The influence of valproic acid on salivary pH in children with cerebral palsy

Abstract

The purpose of this open-label, crossover study was to measure salivary pH after the oral administration of distilled water, a 10% sucrose solution, and valproic acid to a population of 10 children with cerebral palsy. Salivary pH was measured just prior to giving the solutions and then every five minutes for 60 minutes. The critical pH was defined at 5.5, below which dental demineralization occurs. In this population, valproic acid decreased salivary pH to below the critical pH for an extended period of time (mean = 4.32 at 20 minutes) when compared to mean salivary pH after administration of distilled water (7.11 at 20 minutes) and a 10% sucrose solution (5.96 at 20 minutes). Recovery from this low pH to above the critical level did not occur until after 50 minutes and furthermore did not recover to baseline, neutral levels, for the duration of this study (60 minutes). Our results suggest that children with cerebral palsy, a population with a tendency toward reduced salivary function, have a compromised ability to buffer the oral administration of an exogenous acid. This can result in an increased susceptibility to demineralization and caries of the teeth.

Caracterização dos pacientes e procedimentos executados no serviço de atendimento a pacientes com necessidades especiais da Faculdade de Odontologia de Araraquara – UNESP

“…Esta última, associada à má higiene bucal que esses indivíduos Indivíduos com alterações neurológicas geralmente apresentam redução do fluxo e do pH salivares, em virtude da utilização sistemática de medicamentos, como os anticonvulsivantes, antipsicóticos, ansiolíticos, antiepilépticos e antidepressivos 19 . No presente trabalho, constatou-se que 62,1% dos pacientes faziam uso contínuo de um ou mais desses medicamentos.…”

Factors that can influence the gingival health of children with cerebral palsy

“…3 The drugs used in the treatment of these conditions carry adverse collateral effects that interfere in one's oral health, such as gingival hyperplasia and the diminution of salivary flow. 22 In this study, the children who used medication for the treatment of comorbidities showed more chance of having gingivitis. Since the use of medication is indispensable, it is necessary to take preventive actions, whether with periodic returns at shorter intervals or with controlling the efficiency of the oral hygiene, in order to intercept the gingival inflammatory process early and preserve the oral health of these patients.…”

“…The presence of damages associated with CP 1 frequently requires the continuous use of medication 22 for long periods of time. 3 The drugs used in the treatment of these conditions carry adverse collateral effects that interfere in one's oral health, such as gingival hyperplasia and the diminution of salivary flow.…”

Avaliação da microdureza do esmalte de dentes decíduos de crianças com paralisia cerebral

“…É importante ressaltar que a doença 'cárie' está relacionada aos aspectos da motricidade oral 6 , da dificuldade em realização da higiene oral 5,8 , da presença dos reflexos de mordida e vômito 3 , da consistência da dieta 6 e do uso de drogas sob a forma de solução açucarada, de maneira contínua 7 .…”

“…Nesse grupo de indivíduos, observa-se uma alta prevalência de cárie, quando comparada à dos pacientes normorreativos [3][4][5] ; essa prevalência é resultante da consistência da dieta alimentar 6 , do uso de drogas de forma contínua sob a forma de xarope 7 , da dificuldade na realização da higiene oral 8 -normalmente realizada pelos cuidadores 5 -, da presença do reflexo de mordida tônica 3 e de refluxo gastroesofágico, que contribui significantemente para a erosão dental 9 .…”