Severity of Cerebral Palsy And Its Association with Oral Health Status, Masticatory Function, and Health-Related Quality of Life in Adolescents: A Cross-Sectional Study

Abstract

Background: Cerebral palsy (CP) is the most prevalent cause of chronic motor disability originating in childhood. While traditionally managed as a motor disorder, contemporary evidence recognizes CP as a multisystem condition with significant oral health, masticatory, and psychosocial consequences. Adolescents with CP represent a particularly vulnerable group due to neuromuscular dysfunction, impaired oral motor control, and reduced access to specialized dental care. However, limited research has simultaneously evaluated oral health status, masticatory function, and health-related quality of life (HRQoL) in this population, particularly in Central Asian regions.
Objective: To investigate the relationship between cerebral palsy severity and oral health status, masticatory function, and health-related quality of life among adolescents with cerebral palsy, and to identify key clinical factors associated with reduced quality-of-life outcomes.
Methods: A cross-sectional observational study was conducted between January 2025 and February 2026 at multidisciplinary rehabilitation and neurological assessment centers affiliated with Tashkent State Medical University. The study included 60 adolescents aged 12–16 years: 40 with spastic cerebral palsy (main group) and 20 age- and sex-matched neurotypical controls. Cerebral palsy severity was classified using the Gross Motor Function Classification System (GMFCS). Oral health was assessed using the DMFT index, Oral Hygiene Index-Simplified (OHI-S), and Gingival Index (GI). Masticatory function was evaluated using a standardized two-color chewing gum mixing test. HRQoL was measured using the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0). Statistical analyses included Student's t-test, Mann–Whitney U test, one-way ANOVA, χ² test, Spearman correlation, and multiple linear regression.
Results: Adolescents with CP demonstrated significantly poorer oral health compared with controls, with mean DMFT scores of 4.1±1.9 versus 1.8±0.9 (p<0.001). A progressive deterioration in oral health was observed with increasing GMFCS level: DMFT scores increased from 2.4±1.1 (GMFCS I–II) to 5.8±1.7 (GMFCS IV–V), while OHI-S and GI scores similarly worsened (p<0.001 for all). Gingival inflammation prevalence reached 84.6% among adolescents with severe motor impairment compared with 27.8% in those with mild impairment (p<0.001), and 92.3% of GMFCS IV–V participants required caregiver-dependent oral hygiene. Masticatory function declined substantially with neurological severity: chewing efficiency decreased from 82.4±8.6% (GMFCS I–II) to 49.6±10.4% (GMFCS IV–V) versus 91.5±5.8% in controls (p<0.001), while chewing time more than doubled in severe CP. All PedsQL domains were significantly reduced in the CP group, with the greatest decline in physical and social functioning among GMFCS IV–V adolescents (total PedsQL score 48.7±8.6 versus 89.9±4.5 in controls; p<0.001). Strong correlations were identified between GMFCS level and DMFT (r=0.62), OHI-S (r=0.59), GI (r=0.58), chewing efficiency (r=−0.71), and PedsQL (r=−0.67) (p<0.001 for all). Chewing efficiency emerged as the strongest independent predictor of quality of life after adjustment for age, sex, and neurological severity (β=0.49, p<0.001).
Conclusion: Increasing severity of cerebral palsy is closely associated with progressive deterioration in oral health, impaired masticatory performance, and reduced health-related quality of life in adolescents. Masticatory dysfunction demonstrated the strongest association with quality-of-life impairment and independently predicted adverse psychosocial and functional outcomes. These findings emphasize the importance of integrating preventive dental care, oral motor rehabilitation, and regular oral health monitoring into comprehensive multidisciplinary management programs for adolescents with cerebral palsy. Future longitudinal multicenter studies are warranted to clarify causal relationships and evaluate targeted oral rehabilitation interventions.