뇌성마비(Cerebral Palsy)는 임신 중이나 출산, 또는 신생아기에 발생된 뇌손상에 의해 발생하는 중추성 자세 및 운동 장애를 말한다. 뇌성마비는 여러 가지 합병증 및 동반증상을 가지게 되는데, 그 증상들에는 지적장애, 언어장애, 간질, 시각장애, 자폐, 이갈이 및 섭식연하장애 등이 있다. 뇌성마비 장애인에서 나타나는 치과적 특징과 고려사항, 그리고 이들의 구강건강관리에 대해 알아보고자 한다.

The objective of this study was to assess oral health status such as prevalence of dental caries, gingivitis and other combined disorder, orofacial dysfunction in patients with cerebral palsy(CP), as well as the state of tooth brushing, possibility of dental treatment. Sixty-six subjects with CP aged 9 to 37 years were included in the study. Clinical caries status(DMFT index) and other data were evaluated and statistically analyzed using SPSS program (SPSS 17.0). The results were as follows: The DMFT index and prevalence of gingivitis of study subjects were 2.82(male), 3.33(female) and 89%, respectively. DMFT index classified into four groups according to age as follows: DMFT index were 1.14(ages 6-11), 1.40(ages 12-14), 2.16(ages 15-24), 4.15(ages 25-37). In addition to the physical disorder, speech difficulty(86%), epilepsy(35%) and visual impairment(14%) were associated and the epilepsy medication was the most common medication. And orofacial dysfunction such as the eating difficulties(79%), drooling(36%), swallowing disorder(30%), breathing difficulty(15%), bruxism(30%) and snoring(33%) was shown. Most people with cerebral palsy can't brush alone and didn't use oral care adjunctive supplies. Moreover, Fifty-nine percent of them were noncooperative to dental treatment.

Background : To do dental treatments successfully for dentally disabled patients who are unable to cooperate to procedures needs deep sedation (DS) or general anesthesia (GA). But there are some difficulties in selecting DS because of some disadvantages such as airway problem etc. But, if we select appropriate cases, DS would be better than GA. Methods : We reviewed total 238 cases of patients who had received dental treatments under GA or DS at the clinic for the disabled in Seoul National University Dental Hospital from November 2007 to February 2009. To compare anesthesia condition between DS and GA, we reviewed preanesthesia evaluation sheet, anesthesia or sedation records and PACU sheets retrospectively. Results : The number of DS cases was 25 (11%) and that of GA was 218 (89%). To maintain DS, intravenous propofol was infused with syringe pump (100%), and sevoflurane (134 cases) or propofol (13 cases) were used for sedation induction. Mean total treatment time for DS was 36 min and 2 hour 25 min for GA. The recovery time at PACU was 44 min for DS and 80 min for GA. There were no severe complications in DS, but 18 cases showed nausea and vomiting in GA. Conclusion : Deep sedation for disabled dental patients should be selected for effective behavioral control in conjunction with general anesthesia, considering duration and pain-evoking potentials of dental treatment and type and severity of patients' disabilities altogether.

A 26-year-old female patient with Down syndrome visited to recieve dental treatment under gnenral anesthesia 6 years ago. The patient had difficulties in oral examination, radiograph taking and laboratory test. The patient had congenital heart disease and medical consultation based on the echocardiography was provided by a cardiologist indicating that the patient could tolearte general anesthesia during dental treatment. And two times of general anesthesia were administered during a dental treament with the interval of 3 years and no postoperpative complicaton was reported. At the third dental operation, the patient had a relatively good condition and her prescreening test revealed no abnormalities. Without further consultation with a cardiologist, general anesthesia was administered to the patient. Anaesthesia was based on thiopental and ventilation of desflurane and $N_2O$ in oxygen via an endotracheal tube with an appropriate monitoring. During the maintenance of anesthesia, the blood pressure of the patient started to drop and the oxygen saturation also began to decrease. Consequently, the proceding operation was discontinued and also inhalation anesthesia was ceased. As the patient was recovered from anesthesia, her systemic conditions were alleviated. After the complete recovery of the patient, she visited the cardiologist, and the cardiologic test revealed her severe right ventricular dilatation. In the anesthesia of patients with congenital heart disease, information on their systemic conditions needs to be undated from the medical consultation, which assures the safety of treatment.

본 증례는 전반적인 치과치료를 위해 본과에 의뢰된 다수의 치아우식증으로 본과에 내원한 중등도 정신지체 환자로, 전치부 개방교합과 함께 상악 전치부의 총생이 있어 이 부분에 대해서는 본원 보철과에 협진을 의뢰하였다. 전신마취 하에 소아치과에서 보존, 외과적 처치 및 치주 치료를 시행하였으며, 보철과에서 상악 좌우측 견치를 지대치로 한 4-unit bridge를 제작, 심미적 결과를 얻었기에 보고하는 바이다. 본 증례 에서와 같이 전신마취 하의 포괄적인 치과치료를 계획함으로써 여러 번 치료의 불편함 없이 한번에 대부분의 치료를 완료할 수 있었다. 또한 환자에게 치과치료에 대한 공포심을 유발하지 않아 환자와 치과의사의 치료적 관계 형 성이 용이하며 양질의 진료가 가능하고 술자 및 환자의 스트레스를 줄일 수 있는 장점이 있다고 할 수 있겠다.