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Friday, September 19, 2014
Dental and Oral Health (Children)
Missing and misshapen teeth with CP
My granddaughter was born with Hypoxic Ischemic Encephalopathy and we had quite a scare and thought we would lose her. She had ischemic strokes all over her brain including 2 vascular distributions and pituitary. She was not supposed to make it but surprised all and did very well. She tests a little above normal cognitively but has cerebral palsy and gets around quite well on her own with AFO`s. She is uncooperative as far as panoramic or dental x-rays. She is 4 years old now and 2 different dentists just want to wait. She has 2 upper front teeth, 2 lower front teeth, and 2 way in the back on the top. She has a small mouth and hard to see but the top 2 teeth for wure are mishapen. She drools a lot at times and just recently got another tooth. My questions is trying to understand why with CP the teeth are mishapen or missing, and is it possible more teeth could be there and slow coming because of CP. A CT scan of her brain at birth you can see what the dentist called normal looking and complete set of adult tooth buds. I am confused how the mishapen and missing teeth happens with her illness at birth and CP. I am also nervous if we should keep waiting and something could be there but not coming in right. Thank you. Worried grandma.
Thank you for a very thoughtful question, with a good amount of background information - I will try to be as concise as possible.
Cerebral palsy affects approximately 300,000 children in the US. The major cause is some form of injury to the motor (movement) portion of the brain at or around the time of birth. The most common dental findings in children with cerebral palsy may include:
- erosion of the enamel (often seen with acid reflux)
- poor gum health
- a high palate with a narrow upper jaw which can result in teeth coming together in a less than ideal manner
- an increased gag reflex
- grinding of teeth
- drooling (which I will discuss later)
- and disruptions in getting/losing teeth
Anytime there is an injury to the brain in a child, growth may be affected, and in many cases of cerebral palsy, teeth will be delayed coming in. Likewise, baby teeth may be delayed in being replaced by grownup teeth. Dental development is just one aspect of overall growth and development.
From your description of what teeth she has, your granddaughter may have a dental age (what teeth she has in) that is lower than her chronologic age of 4. Drooling has been shown to be more common in children with baby teeth than grownup ones, with reports as high as 75% for children with baby teeth. The misshapen teeth can be a result of the injury during the time of her birth - the teeth developing during that period of time were most prominently affected.
With respect to you concerns - let me tell you that what you are doing is on the right course! You are getting your granddaughter regularly examined by a dentist, and they are following her dental development. Let's assume for the sake of argument that some teeth are missing. This is not something that can be directly treated at this moment in a 4 year old. Having her regularly examined and having her existing teeth cleaned routinely are important parts of establishing a "Dental Home," somewhere where a qualified professional can attend to the dental development of your granddaughter and time any intervention or referrals appropriately.
I hope this addresses your questions/concerns. Thank you.
Sarath Thikkurissy, DDS, MS
Director, Residency Program, Division of Pediatric Dentistry and Orthodontics
College of Medicine
University of Cincinnati