Oral Health

This page covers:

• The importance of oral health for people with Cerebral Palsy
• Common oral health challenges
• Preventive care and adapted toothbrushing techniques
• Managing specific issues like dry mouth and drooling
• Dental treatment options and accessibility
• Finding the right dental professional

What is the problem?

Up to 75% of adults with Cerebral Palsy experience dental problems, which can significantly impact daily life and overall health. People with CP may face challenges with tooth brushing due to movement difficulties, have a higher risk of dental decay, and may experience barriers to accessing appropriate dental care.

Research indicates that people with Cerebral Palsy are more susceptible to oral health issues due to several factors:

• Movement challenges that make regular brushing difficult
• Increased muscle tone affecting the jaw and mouth
• Difficulty in coordinating swallowing
• Possible side effects from medications
• Dietary factors including textures of food and frequency of eating

Poor oral health isn’t just a dental issue – it’s linked to several general health conditions. There’s strong evidence connecting oral health with diabetes and cardiovascular disease, and some evidence suggesting links to respiratory infections, stroke, and certain types of cancer.

Common Oral Health Challenges

People with Cerebral Palsy may experience several oral health challenges:

Physical challenges:

• Spasticity or involuntary movements: Can make it difficult to open the mouth, hold still, and control jaw movements during toothbrushing or dental treatment
• Poor muscle tone: Some people with CP may have difficulty maintaining posture while receiving dental care
• Limited mouth opening (trismus): Makes accessing the mouth for brushing or treatment difficult
• Wheelchair use: May present logistical challenges when accessing dental facilities
• Dysphagia (swallowing difficulties): Can create concerns about aspiration during dental procedures

Sensory challenges:

• Heightened gag reflex: Can make dental treatment, X-rays, or even toothbrushing difficult
• Sensory sensitivities: Some people may be sensitive to unfamiliar dental tools
• Communication difficulties: May limit the ability to express discomfort during dental visits

Dental issues:

• Malocclusion (misaligned teeth): Affects approximately 75% of people with CP, complicating chewing and toothbrushing
• Increased risk of gum disease: Due to difficulties with effective oral hygiene
• Tooth decay: Higher prevalence due to challenges with brushing and dietary factors
• Drooling: Affects up to half of people with CP due to poor oral motor control or open mouth posture
• Teeth grinding (bruxism): Can cause tooth wear, chipping, and jaw pain

How do we manage it?

Preventive Care

Prevention is the cornerstone of good oral health. This includes:

Effective Toothbrushing

• Brush teeth twice daily – ideally for two minutes each time
• Use fluoride toothpaste (a pea-sized amount is sufficient)
• Consider adaptive equipment for better grip and control:
  • Electric toothbrushes can be easier to use as they require less manual dexterity
  • Manual toothbrushes can be adapted with foam grips, putty, or other materials to make them easier to hold
  • Three-headed toothbrushes can clean multiple surfaces simultaneously
• Toothbrush adaptations can be recommended by occupational therapists or dental professionals

Toothpaste Considerations

• Choose toothpaste with fluoride (the main protective ingredient)
• For those who struggle with foaming, look for toothpaste without sodium lauryl sulphate
• If taste sensitivity is an issue, consider unflavoured toothpaste like Oranurse
• For those with swallowing concerns, use a small amount (smear) of toothpaste pressed into the bristles

Cleaning Between Teeth

• As we age, cleaning between teeth becomes increasingly important as gums recede
• Interdental brushes are often easier to use than traditional floss
• Handles for interdental brushes can be adapted for better grip
• Water flossers/water picks are a good alternative for those with dexterity issues, though they can be messy (consider using them in the shower)

Mouth Props and Supports

• Mouth rests or bite blocks can help keep the mouth open during brushing
• Foam mouth props can prevent bite reflex while brushing
• For those who grind their teeth, “chewy tubes” may provide sensory stimulation and reduce grinding

Diet Advice

• Limit the frequency of sugar intake rather than cutting it out entirely
• Consider the timing of sugar consumption (avoid just before bedtime)
• Be aware that some nutritional supplements can be high in sugar
• Ensure oral care is performed after meals

Dry Mouth Management

Dry mouth can be common in people with CP, particularly those on multiple medications. To manage this:

• Stay well hydrated
• Use good quality lip balms
• Consider products that stimulate saliva (sugar-free chewing gum, sweets)
• Try dry mouth sprays or gels if they feel comfortable

Saliva Management and Drooling

Drooling (excessive saliva) affects many people with CP and can cause skin irritation and social discomfort:

• Good posture can help reduce drooling
• Speech and language therapists can recommend swallowing exercises
• Medications may help reduce saliva production, though they can have side effects
• Botox injections into the salivary glands can be effective for some people
• Hyoscine patches can help, though availability varies

Dental Treatment Options

When preventive measures aren’t enough, various dental treatment options are available:

Patient Positioning

• Some dental practices have wheelchair tippers to accommodate those who can’t transfer
• Cushions and supports can help control movements and increase comfort
• Hoists may be available for transfers in some facilities

Communication Support

• Bring any communication aids to appointments
• Hospital passports can be useful to share important information
• Let the dental team know your preferred communication method

Anxiety Management and Sedation Options

• Calming techniques like pressure desensitisation or music therapy
• Cognitive behavioural therapy for dental anxiety
• Short appointments or breaks during treatment
• Pre-medication (sedative before appointment)
• Inhalation sedation (gas and air)
• Intravenous sedation to reduce anxiety, improve mouth opening, and reduce involuntary movements
• General anaesthesia (as a last resort for complex treatment)

Treatment Types

• Preventive care (fluoride application, fissure sealants)
• Fillings to repair decayed teeth
• Extractions for teeth that can’t be saved
• Root canal therapy to save infected teeth
• Crowns for heavily restored teeth
• Bridges, dentures, or occasionally implants for missing teeth
• Gum treatment (scaling and cleaning)
• Orthodontic treatment in some cases

Accessing Dental Care

There are several options for accessing dental care in the UK:

High Street Dentists

• Can be NHS or private
• Most accessible and ideal for regular check-ups
• Not all have wheelchair access or specialised equipment

Community Dental Services

• NHS services designed for people with additional needs
• Specialist dentists trained in treating people with disabilities
• Better facilities for wheelchair users
• May have long waiting lists
• Usually requires referral from another healthcare professional
• NHS charges apply unless you have an exemption

Hospital Dental Services

• For the most complex cases
• Specialist consultants with expertise in treating people with disabilities
• Requires referral from another dentist or healthcare professional

If you’re struggling to find an NHS dentist with appropriate access:

• Ask your GP or other healthcare professional for recommendations
• Contact your local Healthwatch for advice
• Approach your Integrated Care Board (who commission dental services)
• Ask for a referral to Community Dental Services if access is a barrier

When making initial contact with a dental practice, ask about:

• Wheelchair accessibility
• Experience treating people with Cerebral Palsy
• Availability of adaptations like wheelchair tippers
• Sedation options if needed