This document discusses developmental disabilities in children, focusing on Down syndrome and cerebral palsy. It provides details on the causes, symptoms, and oral manifestations of each condition. For Down syndrome, it describes physical characteristics like a flat facial profile and health issues such as congenital heart defects. Common oral findings include hypodontia, delayed tooth eruption, and early periodontal disease. For cerebral palsy, it defines the condition and classifies types based on affected areas of the brain and resulting motor dysfunctions. Key dental problems for both conditions include higher rates of caries and periodontal disease due to difficulties maintaining oral hygiene. The document concludes that preventive dental care and modified treatment approaches are important for managing the oral health

1. DEVELOPMENTALLY
DISABLED CHILDS U B M I T T E D TO : D E PA R T M E N T O F
P E D O D O N T I C S
SUBMITTED BY : PRABHJOT KAUR
ROLL NO. 22342
BDS FINAL YEAR

2. CONTENTS:INTRODUCTION
 DEVELOPMENTAL DISABILITY
 DISABLED CHILD
DOWN’S SYNDROME
 INCIDENCE/PREVALENCE
 PREDISPOSING FACTOR AND CAUSES
 GENERAL MANIFESTATION
 ORAL MANIFESTATION
 DENTAL TREATMENT
CEREBRAL PALSY
 ETIOLOGY
 CLASSIFICATION:-1) SPASTIC
2) ATHETOSIS
3) ATAXIA
4) RGIDITY
5) TREMORS
6) ATONIA
7) MIXED
 DENTAL PROBLEMS
 TREATMENT

3. DOWN’S SYNDROME
This is one of the most recognizable malformation syndromes. It may occur due to
trisomy of chromosome 21(95%), translocation(3%) or due to mosaicism(2%).
INCIDENCE/PREVALENCE
It is found to occur 1 in every 600 live birth. With the advancement in the diagnostic
techniques, proportion of cases diagnostic techniques , proportion of cases diagnosed
prenatally increased from 3% to 60% in younger women. In a study done in Australia the
birth prevalence of down syndrome patients has declined from 1986 to 2004
PREDISPOSING FACTORS AND CAUSES
Advanced maternal age, uterine and placental abnormalities and chromosomal
aberrations

4. GENERAL MANIFESTATIONS:
• SKULL: Brachycephalic (round) skull resulting in a flattened face and occiput.
• Presence at birth of third fontanelle just anterior to the posterior fontanelle.
• Flat nasal bridges with a small maxilla.

5. • EYES: oblique palpebral fissures with prominent epicanthic folds.
• Brushfield’s spots appear on the iris in a ring concentric with the pupil.
• Scanty eyelashes.
• Cataracts, squint and nystagmus are common.

6. • EARS: Dysplastic ears with abnormal pinna.
• NECK: Short and broad with excess skin posteriorly.

7. • MUSCLES AND JOINTS: Hypotonicity and Hyperextensibility.
• IQ: often severally retarded with an IQ of 25-50.

8. ASSOCIATED CONGENITAL
ABNORMALITIES
• Congenital heart lesions are found in about 50% (atrial septal defect, atrioventricular
canal and VSD)

9. • Duodenal atresia.

10. • Atlantoaxial instability

11. • Umbilical hernia.

12. • Multiple immunological defects affecting the skin, GIT and respiratory tracts.
• Acute lymphoblastic leukemia is 20 times more common in these children.
• Hypothyroidism and Alzeimer’s disease

13. ORAL MANIFESTATION
• MOUTH: Small drooping mouth
• Open mouth posture

14. • Tongue: protrusive, fissured tongue.
• Circumvallate papillae may be enlarged, but filiform papillae may be absent.
• Macroglossia.

15. • LIPS: thick, dry, fissured.
• OCCLUSION: anterior open bite and crossbite, class III tendency.
• Small maxilla.

16. • PALATE: often appears high with horizontal palatal shelves.
• Bifid uvula, cleft lip and palate.

