We're not too sure exactly when they all came through,
as he was going through chemotherapy at the time.
Fortunately, not many of Dexter's teeth
have been damaged from the chemotherapy drugs.
And, only one tooth has been chipped during an intubation time...
when he reacted to pain killing medication and stopped breathing.
But, Dexter may be facing many more teeth problems, due to his cerebral palsy.
Cerebral palsy doesn't cause dental or oral problems.
It can cause the teeth to vary in size and shape, be overcrowded or misaligned.
And, because he has cerebral palsy, there can be many problems with his mouth and teeth.
People with cerebral palsy sometimes have difficulty chewing and swallowing saliva. They have low tone in their cheek muscles. This means, they have increased difficulty when brushing their teeth, and rinsing and flossing might be very difficult.
They might also have pockets of food left in their mouth for lengthy periods of time. Dexter has a very high palate and food often gets stuck at the top of his mouth.
Dexter understands that when we put a finger in his mouth, to remove the food, or dislodge it, he shouldn't bite us. (This took a lot of training! He has given many very, very deep bites. He is much better with not biting people now! And, the cheeky little boy was selective about who he bit... only his parents!)
At the moment, Dexter can't brush his teeth but is happy enough for someone to do it for him. It's not easy! He tends to smile and bite down on the toothbrush and it is difficult to make sure every tooth has been cleaned. Lucky he has a specially designed toothbrush that has three sides to make cleaning his teeth much easier.
Try brushing your teeth with your mouth closed.
Brushing Dexter's teeth can be a little bit like that.
For people who have gastroesophageal reflux, who aspirate, vomit or drool, their teeth are more exposed to acid... and this leads to bacterial plaque forming on the teeth. (Dexter has and does all of those things!) This can also happen when people have difficulty swallowing and chewing. Luckily, Dexter is able to swallow food. He is getting better at chewing. Coughing, gagging, choking and aspiration can also cause bacterial build up on the teeth. Fortunately, Dexter rarely coughs or gags, and he is much better at chewing and swallowing, so choking is not a major problem for him. **His food is cut very small, or slightly mashed.
Medicine is not good for teeth, either. Often, it is a sugary syrup, to help the children take the medicine. Dexter has needed a lot of medication in his two years, especially while he was undergoing chemotherapy treatments. His teeth must have been exposed to a lot of sugary syrup, leading to sugar attaching itself to his tooth enamel.
Having cerebral palsy, Dexter takes a long time to finish a meal. He needs additional time, because he chews more slowly. (During meals, Dexter gets distracted easily by the things happening around him, and he also uses his meal times as a chance to see the world from a seated position and explore with his eyes.) Because eating is a longer process for him, food is in his mouth longer, increasing the risk of developing cavities.
So, Dexter's cerebral palsy means he may suffer from oral problems, such as tooth decay and periodontal problems.
He will need additional care and support, in order to ensure his teeth are well looked after and not full of holes.
At the moment, Dexter loves grinding his teeth.
It could be an age thing... it could be a cerebral palsy thing.
He's been a couple of times, already.
Going to the dentist is hard enough with any child, but when a patient has cerebral palsy, things can become even more complicated!
Dexter is a fairly good patient. This might not be the case with all patients who have cerebral palsy.
Dentists who treat people with special needs need specialised training.
Additional safety requirements are needed. Dentists need to be trained in CPR. They need to know how to clear the airways of someone who has difficulty with swallowing.
They need to be able to work around the involuntary movements or shakes and seizures patients may experience. (Dexter's dystonia means he has involuntary movements, and these do occur with his head and mouth.)
These patients may also aspirate and dentists will need to know how to reduce the risk of this happening. (Dexter developed pneumonia after aspirating saliva.)
And, people with disabilities may not be able to sit in a dentist's chair. The dentist may need to work while the patient is sitting in their own wheelchair.
or a pain in his teeth or a cut on the inside of his cheek.
At the moment, Dexter's dentist is happy with his teeth.
Here's hoping that continues!
#Raising awareness of cerebral palsy