Serebral palsili çocuklarda intraoral yumuşak doku sağlığı ve ilişkili faktörler

Yıl 2021, Cilt: 4 Sayı: 2, 41 - 49, 30.06.2021

Esra Tunalı , Şeniz Karaçay Arda Tabancalı Büşra Seda İmamoğlu Ersin Yıldırım Turgay Arık

https://doi.org/10.33204/mucosa.950761

Cited By: 1

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47:571.
• Cans C, Dolk H, Platt MJ, et al. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol 2007;49:35-8.
• Serdaroglu A, Cansu A, Ozkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol 2006;48:413-6.
• Cans KM, Cans C. Cerebral palsy update. Brain Dev 2009;31:537-44.
• McIntyre S, Taitz D, Keogh J, Goldsmith S, Badawi N, Blair E. A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Dev Med Child Neurol 2013;55:499-508.
• Winter S, Autry A, Boyle C, Allsopp MY. Trends in the prevalence of cerebral palsy in a population based study. Pediatrics 2002;110:1220-5.
• Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities.Dev Disabil Res Rev 2008;14:128-36.
• Henderson CM, Rosasco M, Robinson LM, et al.Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy. J Intellect Disabil Res 2009;53:887-97.
• Akhter R, Hassan NMM, Martin EF, Nadkarni M, Khandaker G. Oral health in children with cerebral palsy. In Cerebral Palsy Clinical and Therapeutic Aspects (Isam Jaber Al-Zwaini, eds.) Intech Open, 2018;79-92.
• Lamkin MS, Oppenheim FG. Structural features of salivary function. Crit Rev Oral Biol Med 1993;4:251-9.
• Sheetal A, Hiremanth VK, Patil AG, Sajjansetty S, Kumar SR. Malnutrition and its oral outcome - a review. J Clin Diagn Res 2013;7:178-80.
• Dougherty NJ. A review of cerebral palsy for the oral health professional. Dent Clin North Am 2009;53:329-38.
• Camargo FD, Aparecida M, Frias AC, Antunes JLF. The incidence of dental caries in children and adolescents who have cerebral palsy and are participating in a dental program in Brazil. Spec Care Dentist 2011;31:210-5.
• Lee ASY, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database Syst Rev 2015;3:380-92.
• Kublay S. Nörogelişimsel bozukluğu olan çocuklarda oral motor terapi sonuçları. Abant İzzet Baysal Üniversitesi İzzet Baysal Tıp Fakültesi 2007.
• Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551-69.
• Blasco PA, Allaire JH. Drooling in the developmentally disabled: management practices and recommendations. Dev Med Child Neurol 1992;34:849-62.
• Rosenbaum CH, Mcdonald RE, Levitt EE. Occlusion of cerebral-palsied children. J Dent Res 1966;45:1696-700.
• Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker LA. Modified gingival index for use in clinical trials. Clin Prev Dent 1986;8:3-6.
• McGaw T, Lam S, Coates J. Cyclosporin induced gingival overgrowth: correlation with dental plaque scores, gingivitis scores, and cyclosporin levels in serum and saliva. Oral Surg Oral Med Oral Pathol 1987;64:293-7.
• Lobene RR, Mankodi SM, Ciancio SG, al. Correlations among gingival indices: a methodology study. J Periodontol 1989;60:159-62.
• Mani SA, Mote N, Kathariya M, Pawar KD. Adaptation and development of dental procedure in cerebral palsy. Pravara Med Rev 2015;7:17-22.
• Nielsen AL. Plaque and gingivitis in children with cerebral palsy: relation to CP diagnosis, mental and motor handicap. Tandlaegernes Tidsskr 1990;5:316-20.
• Alhammad NS, Wyne AH. Plaque and gingival health status among cerebral palsied children of Riyadh city. Pakistan Oral & Dental Journal 2011;31:116-9.
• Erasmus CE, van Hulst K, Rotteveel JJ, et al. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr 2012;171:409-14.
• Guare RO, Ferreira MC, Leite MF, et al. Dental erosion and salivary flow rate in cerebral palsy individuals with gastroesophageal reflux. J Oral Pathol Med 2012;41:367-71.
• Giudice ED, Staiano A, Capano G, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain Dev 1999;21:307-11.
• Rieken R, van Goudoever JB, Schierbeek H, et al. Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability. Am J Clin Nutr 2011;94:759-66.
• Asgarshirazi M, Soltani MF, Keihanidost Z, Shariat M. Evaluation of feeding disorders including gastro esophageal reflux and oropharyngeal dysfunction in children with cerebral palsy. J Family Reprod Health 2017;11:197-201.
• Tahmassebi JF, Curzon MEJ. Prevalence of drooling in children with cerebral palsy attending special schools. Dev Med Child Neurol 2003;45:613-7.
• Kirzioglu Z, Bayraktar C. Serebral palsili çocuklarda sık rastlanan oral problemler, ağız dışına salya akışı ve tedavi önerileri. SDÜ Sağlık Bilimleri Dergisi 2018;156-62.
• Garde JB, Suryavanshi RK, Jawale BA, et al. An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children. J Int Oral Health 2014;6:39-43.
• Andersen GL, Irgens LM, Haagaas I, Skranes JS, Meberg AE, Vik T. Cerebral palsy in Norway: prevalence, subtypes and severity. Eur J Paediatr Neurol 2008;12:4-13.
• LiraI ALS, IzquierdoI AM, Prado S, et al. Adenoid hypertrophy and open bite. Braz J Oral Sci 2011;10:17-21.
• İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D. Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children. Biomed Res Int 2021;2021:5550267.
• Bhowate R, Dubey A. Dentofacial changes and oral health status in mentally challenged children. J Indian Soc Pedod Prev Dent 2005;23:71-3.