Journal of Disability and Oral Health

cover art

Cover Date:
October 2005
Print ISSN:
1470-8558
Electronic ISSN:
1754-2758
Vol:
6
Issue:
2

A report from an investigation of abnormal oral reflexes, lip trauma and awareness levels in patients with profound brain damage

Journal of Disability and Oral Health (2005) 6/2 72–78

A report from an investigation of abnormal oral reflexes, lip trauma and awareness levels in patients with profound brain damage
Joanna Millwood1, Sophie MacKenzie1, Ros Munday1, Elaine Pierce1 and Janice Fiske2
1

The Royal Hospital for Neuro-disability, Putney, London, UK; 2Department of Special Care Dentistry and Sedation, Guy’s, King’s and St Thomas’ Dental Institute, King’s College London, UK
Abstract Aim: To study abnormal oral reflexes and lip biting in a group of subjects with profound brain injury and any associations with levels of awareness. Design and subjects: A multi-disciplinary assessment of abnormal oral reflexes, lip biting and levels of awareness for all patients admitted to the Brain Injury Unit (BIU) at the Royal Hospital for Neuro-disability over a twelve-month period (n=45). The study observed patterns of resolution of lip trauma and documented the effectiveness of treatment options. Results: Abnormal oral reflexes were observed in 39 subjects (87%). Lip trauma was observed in 23 (51%) subjects. Bite-raising appliances were constructed for 9 subjects (39%). Dental extractions were resorted to in 3 cases (13%). Overall the lip trauma resolved in 14 subjects (61%). In 9 cases (39%) the trauma was ongoing and any improvements were short term. There was no statistically significant evidence of associations between awareness and lip trauma or oral reflexes. Conclusions: Lip trauma may be a significant problem for individuals with profound brain injury. Clinical management options are limited and often ineffective. Chronic repeated trauma seems not to respond to many of our current options. Management options and regimens need to be further developed. Key words: Trauma, profound brain injury, neurodisability

Introduction
Lip trauma is a condition associated with individuals who have profound neuro-disability (Griffiths, 2001; Millwood and Fiske, 2000) (Figures 1 and 2). It has been reported in people with developmental disability, including cerebral palsy (Dura et al., 1988; Fenton, 1982), epilepsy, autism and Lesch Nyhan syndrome (Dicks, 1982; La Banc and Epker, 1981; Shapira et al., 1985). Various oral appliances have been used in an effort to prevent further trauma and allow healing of the lesion (Dura et al., 1988; Fenton, 1982; Griffiths, 2001; Sonnenberg, 1990; Turley and Henson, 1983; Wilkinson and Wilkinson, 1992; Willette, 1992). These include cemented upper and lower splints, functional appliances (Roberts, 1995), removable appliances with lip bumpers, ‘lip plumper’ cemented with orthodontic bands, occlusal guards (Crespi and Friedman, 1986) and lip shields. More drastic solutions have included the extraction of teeth (Evans et al., 1993) and, in specific cases, the use of orthognathic surgery has been proposed to create an anterior open bite (Macpherson et al., 1992).

Abnormal Oral Reflexes
The bite reflex occurs pathologically in neurologically impaired individuals (Davies, 1994) and is often a result of oro-facial hypersensitivity. Bruxism has been described following brain injury (Ivanhoe et al., 1997) and is reported to be linked to an improvement in levels of consciousness in previously comatose patients, and its resolution after further improvement in consciousness (Pratap-Chand and Gourie-Devi, 1985). Associations between oral reflexes and changing levels of awareness have been suggested in patients with dementia (Stewart et al., 1993) and those with Huntington’s Disease (Tan et al., 2000). The aims of the investigation were to: 1. Examine the occurrence of abnormal oral reflexes in a group of subjects with profound brain injury 2. Describe patterns of lip biting and trauma in this group 3. Obser ve the effectiveness of different oral appliances and techniques used to manage lip trauma 4. Assess the association between awareness and abnormal oral reflexes.

Article Price
£15.00
Institution Article Price
£
Page Start
72
Page End
78
Authors

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