A case of Beckwith-Wiedemann syndrome with peculiar dental findings

BACKGROUND

Beckwith-Wiedemann syndrome (BWS, OMIM 130650) is a rare genetic disorder characterised by overgrowth, tumor predisposition and congenital malformations. Few systemic manifestations and oral features have been reported so far.

CASE REPORT

We report on a case of BWS, describing all features expanding the knowledge on oro-dento-facial phenotypes, along with a review of the literature.

[The evaluation of anxiety and the analysis of pain perception in Down's syndrome patients undergoing dental procedures]

Twenty Down's syndrome dental patients between 9 and 20 years of age have been identified in order to evaluate anxiety and pain induced by various kinds of dental treatment such as some "moderately painful" dental out-patient procedures (10 subjects), general anaesthesia dental treatment (5 subjects) and painless out-patient visit or routine orthodontic services (5 subjects). Each patient received a previous psychological evaluation to assess his intellectual and cognitive developmental degree. Anxiety was assessed twice, before and after intervention by means of a questionnaire; pain was tested in a subjective way during the procedure (or the control oral visit 12 hours after the g.a. treatment) and by a questionnaire in the post-treatment phase. This investigation indicates that anxiety increased in Down's syndrome subjects receiving out-patient interventions, remained at the original level in the general anaesthesia hospitalized patients, while it showed a clear reduction in the out-patient painless control group. Anxiety, however, proves to be influenced also by the patient's effective mental age so it my be lessened after painful dental treatment when the intellectual development is about or above that of a 7 year old boy. Our study could prove to be important since it underlines the need to assess, at least approximately, the Down's syndrome patient's cognitive development before giving dental treatment, especially if it is an out-patient intervention. This may not be necessary for routine free of pain dental visits.

[A global approach to the dental care of children and young adults with trisomy 21. II. The planning of the preventive and interceptive care of Down's syndrome patients]

In this second part, the principles and modalities of a personal contribution to the realisation of a specific protocol that uses preventive and interceptive criteria to plan odontostomatological treatment in patients with Down's syndrome are presented. A special type of treatment is proposed. This is distinguished chronologically into five stages with periodic visits to specialist hospital structures, implying the start of treatment in Down's children at the age of 2-3 months and programmed continuation of such treatment right up to the age of at least 18 years.

[A global approach to the dental care of children and young adults with trisomy 21. I. The dental and orofacial characteristics of Down's syndrome]

On the basis of a full analysis of recently reported data, it is shown that manifold and quite characteristic problems of dental and orofacial nature requiring global consideration coexist in Down's syndrome. These are addressed one by one in order to stress the need for dental treatment and to provide for correct planning of interventions right from the early months of life in the case of a patient with Down's syndrome.

[The incidence of malocclusion in the school population of the the Province of Trieste]

The results of an epidemiological investigation on the prevalence of malocclusions in the school population of the Province of Trieste carried out on a sample of 2099 subjects aged 10 and 12 are reported. Subjects were classified according to Angle classes. Other malocclusion parameters such as overjet, overbite, median line deviation, crossbite and upper and/or lower crowding have also been investigated.

[The incidence of dental caries in the school population of the Province of Trieste]

The results of an epidemiological investigation on the prevalence of dental caries in the school population of the province of Trieste carried out on a sample of 2954 children aged 6, 10 and 12 years are reported. The results were evaluated using the dmf and DMF epidemiological indices suggested by the WHO. Certain "intervention indices" were also calculated.

[A simple method for proposing several profiles to patients undergoing rhinoplasty or profileplasty]

The authors describe a simple mean to visualize the several profiles which is possible to perform in the patient who is undergoing rhinoplasty or profiloplasty procedure. Failure in giving a clear opportunity of choice of a profile may lead to misunderstanding between surgeon and patient.

[Hypertrophy of the concha of the auricle. Details of the technic]

Ear concha hypertrophy corrected by elliptical conchal excision often resulted in deformity due to lateral deviation of the anterior part of the concha. A modification of the method allows to avoid that deviation: the conchal ellipse is left connected to the conchal floor, is weakened by half thickness incisions parallel to the edge; the conchal floor thus flattened is sutured to the lateral side of the head by non absorbable suture.