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Factors affecting oral health in cerebral palsy patients: dental caries experience, microbiome and oral health related quality of life (OHRQoL)


Cerebral palsy (CP) is a set of nonprogressive neuromuscular disorders caused by defects in the developing fetal brain. Children with Cerebral Palsy are often have physical, coordinative, sensory, intelligence, communication and cognitive difficulties in performing, sensing and memorizing self-care activities of daily living (ADLs), such as walking, bathing, dressing, brushing the teeth, eating, conversing, and ambulating (1-2). These difficulties severely impact their ADLs and oral health related quality of life (OHRQoL) and lead to a deteriorated oral health status such as a high caries rate and number of decayed teeth, low restoration teeth number and rate and/or poor restorative quality, and profound periodontal inflammation. As a result, children with CP often require extensive dental treatment. The associations of mutans streptococci and lactobacilli with the prevalence of dental caries have been studied throughout the world but no studies in Australia have addressed the issue in children with cerebral palsy [2]. Several studies have examined caries rates in individuals who have CP [7-9]. Tooth decay in CP children is unacceptably high, and their general and oral health-related quality of life is significantly compromised. There is an urgent need to reduce the burden of dental decay in children and adolescents with CP, by implementing effective, cost-effective, feasible and sustainable dental prevention programmes.


Dr Rahena Akhter.

Research location

Sydney Dental School

Program type



The aim of the present study is-
STUDY 1: to determine factors affecting dental caries experience and oral health status among children, adolescents and adults with cerebral palsy in Australia.
STUDY 2: to determine the relationship between the salivary and microbial factors on dental caries experience in these CP children.
STUDY 3: to determine the caries experiences and oral health-related quality of life (OHRQoL) in children with cerebral palsy
Methods: In this study, children with CP of more than 2 years old will be selected from the Pediatric dentistry department and special care dentistry at Westmead Hospital and dental clinic from children's hospital at Westmead. CP types in terms of clinical patterns of involvement (quadriplegia, diplegia, hemiplegia or double hemiplegia) and Severity of CP would be measured using the Gross Motor Function Classification System (GMFCS I-V). Caries experience would be measured by decayed, missing, and filled teeth (dmft/DMFT) index. Clinical periodontal index (CPI), BMI, oral hygiene behaviour (tooth brushing frequency, use of toothbrush and FL toothpaste), dental visit, masticatory ability and dietary habit would also be assessed. Saliva samples will be collected from each child for determination of the pH and potential cariogenic bacterial species (high count of mutants streptococci, >10 6 cfu/ml) and lactobacilli to recognise individuals who may have high risk of caries. Data would be analysed using chi-square and Fisher's exact test. After bivariate analysis, variables with a p-value <0.05 will be selected for incorporation into the binary regression models. This study would emphasize on earlier preventive measures for CP patients because they are a high-risk group for dental caries. Effort should be made for better organization of preventative dental care and promoting dental health of this challenged population.

Additional information

With little known about the relationship between dental caries and salivary and microbial factors among patients with cerebral palsy, Australian researchers in oral Health and CP, the government and service providers are limited in their capacity to quantify current and future resource allocation needs or to identify oral health (e.g., dental caries) preventative strategies. Therefore, we aim to provide preliminary data on the factors affecting dental caries experience and its relation with reduced salivary flow and colonization by mutans streptococci and lactobacilli in children and adolescents with CP in Australia. This study will contribute to the understating the risk factors affecting dental caries experience

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Opportunity ID

The opportunity ID for this research opportunity is 2178