Serebral palsili çocuklarda intraoral yumuşak doku sağlığı ve ilişkili faktörler

Abstract

Arka plan Serebral Palsi (SP) immatür beyindeki hasara bağlı oluşan hareket ve postür bozukluğudur. SP’li çocukların kas ve sinir sistemindeki gelişimsel bozukluklar sebebiyle ağız sağlığı ve fonksiyonları etkilenmektedir. Bunların başlıcaları ağız içindeki sert ve yumuşak dokular ile çiğneme ve yutkunma fonksiyonlarıdır. Amaç Çalışmamızın amacı büyüme ve gelişim dönemindeki SP tanısı almış çocuklarda ağız içi yumuşak dokuların durumunu ve ilişkili faktörleri tespit ederek, olası problemleri engellemeye yönelik çalışmalara öncülük etmektir. Yöntem Çalışmaya Metin Sabancı birimlerinden hizmet alan 51 çocuk dahil edilmiştir. Çocukların SP’ye eşlik eden hastalıkları, beslenme alışkanlıkları, kullandıkları ilaçlar ve aile durumlarını içeren anamnez formları hazırlanmıştır. Tonsil muayenesi Brodsky Skalasına göre, salya akışı Balasco yöntemi ile, yutkunma klinik muayene ile, diş eti enflamasyonu Modifiye Gingival İndex (MGI) sistemine göre, beslenme durumları ve reflu şikayeti bulguları ebeveynlerle yüz yüze yapılan görüşmelerle gerçekleştirilmiştir. Bulgular Çalışmamıza dahil edilen SP’li çocukların %62.7s’i erkek, %37.3’ü kızdır. Çocukların yaş ortalaması 9.63 ± 2.40’tür. Çocukların %45’inde beslenme bozukluğu, %57’sinde ağız solunumu, %19’unda gastroözofagial reflü şikayeti tespit edilmiştir Hatalı yutkunma tespit edilen SP’li çocuk oranı %63, ağız dışına salya akışı tespit edilenlerin oranı ise %45’tir. Ağız dışına salya akışı ve hatalı yutkunma arasında anlamlı ilişki bulunmuştur. Muayene edilen SP’li çocukların %45’i epilepsi şikayeti sebebiyle ilaç kullanmaktadır. Çocukların %12’sinde tonsil dokusu havayolu açıklığının %50-75’ini kapatmaktadır. Çocukların %78’inde MGI değeri 1 ve üzeridir, %37’sinde dişeti büyümesi gözlenmiştir. Sonuç SP’li çocuklarda etkin ağız hijyeninin sağlanması dişeti enflamasyonu ve büyümesinin oluşmaması açısından önemlidir. Ağız solunumu, hatalı yutkunma, salya akışı tedavilerine yönelik interdispiliner çalışma önemlidir. Ağız sağlığının iyileştirilmesi için ilişkili faktörlerin de incelenerek tedavilerin yapılması gereklidir.

Keywords

• serebral palsi
• yumuşak doku
• ağız mukozası
• yutma bozuklukları
• sialore
• ağızdan soluma

Health of intraoral soft tissues in children with cerebral palsy and associated factors

Abstract

Background Cerebral palsy (CP) is a movement and posture disorder caused by damage to the immature brain. Oral health and functions are affected due to developmental disorders in the neuromuscular system of children with CP. The main ones are the hard and soft tissues in the mouth and chewing and swallowing functions. Objective The aim of our study is to determine the condition of the oral soft tissues and associated factors in children diagnosed with CP in the growth and development period and to lead studies to prevent possible problems. Methods Fifty-one children who receive service from Metin Sabancı units were included in the study. Diseases concomitant with CP, dietary habits, medications, and medical history forms, including the family status of the children were prepared. Physical examination of tonsillitis according to Brodsky Grading Scale, drooling with Balasco method, swallowing with clinical examination, gingival inflammation according to Modified Gingival Index (MGI) Classification, nutritional status and findings of reflux complaint were performed through face-to face interviews with parents. Results 62.7% of children with CP included in our study were boys and 37.3% were girls. The mean age of the children was 9.63 ± 2.40 years. Nutritional disorders were found in 45% of the children, mouth breathing in 57% and gastroesophageal reflux disease in 19%. The rate of children with CP with incorrect swallowing was 63% and the rate of those with drooling was 45%. A significant relationship was found between drooling and incorrect swallowing. 45% of the examined children with CP use medication due to the complaint of epilepsy. In 12% of children, the tonsillar tissue covers 50-75% of the airway patency. In 78% of the children, the MGI value was one and above and gingival enlargement was observed in 37%. Conclusion Providing effective oral hygiene in children with CP is important in terms of preventing gingival inflammation and enlargement. Interdisciplinary studies on mouth breathing, incorrect swallowing and drooling treatments are important. In order to improve oral health, it is necessary to examine the associated factors and administer treatments.

Keywords

• Cerebral Palsy
• soft tissue
• mouth mucosa
• swallowing disorders
• sialorrhea
• mouth breathing

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