Oral health care for children and adolescents with cerebral palsy: perceptions of parents and caregivers

Abstract The aim was to evaluate the oral health care of children/adolescents with Cerebral Palsy (CP) according to severity through the perceptions of parents/caregivers. A case series study was conducted at health services in the state of Pernambuco, Brazil with 94 mothers/caregivers of subjects with CP from 5 and 18 years old. Sociodemographic factors, oral health care and use of dental services (DS) were evaluated. The Gross Motor Function Classification System showed 67% with severe motor impairment. Subjects with severe CP had significantly higher frequencies of belonging to families with lower income (89%, p < 0.001), living in the interior (44%, p < 0.005), having transportation difficulties (60%, p = 0.04), difficulty regarding access to DS (88%, p = 0.009) and a greater need for oral hygiene (67%, p = 0.008), which was performed exclusively by the caregiver (94%, p < 0.001). Despite identified access barriers, dental care was facilitated for those with severe CP, early DS use, but low availability of dentists and low degree of humanization were cited as major problems. These results reveal problems related to daily oral health care, family living context, institutional support and quality of DS that should be addressed in comprehensive, inclusive, equitable social and economic public policies.

摘要 本研究旨在通过患儿家长/照料者的主观视角，依据病情严重程度评估脑性瘫痪（Cerebral Palsy，CP）儿童与青少年的口腔健康照护现状。本研究为病例系列研究，在巴西伯南布哥州的医疗卫生服务机构开展，共纳入94名年龄介于5至18岁的脑性瘫痪患儿的母亲或照料者。研究评估了社会人口学特征、口腔健康照护情况及牙科服务（Dental Services，DS）使用情况。粗大运动功能分级系统结果显示，67%的患儿存在重度运动功能障碍。病情为重度的脑性瘫痪患儿，其家庭收入水平更低（89%，p < 0.001）、居住于州内内陆地区（44%，p < 0.005）、存在出行交通困难（60%，p = 0.04）、牙科服务获取难度较高（88%，p = 0.009）且口腔卫生需求更高（67%，p = 0.008），且口腔卫生照护完全由照料者承担（94%，p < 0.001），上述差异均具有统计学显著性。尽管存在上述就医获取障碍，但重度脑性瘫痪患儿的牙科诊疗可获得一定便利；研究同时指出，早期牙科服务使用率偏低、牙医资源匮乏以及人文关怀程度不足为主要现存问题。本研究结果揭示了与日常口腔健康照护、家庭生活环境、机构支持以及牙科服务质量相关的诸多问题，亟需通过全面、包容、公平的社会经济公共政策加以应对与解决。