Dental health of children with cerebral palsy following sialodochoplasty

Abstract

Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as slalodochoplasties, are often performed for the control of drooling. These include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation. This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience-including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only-plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed. The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001. This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre- and postsurgical preventive dental therapy.

Drooling: review of the literature and proposals for management

“…An Australian study reporting on the dental health of a group of children with cerebral palsy who drooled and had had surgical corrections showed that they had a significantly greater prevalence of dental caries by comparison with a control group of cerebral palsied children who had been treated for drooling by non‐surgical means ( Hallett et al , 1995 ). Nor is total success guaranteed.…”

Randomized trial of botulinum toxin injections into the salivary glands to reduce drooling in children with neurological disorders

“…Oral sensorimotor therapies, 3 anticholinergic medication, 4 surgery, 5 and intra-oral appli ances 6 have all been used to reduce drooling with varying side effects and degrees of success. 7 Botulinum toxin A (BoNT-A), widely used as a treatment for spasticity in children with CP, blocks the release of acetylcholine at the neuromuscular junction and selectively weakens the muscles for 3 to 6 months. More recently, BoNT-A has been used in the treatment of drooling.…”

Parotid and submandibular botulinum toxin A injections for sialorrhoea in children with cerebral palsy

“…8 Botulinum toxin A (BTX-A) has been shown to exert an effect at the neuroglandular junction in animal studies by causing a fully reversible reduction in acetylcholine release from presynaptic nerve terminals. 9 Intraglandular injections of BTX-A have been used in adults with excess drooling due to Parkinson's disease, head and neck carcinoma, neurodegenerative diseases, and stroke, with few adverse effects.…”