Infantile hemiplegia in pediatric dental set-up
A 12-year-old girl child reported to the department of Pedodontic and Preventive Dentistry of College of dental Sciences, Davengere, (Karnataka, India) with the chief complaint of pain in the right and left lower teeth region since 5 days []. Medical and family history was non-contributory. The patient was the younger of the two siblings born to parents of a non-consanguineous marriage. This is reported to be first dental visit of the patient. The patient was thereby taken by the authors to the medical practitioners for their opinion and further follow-ups. The brushing was not regularly followed by patient due to impaired cognitive abilities. The parents seemed to have neglected the child due to her ailment. There was no supervision of oral hygiene maintenance. The only reason the parents got the child was due to her tooth ache and bleeding from gums.\nThe patient seemed to have left hemiparesis with left facial weakness. The entire affected side of the body was noted to have significant hypoplasia. When reported to our department patient was afebrile. Examination revealed, left visual field neglect, slight flattening of the left nasolabial fold, a mild left flaccid hemiparesis and left hyperreflexia with left Babinski's reflex. The deep tendon reflexes were normal and pain sensation was intact. The anterior fontanelle was flat. There appeared to be severe left hand function impairment compared to the right hand []. Observations of growth in the legs revealed average differences of length of 2.5 mm [].\nThe patient had lower than normal IQ level when assessed with basic Stanford-Binet scale. There also appeared to be a reduced verbal ability, with mild dysphasia. Impaired voluntary movements, such as protruding the tongue, expectorating, and lip puckeringalong with decreased chewing efficacy, lower biting and lip restraining forces were observed.\nAs per the behavior assessment of the child was concerned, the patient rated to have Frankel's positive scale with outbursts of severe temper tantrums.\nThe patient presented with mixed dentition status. Examination revealed generalized gingival inflammation along with generalized gingival over-growth with plaque deposits. Grossly decayed 36, deep retentive pit and fissures with 46, 16 and 26 were present. There were also present retained root stumps with respect to 74, 75, 84, 85, 55 and 65. Macroglossia was also noticed. Patient presented with poor oral hygiene [Figures and ].\nTreatment plan decided was to perform oral prophylaxis followed by fluoride application, sealant placement with 46, 16, 26 and extraction of 36 also along with extraction of retained primary tooth root stumps followed by diet counseling.\nPrior to initiating the planned treatment regimen, the patient was implied with desensitization behavior management technique. The patient was made to familiarize the surrounding operatory area with modeling of dental procedures on other child patients. Gradual introduction of less threatening and non-invasive procedures were done following which the actual treatment was performed.\nParents were reinforced to stop in-between meal snacking of the patient. Horizontal brushing technique was taught to the patient, which is easy to master and perform. To enhance the strength and tonicity of orofacial muscles, the child was also taught few oral-motor and tongue exercises. The parents were further suggested to initiate Speech therapy classes for the child.\nUpon follow-up after 2 weeks, the patient had mastered the cognitive ability of brushing. The calculus and stain deposits were nearly minimal. The oral hygiene index and the gingival index illustrated fair scores. The diet history chart scored minimum sugar intake and the patient was recalled for sealant application periodically, every 6 months. Following the positive outcome on the response from family, the authors also suggested the usage of an electronic toothbrush with customized handle for the patient. Continued motivation and follow-ups were also suggested.