Salivary Glands’ Removal Linked to Dental Issues in Young CP Patients

Surgical removal of salivary glands to treat drooling in children and adolescents with cerebral palsy (CP) increases the number of white spots in their teeth, which must be treated promptly to avoid complications such as caries (cavities), a study finds.

The study, “Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy,” was published in the journal Medicina Oral, Patología Oral y Cirugía Bucal.  

Movement impairment, such as difficulty controlling neck mobility, swallowing, and chewing, can make some people with cerebral palsy more prone to drooling.

The first treatment option is usually oral motor therapy for rehabilitating movements of the mouth and neck. A second treatment option includes medications to help reduce saliva secretion without affecting swallowing. Some examples include anticholinergic drugs, such as scopolamine or atropine, and botulinum toxin injections.

These compounds usually block the action or the production of a neurotransmitter called acetylcholine — a molecule that transmits signals between cells of the nervous system, important for muscle contraction, learning and memory.

In more persistent situations, where prior therapy has failed, surgery may be used to remove some of the salivary glands.

This reduces salivary flow; however, these treatments may increase the risk of tooth decay or dental caries, as saliva is important to keep the mouth clean and protected from infections.

Recognizing the paucity of studies of this issue, researchers at Cruzeiro do Sul University in Brazil compared the effects of different treatments on risk of caries in 142 children and adolescents, ages 6–18, with CP.

Patients had been referred to a specialized physical rehabilitation center in São Paulo, and were assigned to four groups based on the treatments they had received: anticholinergic drugs (18 patients), botulinum toxin injection (16 patients), salivary gland surgery (16 patients), or no treatment (42 patients). A control group of 50 patients without drooling was included.

All patients had received a preventive regimen (including biofilm control, teeth cleaning, and fluoride therapy) and dental treatment as needed before the drooling treatment.

A dentist examined teeth’s cleanliness using the Simplified Oral Hygiene Index (OHI-S), and the presence of dental caries, including decayed, missing, and filled teeth, as well as white spots.

White spots are signs of tooth demineralization. There are several possible causes, including the intake of too much fluoride, poor dental hygiene, and eating too many acidic or sugar-rich foods.

Along with that, the amount and characteristics of participants’ saliva were measured.

The results showed that the groups did not significantly differ in terms of decayed, missing, and filled teeth or overall oral health as measured by OHI-S.

However, patients who had undergone salivary gland surgery presented significantly more white spots, accompanied by a lower salivary flow and more concentrated saliva. This suggests that “the surgical procedure was the most harmful treatment modality,” putting patients at a higher risk of dental caries.

Researchers also said that white spot lesions “require immediate non-invasive treatment by application of fluoride varnish or occlusal sealants with fluoride-releasing material, such as the latest generation of glass-ionomer cements (a dental restorative material).”

If first lesions are not controlled, they can progress toward cavitation (holes in the jawbone), painful sensation, difficulty in chewing, and the need for rehabilitation, researchers said.

Thus, it is essential that dental surgeons take part in multi-disciplinary medical teams “in order to prevent and treat the early signs of damage caused by treatments for drooling and to maintain individuals’ follow-ups to promote oral health,” they said.

Caregivers should also be alerted to the possible consequences of various drooling treatments.