Strategies and dental care in the treatment of patients with myelomeningocele

Abstract

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing oral medications. This paper reports the oral findings and dental treatment in a 15-year-old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients' mobility problems; prevention of latex-related allergic reactions; reduction of gag reflex during dental procedures.

Management of internal and external root resorption in primary teeth of a 3‐year‐old with myelomeningocele: A case report

“…The child had neurogenic bladder (lack of bladder control) and extraoral examination showed flat nasal bridge, short stature and hydrocephalic head (i.e., fluid buildup in ventricles of the brain which had been treated by shunt placement) (Figure 1A). As literature reports 1,8,14 high prevalence of latex allergy in individuals with MMC, the patient was assessed (referred to a hospital) and was found non-allergic. In the first and second quadrant, the primary incisors and molars had deep caries and were associated with dentoalveolar abscesses.…”

“…7 Despite the severity of the condition, new advents in the field of medicine and surgery have increased the average life span and about 75% of the patients with MMC now reach the young adult age group. 8 Root resorption in teeth is a convoluted response of the body to a myriad of factors. Trauma and pulpitis are commonly known to cause root resorption.…”

“…1,8 Other factors that might affect the treatment are intellectual and motor impairment, difficulty in keeping the mouth open, heightened gag reflex and possibility of convulsions. 1,8 Dental treatment in children with MMC is challenging and requires the dentist's extensive knowledge and expertise on the subject. Following the routinely practiced treatment protocol for root resorption would severely compromise the already hampered nutrition of the child.…”

Manejo odontológico del paciente pediátrico con espina bífida y alérgico al látex. Revisión de la literatura

“…53-63 colocación de abrebocas, retractor de lengua y dique de goma para así poder controlar movimientos involuntarios de la lengua y la deglución accidental de materiales o instrumental odontológico 23 . La planificación del tratamiento del paciente con hidrocefalia con una DVP es de suma importancia, ya que se le debe indicar antibioticoterapia profilaxis antimicrobiana una hora antes del procedimiento odontológico, siendo la amoxicilina el antibiótico de primera elección 21,23,34 , siguiendo de esta manera los lineamientos de la Academia Americana de Odontopediatría (AAPD) 25 que dice: "se prescribe un antibiótico previo a un procedimiento odontológico no solo enfocado a la previsión de endocarditis infecciosa sino también para disminuir el riesgo de posibles infecciones a distancia en ciertos pacientes" como es el caso de los que tienen una DVP. 26 Con respecto al látex y los pacientes con EB, deberán extremarse las medidas en el consultorio odontológico para evitar el contacto con este material, lo cual realmente puede resultar difícil ya que mucho de los instrumentos/equipos que se utilizan de forma rutinaria en odontología contienen látex.…”

Dental Care for a Child with Congenital Hydrocephalus: A Case Report with 12-Month Follow-Up

“…Despite the possibility of early diagnosis and surgical treatment, the prognosis for CH is still not good, as the perinatal mortality rate is as high as 38% [8]. Most cases of hydrocephalus require extracranial shunts, particularly ventriculoperitoneal shunts (VPSs), which generally consist of Silastic tubing that runs subcutaneously from the head to the abdomen with a valve between the ventricular and distal catheters.…”