Temporomandibular disorders in cerebral palsy: literature review

Abstract

Introduction: In cerebral palsy the greater neurologically compromised patients have the highest functional involvement of the masticatory system and the highest structural involvement of the temporomandibular joint (TMJ). These conditions contribute to the likelihood of the onset of articular and muscular disorders. These disorders affect the orofacial region and can cause pain, audible noise upon articulation, irregular mandibular functions with deviations, known as Temporomandibular Joint Dysfunctions (TMD). Traditionally, clinical studies have been limited to articular restrictions in detriment to the various neurological and motor clinical aspects. The objective of this research is to examine studies which investigated the prevalence of TMD signs in cerebral palsy, as well as studies about several aspects of the pathology surrounding TMD, including functional, structural, neurological, and clinical aspects. Materials and Methods: We carried out literature review of several studies published between 1976 and 2014. Scielo, MEDLINE, PubMed, EMBASE, CINAHL, DARE, Psych Info, ERIC, AMI, Cochrane, and PEDro databases were used to research literature on TMD using the following keywords without restrictions: cerebral palsy, temporomandibular disorders, and rehabilitation. Results: The literature showed that signs of TMD in cerebral palsy may be prevalent in severe clinical forms which can make cervical control more difficult and lead to postural deviations. Conclusion: Craniometric changes in head circunference may limit TMJ and occlusion movements, worsened by hypertonia and asymmetry in the pterygoid and masseter muscles. Children with swallowing and oropharyngeal dificulties are more likely to show signs of TMD.

Keywords

cerebral palsy - temporomandibular disorders - oral rehabilitation - tonus - head circumference - oropharyngeal - mastication - postural control