CP Special Needs
CP Special Needs
CP Special Needs
Larissa Henecke
inspiration for his research, discovered Cerebral Palsy (CP). It is now estimated that
764,000 people have CP in the US. CP is a non-progressive disorder that occurs when
there is neurological damage to the fetal or infant brain that prevents it from developing
properly. The word “cerebral” refers to the cerebrum of the brain, which regulates motor
function and “palsy” describes paralysis of voluntary body movements. Common causes
of CP are bacterial and viral infections, brain hemorrhaging, lack of oxygen to brain,
prenatal exposure to alcohol or drugs, and head injuries during birth or infancy. There are
many symptoms and signs of CP that occur in varying severities depending on the injury.
Commons signs are problems with movement, stiff muscles, jerky reflexes, tremors, lack
delayed motor skill development, and gastrointestinal problems. Other conditions that
may also be commonly present along with CP include epilepsy, vision or hearing
There are four main types of CP. The most common is spastic which makes up
70% of cases. It is most commonly characterized by stiff or rigid muscles, legs that are
turned inward, or arms that are flexed and against their bodies. Many also experience
noted by slow, uncontrolled, squirming movements and tremors. They may also have
speech disorders. Ataxic is often characterized by problems with balance and depth
perception, along with an unsteady gait. The last type, combined form, is a combination
of all types. Every person with CP exhibits problems with movement and posture.
Severity of all cases is dependent on the injury and the individual. (About, 2017)
There is currently no cure for CP, but there are many treatments that can help
children and adults live a full life. Patients with CP should have a multidisciplinary team
muscle relaxants, nerve blocks, Botox, Benzodiazepines, and Baclofen, given for muscle
incontinence, acid reflux, or behavioral disorders also may be given. Side effects of the
Cerebral Palsy does not directly cause any oral abnormalities, but there are many
conditions that are more common and severe in people with CP. Periodontal disease is
more prevalent due to poor oral hygiene, physical ability, malocclusion, and medications
causing gingival hyperplasia. Dental caries are also common due to lack of oral hygiene,
mouth breathing, dry mouth caused by medication, and food pouching. Malocclusion is
usually seen with association to musculoskeletal problems. The patient may have an open
bite with protruding anterior teeth potentially caused by tongue thrusting. This also
creates an inability to close the lips and creates excessive drooling. Dysphagia, or
difficulty swallowing, can often be a problem for people with CP. This means food may
stay in the mouth longer, creating a higher caries risk. Bruxism is also common, which
causes a permanent wearing away of the tooth surface. Mouth guards or splints may not
be ideal due to CP patient’s difficulty swallowing and strong gag reflexes. Trauma or
injury to the mouth from accidents or falls are also important to keep in mind with CP
patients, due to lack of coordination and stability when walking. (Chin, 2009)
more comfortable for both the CP patient and the provider. Barriers that may be
experienced by any special need patient, including CP patients, in the dental office are
language barriers, vision or hearing problems, low oral health literacy, dental anxiety, or
and tone of voice are all important for the clinician to keep in mind when communicating
with a CP patient. The clinician also needs to be aware of the patient’s verbal and
When discussing treatment plans the clinician needs to make sure they use terms that are
appropriate for the patient’s comprehension level. Using the tell-show-do method may
help calm patient’s anxieties. Patients who are in wheelchairs should not be transferred if
it is not necessary. When possible the wheelchair should be modified to mimic the dental
chair or the clinician should stand-up during the dental procedure. (Moore, 2016) This
helps to prevent risks with transfer and workplace injuries. Other considerations during
the dental appointment may include making the treatment environment calm and relaxed
with minimal distractions, observing patients movements and looking for patterns in
muscle spasm so they can be anticipated and worked around, keep appointments short
with frequent breaks, being empathetic toward the patient, and being patient. (Chin,
2009)
When discussing homecare the clinician must again evaluate the patient’s abilities
and comprehension level. Clinicians should talk to the parent or caregiver to determine
the intellectual ability of the patient. All homecare instructions should be simple, spoken
slowly, and given one at a time. Demonstrations may help the patient remember.
Encourage independent daily oral hygiene care, but share the oral hygiene instructions
given to the patient with the caregiver. A power toothbrush or floss holder may aid in
cariogenic foods and using water to rinse their mouth after meals. Recommend
preventative treatments such as fluoride and sealants and explain how they are beneficial
Having the knowledge and understanding of Cerebral Palsy, what it is and how it
affects the patient, helps the dental team better care for CP patients. With slight
modifications to the appointment, treatment, and homecare instructions, the dental care
experience can be made more enjoyable for the dental team, the caregiver, and most
http://www.cerebralpalsy.org/
Chin, M., Fenton, S., Lyons, R., Miller, C., Perlman, S., & Tesini, D. (2009). Practical
Oral care for people with cerebral palsy. Bethesda, MD: National Institute of
Moore, T. A. (2016). Dental care for patients with special needs. Decisions in