Oral findings in children and adolescents with Prader-Willi syndrome

Prader-Willi syndrome: Periodontal-prosthodontic rehabilitation in an adult patient

INTRODUCTION

Prader-Willi syndrome (PWS) is a rare genetic multisystemic disease that is the most common inherited cause of severe childhood obesity. PWS patients are prone to significant oral and systemic health issues that detrimentally affect quality of life and decrease longevity. This report documents full-mouth pre-prosthetic surgical and restorative care in an adult PWS patient.

CASE REPORT

The patient, a 29-year-old male, presented to the clinic accompanied by his guardians (parents) with the chief complaint that "My Teeth are breaking down and I would like to get them fixed". Periodontal and prosthetic comprehensive clinical and radiographic exams revealed a severely worn dentition, deep anterior overbite, altered passive eruption with generalized biofilm-induced gingivitis, and altered occlusal vertical dimension. Full mouth crown lengthening surgery combined with full mouth prosthodontic reconstruction was performed under parenteral sedation and local anesthesia. Completion of treatment was successful, and the patient was placed on a 3-month periodontal maintenance interval.

DISCUSSION

Full mouth periodontal surgical and prosthodontic reconstruction on a PWS patient has not previously been reported in the literature. This case underscores the potential need for complex dental care in patients with this syndrome.

Craniofacial and dentoalveolar morphology in individuals with Prader-Willi syndrome: a case-control study

BACKGROUND

Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder with distinct genetic and clinical features. Among other clinical symptoms, PWS is characterized by severe infantile hypotonia with feeding problems, childhood onset hyperphagia, obesity, scoliosis, short stature combined with growth hormone deficiency and developmental delay. PWS is associated with facial dysmorphology, orofacial dysfunction, oral abnormalities, low salivary flow and subsequent severe tooth wear. Little is known about the craniofacial growth direction or dental and skeletal relationships in individuals with PWS in different ages. The purpose of this study was to assess the craniofacial and dentoalveolar characteristics and to investigate the craniofacial growth direction separately in children, young adults and adults with PWS, using a cephalometric analysis of lateral cephalograms.

RESULTS

Lateral cephalograms of 42 individuals with a confirmed genetic diagnosis of PWS were analysed and divided into three groups according to their age: Children (< 12 years), young adults (12-20 years) and adults (> 20 years). Cephalometric variables were compared between PWS patients and controls by age and sex. Significant deviations and distinct craniofacial patterns were found in children, young adults and adults with PWS compared with the control group. Children showed retrognatic mandible with a skeletal class II relationship, posterior growth direction and longer anterior face height. The young adults had smaller cranial base angle, a skeletal class II pattern and a higher anterior lower face than the control group. Adults with PWS had a prognathic mandible, skeletal class III relationship with anterior growth direction, more retroclined lower incisors and proclined upper incisors than the controls. Similar results were found when comparing the three groups with PWS; the adults had a prognathic mandible, skeletal class III pattern and anterior growth direction. Children had a retropositioned mandibula, skeletal class II relationship and posterior growth direction.

CONCLUSION

This study may contribute to a better understanding of the craniofacial growth pattern in children, young adults and adults with PWS and may have a clinical importance when planning dental treatment, such as prosthodontics and/or orthodontics.

Sleep Disorders in Children with Prader Willi Syndrome: Current Perspectives

Children with Prader-Willi syndrome (PWS) face a multitude of potential health challenges including life-threatening obesity, endocrinopathies, behavioral and emotional dysregulation, developmental delays, and sleep disorders. In the current perspective piece, we provide a focused review of the condition's etiology and clinical findings, as well as a more in-depth discussion of sleep disorders frequently associated with PWS. In particular, we highlight and discuss difficult clinical scenarios frequently encountered by the pediatric sleep physician caring for this patient population, including diagnosis and treatment of complex sleep-related breathing disorders, considerations for sleep apnea surgery, the interplay between growth hormone and sleep apnea, diagnostic challenges in hypersomnia/narcolepsy, and current and emerging therapies for hypersomnia/narcolepsy. Overall, although there are many areas that need further research, sleep disorders remain a fruitful target for improving quality of life of children with PWS and their families.

Bridging Oral and Systemic Health in Children with Prader-Willi Syndrome: Case Reports and Dental Treatment Recommendations

BACKGROUND

Prader-Willi Syndrome (PWS) is a complex neurodevelopmental disorder caused by gene alterations on chromosome 15q11-q13, resulting in hyperphagia and neuroendocrine deficits. A comprehensive guide for dental treatment for PWS is lacking despite numerous case reports. The objective of this report was to develop a problem-focused list of the interrelationship between oral and systemic parameters of PWS and enable dentists in anticipating the unique treatment needs of children and individuals with PWS.

