Kompleksowe leczenie zębów pod narkozą ogólną u dziecka z porażeniem mózgowym i epilepsją: opis przypadku
Oral Rehabilitation Under General Anesthesia in a Child with Cerebral Palsy and Epilepsy: A Case Report
W skrócie
Dziewczynka w wieku 9 lat z porażeniem mózgowym i epilepsją miała wiele niezaleczonych ubytków zębów i problemy ze zbyt słabą higieną jamy ustnej, co uniemożliwiało leczenie w tradycyjny sposób na fotelu dentystycznym. Podczas jednej sesji pod narkozą ogólną lekarze wyczyścili zęby, zalecili ubytki, wyleczyli zapalenie miazgi zęba, usunęli kilka zębów, które nie dało się uratować, i zaaplikowali fluor. Po zabiegu matka dziecka zauważyła, że dziewczynka lepiej się je, lepiej śpi bez bólu i przybyło jej 2 kilogramy.
Oryginalny abstract (angielski)
BACKGROUND: Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder that often coexists with epilepsy and oromotor dysfunction, leading to poor oral hygiene, high caries burden, and limited cooperation during dental care. Comprehensive dental rehabilitation under general anesthesia (GA) may be required to deliver safe and definitive treatment in children with extensive disease and significant treatment barriers. OBJECTIVE: This case report aimed to describe comprehensive oral rehabilitation under general anesthesia in a child with cerebral palsy and epilepsy, and to evaluate short-term mother-reported outcomes after treatment. METHODS: A clinical case report was prepared based on history taking, extraoral and intraoral examination, perioperative documentation, and mother-reported follow-up. Tooth notation followed the Federation Dentaire Internationale (FDI) two-digit system. Radiographic examination was not performed because the patient was unable to maintain the required posture. CASE REPORT: A 9-year-old girl with spastic cerebral palsy and tonic-clonic epilepsy presented with fever and multiple untreated carious lesions. Examination revealed mixed dentition, poor oral hygiene, limited mouth opening, reversible pulpitis in teeth 62, 63, 72, 26, 16, 36, 46, and 83, and pulpal necrosis with non-restorable root remnants in teeth 85, 84, 75, 74, 55, and 54. Single-session full-mouth rehabilitation under GA included scaling and prophylaxis, composite restorations of teeth 62, 63, 72, 26, 16, 46, and 83, pulpotomy of tooth 36, extractions of teeth 85, 84, 75, 74, 55, and 54 and topical fluoride application. Transient postoperative facial edema occurred and was managed conservatively. At 1-month follow-up, the mother reported improved feeding comfort, pain-free sleep, and a 2-kg weight gain. CONCLUSION: Full-mouth dental rehabilitation under GA provided a feasible approach for managing extensive dental disease in a child with CP and epilepsy when conventional chairside treatment was not possible. The intervention enabled completion of definitive dental care in a single session and was associated with mother-reported improvements in feeding comfort, sleep, and short-term weight gain. Longer follow-up and standardized outcome measures are needed to evaluate sustained oral health, function, and quality-of-life benefits in similar patients.