Table 3.29.
Key considerations in dental management in cerebral palsy (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2/4 | Uncontrollable movements; epilepsy; abnormal biting reflex and swallowing |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | |
| – Conscious sedation | 2 | |
| – General anaesthesia | 3/4 | Gastro-oesophageal reflux; poor laryngeal reflex; aspiration possible; hypothermia. |
| Patient access and positioning | ||
| – Access to dental office | 1 | Transfer to dental chair |
| – Timing of treatment | 1 | Short appointments |
| – Patient positioning | 1 | Manual support; tilt backwards |
| Treatment modification | ||
| – Oral surgery | 1/4 | Possibly GA |
| – Implantology | 1/4 | Possibly GA |
| – Conservative/Endodontics | 1/4 | Possibly GA |
| – Fixed prosthetics | 1/4 | Possibly GA |
| – Removable prosthetics | 1/5 | Difficult to insert and stabilise |
| – Non-surgical periodontology | 1/4 | Possibly GA |
| – Surgical periodontology | 1/4 | Possibly GA |
| Hazardous and contraindicated drugs | 0 | |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.