NOT-S is Valuable Screening Tool to Assess Orofacial Impairments in Children with Cerebral Palsy, Study Says

NOT-S is Valuable Screening Tool to Assess Orofacial Impairments in Children with Cerebral Palsy, Study Says

A screening test that evaluates the function of facial muscles that control breathing and chewing may be a valuable tool to assess children with cerebral palsy, a Turkish study suggests.

The study, “Assessment of orofacial dysfunction using the NOT-S method in a group of Turkish children with cerebral palsy,” was published in the journal European Archives of Paediatric Dentistry.

People with cerebral palsy can experience extensive oral and dental dysfunctions that significantly impact their overall health. Orofacial impairments can especially be a problem for children with cerebral palsy, as they are more likely to have cavities than children without a disability. Studies have shown that 39%–85% of children with cerebral palsy have eating problems, while 22%–40% have difficulties in controlling saliva, and 53%–59% experience speech problems.

Improvements in social and healthcare support have given people with disabilities better access to dental care. However, “there is lack of exact knowledge about the dental situation of the different disabled populations for correct treatment planning,” the study’s researchers noted.

To address this knowledge gap, these Turkish researchers explored the potential of the Nordic Orofacial Test-Screening (NOT-S) for cerebral palsy patients.

NOT-S resulted from a joint project involving dentists and speech therapists, which was supported by the Nordic Association for Disability and Oral Health. The screening addresses six domains that are covered in a structured interview and clinical examination.

The patients are interviewed about their sensory function, breathing, oral habits, ability to chew and swallow, drooling, and mouth dryness. The physical examination includes assessment of the face at rest, and tasks involving nose breathing, facial expression, masticatory muscle and jaw function, oral motor function, and speech.

NOT-S was used to evaluate orofacial dysfunction in 42 children (20 boys and 22 girls, between 3 and 16 years old) who were diagnosed with cerebral palsy. The same number of age- and sex-matched typically-developing children were used as controls.

Cerebral palsy patients had a significantly higher NOT-S total mean score of 3.71 points, compared with the control group’s score of 1.22 — from a possible maximum of 12 (the higher the score, the more significant the dysfunction).

The interviews revealed that orofacial impairments were prevalent among the cerebral palsy group. In particular, approximately 52.4% of the children in this group had chewing and swallowing problems, while 47.6% had impaired sensory function issues, and 45.2% experienced problems related to mouth dryness.

The physical examinations revealed that the most common dysfunctions were in facial expression (55.9%), oral motor function (44.1%), and face at rest (20.6%) domains.

The children with cerebral palsy showed more difficulty in attempting to whistle, lick their lips, and blow up their cheeks and hold for at least three seconds. They also had significant differences in nose breathing and speech domains compared with the controls.

The most prevalent problems in the control group pertained to habits (35.7%), followed by chewing and swallowing (23.8%), and dryness of the mouth (19%).

Taken together, these findings show that the NOT-S protocol is “an effective and valuable tool for comprehensive screening to assess orofacial dysfunction” in children with cerebral palsy, the researchers said.