Dental care access suboptimal in kids with cerebral palsy, SG study shows

In Singapore, children with cerebral palsy (CP) have suboptimal access to dental care, especially among those younger than 6 years, a study has shown.

“Our study showed … poor access to dental care among children with CP, who are at high risk of dental caries. Only 41.7 percent of our population reported having ever visited a dentist, with 25.4 percent reporting the presence of dental caries,” said the researchers.

The investigators reviewed the data of 151 CP patients born in or after 1994 (mean age 7.8 years, 70.2 percent male, 60 percent Chinese). Most participants were paediatric patients, with only 10 aged >18 years. About 70 percent had spastic CP, 75 percent had cognitive impairment, and 67 percent had epilepsy. [Singapore Med J 2024;doi:10.4103/singaporemedj.SMJ-2022-022]

Over 40 percent of children aged 7–12 years had dental visits, while 20 percent of those aged 2–6 years had ever received dental care. None below 2 years of age ever received any dental care. “The only factor found to affect access to dental care was age,” the researchers said.

The incidence of dental caries was highest among children aged 7–12 years (62.5 percent). For those aged 2–6 years, the corresponding rate was 18.8 percent. “We believe the prevalence of dental caries was underreported, as many children did not receive any dental care and may thus have undetected dental caries,” they said.

Driving factors

Several factors may have driven the higher risk of dental caries in children with CP, the researchers noted. Apart from the physical and/or intellectual disability precluding them from independently performing oral hygiene practices, the chewing and swallowing difficulties with food pouching due to pseudobulbar palsy, excessive drooling, and loss of protective saliva may factor in.

Other factors are gastro‑oesophageal reflux disease which could lead to dental erosions; CP patients’ frequently soft, carbohydrate-rich diet; malnutrition; higher prevalence of developmental enamel defect; and immobility. [J Contemp Dent Pract 2004;5:23-31; J Oral Rehabil 2005;32:880-885; Int J Clin Pediatr Dent 2014;7:109-118] Moreover, dental appointments may not be as frequent due to the limited mobility, and even if they do come in for a routine check, behavioural issues may render them uncooperative.

“Delays in seeking dental care may result in increased severity of disease, leading to more extensive and costly treatment,” they said.

Early dental care access important

“[O]verall, there is poor oral health awareness among parents in Singapore,” said the researchers. In one study, only 8 percent of Singaporean children aged 3–6 years and 3 percent of those aged 18–48 months have regular dental visits, with only 1 percent of parents being aware of the recommended dental visits for infants. [Int J Paediatr Dent 2014;24:32-42; Community Dent Health 2009;26:12-17] In another study, 40 percent of Singaporean preschool children under 6 years of age had early childhood caries, while another showed a higher incidence of dental caries among those from lower socioeconomic status. [J Dent Res 2010;89:637-643]

“We hope our findings can raise awareness on the importance of early dental [care access] for the prevention, early detection, and treatment of dental caries in children with CP,” they said. “Early dental visits will offer an opportunity to provide anticipatory guidance to parents and children, allowing for early detection of dental caries.”

Medical professionals should also be equipped with knowledge on oral and dental health, the investigators noted. “Children with CP usually have more frequent encounters with medical and early childhood professionals … Instead of being a potential rate-limiting factor to dental visits, these frequent medical visits can be used opportunistically for oral health assessment and early dental referrals.”

However, recall bias and underreporting are not unlikely, as the findings were provided by parents and patients. Also, the population was relatively small, and other dental issues (eg, gum diseases, bruxism) were not evaluated, given the potential difficulties for parents in identifying or recalling them.

“Nonetheless, this study has yielded useful information regarding dental care, caries experience, and risk factors in children with CP, where literature is scarce, to allow better design of future studies,” the researchers said, calling for larger prospective trials, preferably those incorporating more comprehensive oral evaluations.