METHODS

Four pediatric patients with PWS presenting to an academic dental clinic were evaluated. A literature review spanning the last twenty years was performed to identify the pathophysiological impact of systemic problems on dental health and treatment.

RESULTS

The four cases along with cases from the literature were used to enumerate salient oro-dental and systemic features influencing treatment decisions in dentistry. They formed the basis for collective recommendations and precautions for rendering dental treatment in patients with PWS.

CONCLUSION

Sedation for dental treatment is contraindicated due to obesity (BMI over 95th percentile), hypotonia, obstructive sleep apnea (OSA), and respiratory limitations (restricted ventilation due to weight on thoracic cage). Prolonged recovery from general anesthesia, OSA, and temperature dysregulation necessitate extended monitoring after dental rehabilitation under general anesthesia. Orthopedic problems and respiratory limitations exclude protective stabilization. Xerostomia and acidic saliva necessitate recommendations for oral rehydrating products. Periodontal assessment is necessary due to poor oral hygiene and diabetes mellitus. Early establishment of a dental home and risk-based frequency of dental care should address caries prevention and restorative needs.

Oral disorders in children with Prader-Willi syndrome: a case control study

INTRODUCTION

Prader-Willi Syndrome (PWS) is a genetic disorder caused by the lack of expression of certain paternal genes located on chromosome 15q11-q13. This anomaly causes cognitive, neurological and endocrine abnormalities, among which one of the most important is hyperphagia. The aim of this study was to assess the oral health of children with PWA and to establish preventive criteria.

RESULTS

Thirty patients with PWS (mean age 10.2 years) and 30 age- and gender-matched controls were included in the study. Twenty-six patients with PWS(86.6%) followed dietary treatment prescribed by their endocrinologist. Individuals with PWS had a mean caries index of 53.3% and Decayed Missing Filled teeth (DMFT) index 2.5, and 53.3% had gingivitis, in the control group the respective figures were 43.3%, 0.93, and 60%. Only the DMFT index (p 0.017) presented significant differences. Regarding stimulated salivary secretion, patients with PWS presented a mean of 0.475 ml/min with a pH of 6.15, while controls presented a mean of 0.848 ml/min with a pH of 7.53; the differences between the groups were statistically significant in both cases (p 0.032 and p 0.0001 respectively). The population with PWS presented a higher plaque index (> 2) than their healthy peers, but the differences were not significant.

CONCLUSION

Pediatric patients with Prader-Willi syndrome have an increased risk of caries and gingivitis. The children with this syndrome have a decreased salivary flow and a more acidic salivary pH. In these patients, dental care is an essential part of their multidisciplinary medical treatment.

Behavioral and clinical aspects associated with probable sleep bruxism in early childhood

Abstract Introduction Although many studies are being carried out with sleep bruxism, the literature points to a lack of studies with methodological quality in children. Objective To evaluate the behavioral and clinical aspects associated with probable sleep bruxism in early childhood. Material and method A cross-sectional observational study carried out with 371 children between 4 and 6 years of age. Parents answered a questionnaire with aspects related to their children's sleep behavior. Among the clinical characteristics, the presence of lip sealing, clicking, teeth marks on the jugal mucosa, and the side of the tongue was evaluated. Tooth wear was assessed using the BEWE index criteria. Simple logistic regression models were adjusted for each independent variable, estimating the gross odds ratios with the respective 95% confidence intervals. Variables with P <0.20 in the individual analyzes were adjusted in a multiple logistic regression model, with those with P ≤ 0.05 remaining in the model. Result 42.4% of parents reported that their children gritted their teeth while sleeping. Children who showed wear on their teeth were 1.53 times more likely to grind their teeth. There was no significant association with the other variables analyzed (P > 0.05). Conclusion Behavioral aspects were not associated with probable sleep bruxism. Among the clinical characteristics evaluated, tooth wear showed an association, which may indicate the probable bruxism of sleep in early childhood.

Oral health in patients with Prader-Willi syndrome: current perspectives

Prader-Willi syndrome (PWS) is a rare complex multisystem disorder and presents several aspects related to dentistry. The purpose of this review is to present current perspectives about oral health in patients with PWS. Delay development, hyperphagia, foamy and highly viscous saliva raise the risk of caries and contribute to tooth wear. Cariogenic foods uncontrolled consumption allows to obesity and dental problems progress worsening systemic disorders. These factors can be controlled. The success in follow-ups with caries free and oral health controlled demonstrate the importance of multidisciplinary team intervention corroborated by support at home from birth to adulthood. Thereby, current perspective on the disease is that there is possibility of proper maintenance of oral health in PWS patients. Guided care interferes positively with the overall well-being and quality of life of the individual with PWS and their family. A multidisciplinary team with a focus on teaching patients and family members will help minimize eventual problems.