17. • ERRUPTION OF TEETH: Retarded.
• Early shedding of deciduous teeth.
• TEETH: Hypodontia, especially third molars and maxillary lateral incisors.
• Microdontia.
• Hypocalcification and hypoplastic defects.
• Low incidence of caries.

18. • PERIODONTIUM: Severe, early onset periodontal disease due to local factors like
poor oral hygiene, tooth morphology and malocclusions and systemic factors like
decreased humoral response, reduced chemotaxis, impaired phagocytosis, poor
circulation, etc.

19. DENTAL TREATMENT
• These children are mentally retarded and require
appropriate treatment.
• Incidence of cardiac disease associated with down’s
syndrome is 40% and will require adequate prophylaxis.
• Increased incidence of leukemia and acute and chronic
infections of the upper respiratory tract can also alter
treatment.
• Children are generally affectionate and cooperative and
present no special problems during management.
• Nitrous oxide analgesia or TSD in mildly apprehensive
patients can be used, general anesthesia in severe
resistance to dental treatment.
• Preventive procedure along with chlorohexidine
mouthwash may be beneficial.
• Pulp treatment in deciduous teeth is contraindicated in
patients with cardiac problems because of the risk of
bacteremia, whereas in permanent teeth it can be
considered if an adequate apical seal can be obtained.

20. CEREBRAL PALSY
• This is one of the most severely handicapping
conditions affecting childhood. Cerebral palsy is
defined as a non-progressive lesion which occurs
in the developing brain before, during or after
birth, leaving the child with a variety of
neurological problem. 50% of these children die in
infancy or require institutional care. The motor
deficit is fully evident only as the child develops.
• The condition manifests itself as a number of
neuromuscular dysfunctions and involves muscle
weakness, stiffness, paralysis , poor balance,
irregular gait and uncoordinated or involuntary
movement. There is a loss of voluntary muscle
control. One newborn in approximately 200 live
births is affected.

21. ETIOLOGY
• Any factor that causes decreased oxygenation to the developing brain can lead to
damage of the brain. Complications of labor or delivery, infections of the brain like
meningitis, encephalitis, toxemia of pregnancy , congenital defects of the brain,
kernicterus , heavy metal and drug positioning, any trauma to the head, premature
birth with CNS abnormality are the common causes.

22. CLASSIFICATION
• I. Based on anatomical involvement
Monoplegia-involvement of one limb only
Hemiplegia-involvement of one side of the body
Paraplegia-involvement of both legs only
Quadriplegia-involvement of all the four limbs
• II. Based on neuromuscular involvement
spasticity
athetosis
ataxia
mixed

24. SPASTIC CEREBRAL PALSY
• Approximately seen in 70% of the cases
• Increased motor tune resulting in stiffness and difficulty
in moving limbs
• Increased deep tendon and stretch reflexes
• Involvement of cerebral cortex
• The foot and leg flexed and rotated resulting in a
limping gait with circumduction of the affected leg
• Lack of control of neck muscles, trunk muscles and
intraoral muscles
• Impaired chewing and swallowing with speech
problems
• The involved muscle show hyperirritability, exaggerated
contractions when stimulated; tense muscles
• Excessive drooling, persistent tongue thrust and speech
impairments

27. ATHETOSIS
• Approximately in 15% of cases
• Involvement of basal ganglia
• Uncontrolled voluntary muscle contraction
• Generalized delay in motor development and the child may
show drooling, dysphagia, speech difficulties and grimacing
• Hypertonicity of the neck musculature with excessive
movement of head leading to held back head with mouth
open and tongue protruded
• Peri-oral muscles hypotonic with mouth breathing and
bruxism
• Most often not associated with convulsion or mental
retardation
• Characterized by slow twisting or writhing involuntary
movement or quick jerky movement and constant
uncontrolled motion of involved muscle
• Frequent uncontrolled jaw movement are seen that causes
abrupt closing of the jaw or severe bruxism

