Cerebral Palsy Clinical Trial
Official title:
Prevalence of Orofacial Dysfunction in Cerebral Palsy Patients by Using Nordic Orofacial Test Screening (NOT-S) and Its Association With Oral Health Status and Quality of Life
The objective of this study is to analyze prevalence of orofacial dysfunction in children with cerebral palsy by using Nordic Orofacial Test screening (NOT-S) and its association with oral health status and quality of life.
Cerebral palsy (CP) is a group of neurodevelopmental conditions characterized by motor
disorders, where orofacial functions, such as controlling saliva, talking, and eating are
often affected. Impaired eating is associated with poor growth and problems with chewing and
swallowing problems may jeopardize respiration. Notably, the most common causes of death in
young individuals with CP are secondary respiratory diseases. Hence, dysfunction in the face,
tongue, palate and throat, generically termed orofacial dysfunction has a strong impact on
health in individuals with CP. From a dental point of view, early examinations for
intervention and prevention among children in general (and those with special needs
specifically) are strongly recommended by major dental academies. However, because children
with CP have multiple medical issues, their dental issues might not receive equal
consideration from healthcare providers trying to provide the best comprehensive care. This
can create significant morbidity that can further affect the wellbeing of these compromised
children and negatively impact their quality of life.
This study will evaluate the relationship among orofacial functions, manual ability, gross
motor function and oral health related quality of life (OHRQOL) in parents / caregivers. One
hundred child (4-16 years) will be assessed for orofacial function using the Turkish version
for the Nordic Orofacial Test-Screening (NOT-S) protocol, which consists of a structured
interview and clinical examination. In NOT-S, aspects of orofacial dysfunction are termed
domains. Each domain consists of questions or tasks, which are termed items. Each item serves
to discriminate between normal function and dysfunction. The domains and items were finally
formulated through discussions in the development team. The NOT-S consists of a structured
interview, registering everyday orofacial functions, and a basic clinical examination
registering intentional sensory-motor control via the cranial nerves. The interview contains
six domains: 'Sensory function', 'Breathing', 'Habits', 'Chewing and swallowing', 'Drooling',
and 'Dryness of the mouth'. The examination contains six domains: 'Face at rest', 'Nose
breathing', 'Facial expression', 'Masticatory muscle and jaw function', 'Oral motor
function', and 'Speech'. Each domain comprises one to five items. Each item is rated with
'yes', if the criterion of dysfunction is fulfilled, or 'no', if not fulfilled. If one or
more items within a domain are assessed with 'yes', dysfunction is indicated in the domain.
Self-initiated functional ability will be classified according to the expanded and revised
version of the Gross Motor Function Classification System (GMFCS) and Manual Ability
Classification System (MACS). Both GMFCS and MACS are five-level systems (I-V) in which level
I represents minor and level V represents major limitations in function and ability. Caries
Status Caries status will be determined by recording the number of decayed (d, D), missing
(m,M), and filled (f, F) teeth in the primary and permanent dentition. With the decayed,
missing, and filled teeth (DMFT) index for permanent, and DMFT index for primary dentition we
will assess the mean dental caries scores for every individual.
Oral hygiene is a basic factor for oral health. Poor oral hygiene leads to dental plaque
collections, which with times turns into the calculus as finally can cause gingivitis and
periodontal diseases. That is why many studies, also ours, have been carried out focusing on
the role of oral hygiene. Some indices have been developed for assessing individual levels of
oral health status. In this study, we decided to use Simplified Oral Hygiene Index (OHI-S).
The OHI-S differs from the original OHI in the number of the tooth surfaces scored. Instead
of 12, there are just six surfaces. The OHI-S has two components, the Debris Index and the
Calculus Index. Each of these indexes is based on numerical determinations representing the
amount of the debris or calculus found on the tooth surfaces. The six surfaces examined for
the OHI-S are selected from four posterior and two anterior teeth.
Oral health related quality of life measures the functional and psychosocial outcomes of oral
disorders. It is now generally accepted in the research community that they are essential as
clinical indicators when assessing the oral health of individuals and populations, making
clinical decisions, and evaluating dental interventions, services, and programs. According to
the US Surgeon General, oral disease and conditions can "…undermine self-image and
self-esteem, discourage normal social interaction, and cause other health problems and lead
to chronic stress and depression as well as incur great financial cost. They may also
interfere with vital functions such as breathing, food selection eating, swallowing and
speaking, and with activities of daily living such as work, school, and family interactions".
People assess their HRQOL by comparing their expectations and experiences. Parental-
Caregiver Perceptions Questionnaire (P-CPQ) was developed to measure parental or caregiver
perceptions of a child's OHRQOL and the impact of the child's condition on the family.
The objective of this study is to analyze prevalence of orofacial dysfunction in cerebral
palsy patients by using NOT-S and its association with OHRQOL.
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