Abstract
BackgroundNeuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries.Material and MethodsThe aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP.Study designA total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1—anticholinergic drugs (n = 18), G2—botulinum toxin injection (n = 16), G3—salivary glands surgery (n = 16), G4—no treatment (n = 42), and G5—non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%.ResultsNo differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p<0.001), lower values of salivary flow rate (p<0.001), and higher values of osmolality (p<0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p<0.001).ConclusionsChildren and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality. Key words:Cerebral palsy, saliva, sialorrhea, dental caries, osmolar concentration.
Highlights
Cerebral palsy (CP) describes a prevalent, clinically important, and identifiable medical condition with nonprogressive permanent neuromotor disorders, caused by damage to the immature or developing brain, with consequent activity limitations regarding movement and posture [1]
The literature regarding drooling in individuals with CP and its therapies is extensive, only one study described the dental health of children with cerebral palsy following sialodochoplasty [16] and another, the use of intraglandular onabotulinum toxin A injection in these patients [17]
The purpose of this study was to compare the effects of pharmacological therapy, botulinum toxin injection, and salivary gland surgery on salivary parameters and caries risk in children and adolescents with CP
Summary
Cerebral palsy (CP) describes a prevalent, clinically important, and identifiable medical condition with nonprogressive permanent neuromotor disorders, caused by damage to the immature or developing brain, with consequent activity limitations regarding movement and posture [1]. A fourth approach, the surgical treatment modality, is elected when drooling persists after at least six months of conservative therapy in patients with cognitive deficits and children over 6 years of age, when maturation of oral motor function is expected to occur. It was hypothesized that individuals with CP who underwent bilateral removal of the submandibular glands with parotid duct ligation would present higher risk for dental caries (WSL) due to the reduction in SFR and increase in SO. Material and Methods: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP.
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