28. ATAXIA
• Approximately in 5% of cases
• Involved muscles unable to contract completely
• Involvement of cerebellum
• Lack of balance leading to staggering gait
• Visual organs may be involved

29. RIGIDITY
• Resistance to passive movements
• Basal ganglia involved
• Voluntary movement are slow and stiff
TREMORS
• Shaking of parts of the body
• Involvement of basal ganglia

30. ATONIA
• Characterized by soft, flabby muscles
MIXED
• Approximately 10% of cases
• Combination of characteristics of more than one type of cerebral palsy

31. DENTAL PROBLEMS
• DENTAL CARIES : Most children may have a higher caries rate than normal children.
This may be due to their inability to maintain good oral hygiene or due to the
tendency to overindulge them with soft and cariogenic food and also due to the
increased prevalence of enamel hypoplastic defects on their teeth.

32. • PERIODONTAL DISEASES: Occur with a great frequency, as the patient is unable to
brush or floss adequately. Due to difficulty in chewing and swallowing, children tend
eat soft food that are high in carbohydrates. They may also be on phenytoin to
seizure activity which is a cause of some degree of gingival hyperplasia.

33. • MALOCCLUSION: Occur twice as often than in the average population. commonly
noticed are protrusion of the maxillary anterior teeth, excessive overjet and overbite,
open bites and unilateral crossbites, the cause being the disharmonious relationship
between intraoral and perioral musculature. In spastics, class II div 2 malocclusion is
observed, along with constricted maxillary and mandibular arches. In the athetoid
group class II div I malocclusion is seen along with a high and narrow palatal vault.

34. • BRUXISM: Commonly seen in athetoid cerebral palsy resulting in severe attrition, loss
of vertical dimension and temporomandibular joint disorders.

35. • TRAUMA: Due to the nature of the disorder, these children are susceptible to trauma,
especially of the maxillary anterior teeth
• Children may have excessive drooling and difficulty in swallowing.
• Spastic cerebral palsy patients present with spastic tongue thrust, constricted
mandibular and maxillary arches, class II div 2 malocclusion (75%) usually with a
unilateral crossbite.
• Athetoid cerebral palsy patients present with mouth breathing, tongue protruding
between the teeth and lips , bruxism, high and narrow palate and anterior open bite.

36. TREATMENT
• Through medical and dental history should be taken,
along with consultation with the child’s physician.
• Maintain a calm, friendly and professional
atmosphere; be empathetic about the child’s
problems.
• Many patients can and prefer to be treated in the
wheelchair, which may be tipped back into the
dentist’s lap.
• The patient’s head should be stabilized throughout
the procedure and the back should be elevated to
reduce swallowing problems.
• Use physical restrains judiciously for control of flailing
extremities.
• A variety of mouth props and finger splints can be
used for control of involuntary jaw movements.

37. • Avoid abrupt movements, lights and noises to
minimize startle reflex reactions and introduce
intraoral stimuli slowly to avoid gag reflex.
• Local anesthetic can be used with care and
stabilization against any sudden movement by the
child.
• Rubber dam can be used to protect the working
area from hyperactive tongue movement, although
floss should be attached to small objects such as
cotton rolls that can become dislodged.
• Gauze shields should be used during extraction to
avoid tooth aspiration.
• Premedication can be used to reduce hypertonicity,
involuntary movement and anxiety.
• General anesthesia can be used as a last resort if the
case is not manageable chairside.
• Do permanent restorations and preventive

38. CONCLUSION
• There is now unanimous agreement that children with special needs have poor oral
hygiene, together with a higher prevalence of periodontal disease and dental caries,
more than normal individual.
• Along with chemical plaque control measures, mechanical plaque control like the use
of powered toothbrushes can greatly help these individuals to have better oral
hygiene.
• HOME dental care should be reviewed periodically and the preventive regimen should
be discussed and modified according to the age of the child.

39. THANK YOU !