Neuropathic chewing in comatose children

Resident: Adam J. Bottrill
Date: 23AAPR10
Region: Providence
Article title: Neuropathic chewing in comatose children
Author(s): Ngan, Peter W., Nelson, Linda P.
Journal: Pediatric Dentistry
Page #s: pp. 302-306
Year: 1985, Dec
Major topic: Neuropathic Chewing Etiology
Minor topic(s): Management of this parafunction
Type of Article: Topic review and suggested management

Main Purpose: Review and discuss etiology and management of neuropathic chewing.
Overview of method of research: N/A

Key points in the article discussion:

I. General:
A. Patients in a coma may develop chewing movements similar to those sleeping. If the coma is prolonged, they might inflict trauma on themselves... “neuropathis chewing”
1. It is possible for various appliances to aid these patients.

II. Methods:
A. Retrospective study on 16 comatose patients with neuropathic chewing at CHOP.
B. Appliances were made for 10 of the patients.

III. Coma
A. Cause by interruption of the integrity of the arousal system.
B. Either brain stem injury or diffuse cortical injury.
C. Masticatory movements are normally rhythmic and automatic.
D. Comatose patients have lost the ability to coordinate these movements.
E. It has been written that a bolus placed between the teeth can trigger chewing. In comatose pt’s the tongue can cause this “reflex”.

IV. Management of Neuropathic Chewing:
A. Suggested indications for the need of fabricating dental appliance:
1. Presence of ruminatory movements of the jaw or bruxism which is usually of more than 24-hr duration.
2. Presence of intraoral soft tissue lacerations.
B. Other potential solutions include a bite block or mouth prop.
1. …though I have a hard time keeping them in place on CONSCIOUS kids.
2. Can be used as a temporary fix
C. Removable custom made appliance.
1. 2nd most hygienic
2. Allows tongue movement but prevents it acting as a bolus.
3. Need to paralyze patient for impression.
D. Intermaxillary fixation NOT recommended
1. Not hygienic
E. Consider NOT making an appliance as more mildly comatose patients have self-limited chewing.
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Assessment of article: There is no post-treatment analysis for the appliance treatment. This seems like a pretty severe shortcoming for such a “respected” author…. I’m calling shenanigans.