their role on the multidisciplinary team (speech therapy, psychology, ophthalmology, orthopedics, pediatrics, neurology, nutrition, and so on) that is responsible for these patients, beginning at an early age. Early, multidisciplinary treatment can help to minimize the harmful effects of malocclusion and improve the quality of life of these patients.”
The main factors associated with severe malocclusion were cerebral palsy, mouth breathing, lip incompetence, and long face. Patients with cerebral palsy also had a greater prevalence of malocclusion compared with healthy children. The benefit of increased knowledge in this area of diagnosis and treatment for those with cerebral palsy will allow you and your staff to be more comfortable and effective in delivering the best possible care.
| Group | |||
|---|---|---|---|
| Control, n (%) | Cerebral palsy, n (%) | P | |
| Tooth loss | |||
| None | 59 (55.1) | 48 (44.9) | 0.001 |
| At least 1 | 1 (7.7) | 12 (92.3) | |
| Crowding | |||
| None | 31 (43.1) | 41 (56.9) | 0.062 |
| 1 or 2 segments | 29 (60.4) | 19 (39.6) | |
| Spacing | |||
| None | 34 (54.0) | 29 (46.0) | 0.361 |
| 1 or 2 segments | 26 (45.6) | 31 (54.4) | |
| Diastema (mm) | |||
| <2 | 47 (54.7) | 39 (45.3) | 0.105 |
| ≥2 | 13 (38.2) | 21 (61.8) | |
| Maxillary irregularity (mm) | |||
| <2 | 48 (47.5) | 53 (52.5) | 0.211 |
| ≥2 | 12 (63.2) | 7 (36.8) | |
| Mandibular irregularity (mm) | |||
| <2 | 50 (47.6) | 55 (52.4) | 0.168 |
| ≥2 | 10 (66.7) | 5 (33.3) | |
| Overjet (mm) | |||
| <4 | 46 (63.9) | 26 (36.1) | <0.001 |
| ≥4 | 14 (29.2) | 34 (70.8) | |
| Mandibular protrusion | |||
| No | 59 (50.4) | 58 (49.6) | 1.000 |
| Yes | 1 (33.3) | 2 (66.7) | |
| Anterior open bite (mm) | |||
| <2 | 57 (62.6) | 34 (37.4) | <0.001 |
| ≥2 | 3 (10.3) | 26 (89.7) | |
| Posterior crossbite | |||
| Absent | 52 (51.5) | 49 (48.5) | 0.453 |
| Present | 8 (42.1) | 11 (57.9) | |
| Facial type | |||
| Average | 45 (61.6) | 28 (38.4) | 0.006 |
| Short face | 1 (50.0) | 1 (50.0) | |
| Long face | 14 (31.1) | 31 (68.9) | |
| Angle classification | |||
| Class I | 31 (56.4) | 24 (43.6) | 0.036 |
| Class II | 25 (53.2) | 22 (46.8) | |
| Class III | 4 (22.2) | 14 (77.8) | |
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