Role of pediatric dentist in West syndrome rehabilitation: A case report

AIM

West syndrome is characterized by a triad of infantile spasms, arrested psychomotor development, and pronounced paroxysmal electroencephalogram (EEG) abnormalities, notably hypsarrhythmia. This case report aims to discuss the various considerations and strategies for the dental management of a child with West syndrome.

METHOD AND RESULT

This report focuses on a case of a 5-year-old girl diagnosed with West Syndrome who presented for her first dental visit with complaints of pain and swelling in the right posterior tooth region for the past three weeks. Due to frequent seizure episodes, neuropsychomotor delay, and multiple dental treatment needs, comprehensive full-mouth rehabilitation was performed under general anesthesia.

CONCLUSION

Awareness of syndromes like West syndrome equips dentists to better manage children with complex conditions. Additionally, parental counselling and early preventive measures can significantly reduce the added burden of dental diseases in these patients.

"West Syndrome-Infantile Spasms": A Pediatric Case Report

West syndrome is a rare, severe form of epilepsy with onset in infancy and early childhood. It combines episodes of epileptic spasms that occur in a cluster, an abnormal pattern of interictal electroencephalogram termed as hypsarrhythmia and neuropsychomotor delay. The syndrome mainly results from brain dysfunction in the prenatal, perinatal, or postnatal period and focal lesions early in life may secondarily affect other sites in the brain presenting with some degree of developmental delay and mental retardation. The oral manifestations vary to a large extent presenting as generalized tooth wear, gingival enlargement, multiple white spot lesions, and a high-arched palate. This case report highlights the importance of early diagnosis, various clinical features, and management in a pediatric patient with West syndrome. How to cite this article: Goswami M, Sharma S. "West Syndrome-Infantile Spasms": A Pediatric Case Report. Int J Clin Pediatr Dent 2021;14(2):323-326.

ORO-Dental Manifestations in West Syndrome

BACKGROUND

West Syndrome is a rare epileptic encephalopathy involving infantile spasms, altered electroencephalographic pattern with hypsarrhythmia, and psychomotor development delay. It arises in paediatric patients, generally within the first year of life, in symptomatic or idiopathic form depending on the presence of hereditary features or not.

CASE REPORT

In this report it is described the case of a West syndrome patient affected by multiple caries, gingival enlargement, dental eruption abnormalities, high-arched palate and MIH, treated at the dental clinic of University of Bari "Aldo Moro".

DISCUSSION

West patients present with multiple oral abnormalities, including altered eruption timing, teeth agenesis, teeth shape and position abnormalities, plaque and calculus accumulation, malocclusions and bad oral habits (mouth breathing, nails biting).

CONCLUSION

West Syndrome patients' oral hygiene is generally bad due to their motor difficulty and to their low compliance towards dentists, which entails general anaesthesia to perform dental treatment. West Syndrome pharmacological treatment is usually based on antiepileptic drugs and/or ACTH. These medications are well known for their ability to induce gingival enlargement, increasing the possibility of plaque accumulation and gingivitis development.

Oral health and dental status in people with epilepsy in rural China

PURPOSE

We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China.

METHODS

A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed "Oral health and Dental status Questionnaire". Univariate and multivariate analyses were used to explore the relationships between seizure frequency and oral health and dental status.

RESULTS

A total of 875 people participated. Almost two thirds (65.8%) reported brushing their teeth at least once a day but 634 (73.0%) brushed their teeth for less than 3 min each time. Only 80 (9.1%) had visited a dental clinic in the previous year. Multivariate logistic regression analysis showed that having 1-4 seizures/month (OR 0.60, 95%CI 0.40-0.90) or >4 seizures/month (OR 0.38, 95%CI 0.22-0.66) was associated with decreased odds of brushing teeth at least once a day, and higher seizure frequency was associated with increased odds of dental injury due to seizures (OR 2.07, 95%CI 1.22-3.50 for <1 seizure/month; OR 2.12, 95%CI 1.25-3.58 for 1-4 seizures/month; OR 3.09, 95%CI 1.57-6.07 for >4 seizures/month).

CONCLUSION

Seizure frequency was significantly associated with seizure-related dental injury, and with the lack of good oral health practice. Improvement in the oral health of people with epilepsy in resource-poor areas should be encouraged.