Dental care for a child patient with holoprosencephaly, cerebral palsy and multiple comorbidities: case report

Abstract

Objective: To describe the comprehensive dental approach in an institutionalized pediatric patient diagnosed with holoprosencephaly, spastic quadriplegic cerebral palsy, and multiple comorbidities, highlighting clinical adaptations and the importance of multidisciplinary collaboration in the management of patients with severe disabilities. Methodology: A descriptive case report was conducted based on the dental care provided to a five-year-old female patient institutionalized in Porto Alegre/RS and residing at the Hogar de Santo Antônio dos Excepcionais. The patient presented with holoprosencephaly, microcephaly, epilepsy, cleft palate, dependence on gastrostomy, and continuous use of seven medications. The clinical evaluation was performed at bedside due to the impossibility of transport, using adapted techniques for postural control and limited mouth opening. Results: The dental examination revealed the absence of the upper left primary central incisor (61) and both lower incisors, presence of dental calculus on primary molars, and predisposing factors for sialorrhea related to orofacial alterations, malocclusion, and poor lip seal. Treatment included supragingival scaling, prophylaxis, oral hygiene education for caregivers, and the establishment of periodic follow-up visits. Sessions were conducted under multidisciplinary supervision, prioritizing the patient’s comfort and safety. Conclusions: This case highlights the complexity of dental care in pediatric patients with severe neurological and systemic disabilities. Ergonomic adaptation, behavioral management, and interdisciplinary coordination are essential to ensure humanized and effective care. Such an approach contributes to improving oral health, preventing systemic complications, and enhancing the quality of life of patients with special healthcare needs.