Abstract
BACKGROUND: Children and adolescents with cerebral palsy (CP) are known to have higher dental caries prevalence due to interacting clinical, behavioral, and socioeconomic factors. Although caregiver burden and suboptimal oral health practices have been implicated, their relative contributions remain unclear. This study aimed to determine caries prevalence in children and adolescents with CP, assess caregiver burden, and identify key predictors of increased caries risk. METHODS: This cross-sectional analytical study was conducted across two hospitals in Kuala Lumpur. Clinical data, including the Gross Motor Function Classification System (GMFCS) levels and CP subtypes, were extracted from patient medical records. Dental caries prevalence was assessed using the Decayed, Missing, and Filled Teeth (DMFT)/decayed filled teeth (dft) index, while caregiver burden was measured using the Zarit Burden Interview. Binary logistic regression was used to identify predictors of dental caries prevalence. RESULTS: A total of 110 children and adolescents with CP and their caregivers participated in the study. The prevalence of caries in primary teeth (70.3%) was consistent with the national average (71.3%). However, for permanent teeth (77.3%), it was over twice the national caries prevalence (33.3%) in 12-year-old children. The Care Index was notably low for both primary and permanent teeth at 6.1% and 20.0%, respectively. On average, caregiver burden was mild to moderate. Binary logistic regression revealed that children with GMFCS levels IV and V were 25.1 times [95% confidence interval (CI): 4.54-138.90] more likely to exhibit dental caries than those at GMFCS levels I-III. CONCLUSIONS: This study demonstrates that children and adolescents with CP experience high caries prevalence and unmet dental treatment needs. On average, the caregivers experience mild to moderate burden and severe motor impairment (GMFCS IV-V) is the sole key predictor of caries risk in children and adolescents with CP. Hence, the GMFCS classification serves as a reliable tool for stratifying caries risk in children and adolescents with CP. Targeted dental caries prevention, early intervention, regular monitoring, and multidisciplinary care involving pediatricians, rehabilitation teams and the pediatric dental team are imperative to improve oral health outcomes.