International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426 Volume 8 Issue 7, July 2019 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Dental Management in Children with Cerebral Palsy Type Spastic Quadriplegia: A Case Report Ruth Christiana Juwitaningrum 1 , Arlette Suzy Setiawan 2 1, 2 UniversitasPadjadjaran, Faculty of Dentistry, Pediatric Dentistry Department, Sekeloa Selatan Road 1 st Bandung, West Java, Indonesia 40132 Abstract: Cerebral palsy is a group of permanent movement disorders that appear in early childhood with a vary signs andsymptomsincludepoorcoordination, stiffmuscles, weak muscles, and tremors.This case report aims to provide clinicians with general description of dental and oral health care for children with cerebral palsy under general anesthesia. A 3.5-year-old boy came with his parents to Al Ihsan General Hospital, complaining of many cavities in their child’s teeth. The patient has been diagnosed by a pediatrician with cerebral palsy type spastic quadriplegia. Intra-oral examination showed multiple caries with pulp involvement.The treatment plan was mouth preparation under general anesthesia, consists of scaling, dental restorations, extractions, and topical fluoride application. The patient with cerebral palsy type spastic cannot control the desired movement, has a hyperactive reflex, and often had seizures. These conditions will make the dental treatment being so difficult. Dental treatment with general anesthesia can be used as the last solution for providing dental and oral health care for the patient with cerebral palsy. Management of dental and oral health care in cerebral palsy patients should be done with a multidisciplinary and comprehensive manner for the optimum treatment results. Keywords: cerebral palsy, spastic quadriplegia, dental management 1. Introduction Cerebral Palsy (CP) is one of the neurological chronic diseases that affect the motoric control center. CP is not caused by muscle problem or peripheral nerve tissue, but rather a result of developmental disturbance or abnormalities in the motoric area of the brain caused by damage at the beginning of its development. This condition can occur during fetus/ prenatal, perinatal, or infant/ postnatal, before the central nervous system grows perfectly. This can interfere with the brain's ability to significantly control movement and posture. 1–5 According to the Dorland medical dictionary, CP is a permanent motoric disorder, non-progressive, and caused by brain damage due to birth trauma or pathological intrauterine conditions. This condition is characterized by an abnormal or late motoric development that causes limited function of extremities. Motoric movement development disorders are generally accompanied by sensory disturbances (vision and hearing), perception, cognitive, communication and behavior, epilepsy and the presence of a secondary skeletal muscle disorder. 6–9 In some industrialized countries, the incidence of CP ranges from 2-2.7 of 1000 births. Surveillance of Cerebral Palsy in Europe (SCPE) reported a higher incidence in men than women with a ratio of 1.33: 1. CP is often found 10 times more in premature infants and in very young infants. 3,4 Classification of CP aimed for predicting prognosis and treatment plans based on changes in the muscle tone, the affected anatomy and the severity. CP can be grouped into three groups: mild, moderate, and severe. Patients with severe CP show inability to walk and require extensive and long-term care. 1,9,10 American Academy for Cerebral Palsy suggests classification of clinical features of CP based on motoric disorders: spastic, athetoid, dyskinetic, ataxia, and combination. Based on the number of extremities affected, CP is classified into monoplegia, hemiplegia, paraplegia, triplegia, diplegia, and quadriplegia. 7,9,11 CP type spastic is the most common with 75% of CP cases in the world. The characteristic of these condition consists of muscle tone and excessive contractions, pathological and hyperactive tendon reflexes. The incidence of athetoid type about 20-25% of CP patients with the characteristic form of repetitive muscle movements and can be excessive if the patient is nervous. CP type ataxia occurs with a percentage about 10% of all CP patients and it characterized by a balance disorder. 2–4,10 The initial signs of CP are generally seen before 3 years of age, and parents can start to realize when the child's motoric development ability looks abnormal. Children with CP is often to have a developmental delay, such as prone position, sitting, crawling, smiling, and walking. Mental retardation can also occur in children who have severe CP as in spastic quadriplegia types. Epilepsy is found in 36% of CP patients. Epilepsy shows the severity of neurological lesions in CP type quadriplegia or cortical involvement in CP type hemiplegia. Children with CP tend to have nutritional problems, due to poor coordination in the upper motoric nerves of the body which resulting a weak muscle coordination during the swallowing and often drooling. 1,4,12,13 Maintenance and improvement of oral hygiene is very important for each individual, including individuals with special needs. In general, dental professionals focus more on oral cavity diseases such as caries and periodontal disease. For patients with CP, the condition of maintaining oral health becomes more difficult due to motoric limitations suffered so that the patient is not able to carry out the oral cleansing movement optimally. Caries prevalence in patients with CP increases especially in patients with long-term care with sweeteners or drugs that cause xerostomia. Other conditions that can also accompany abnormalities in the oral Paper ID: ART20199774 10.21275/ART20199774 1428