Child Dental Patient with NEUROFIBROMATOSIS

Clinical cases

Clinical case 1.                            LD, male, age 8

General Dg: mild NF Type 1, with:

moderate mental challenge
behavioural disturbancies
typical skin spots
facial dysmorphism
right parietal bone mass
atopic dermatitis


multiple extractions of carious primary teeth under GA at approximately age 3, motivated by young age and lack of cooperation for treatment

Reason for seeking treatment:

Family concern due to delayed eruption of upper central incisors



Dental dg.     Mixed dentition, with:

  • MIH lesions on erupting 16
  • Extracted 54, 64, 84 with consequent mesial drifting of first permanent molars; caries on remaining deciduous teeth
  • Mild gingivitis
  • Functional examination revealed:
    • chronic oral breathing
    • lip incompetence



Steps in case management:

  1. Address family’s concerns (delayed eruption) – easy, as 11 was already erupting
  2. Progressive gain of patient’s trust – non-invasive manoeuvers during first visit (brushing, photos), followed by sealants
  3. Correct altered function (breathing) by recommending functional exercises
  4. Orthodontic approach according to: clinical situation, family expectations, patient’s likeliness to comply

Problems encountered:

  • Geographic – patient from another county – longer time between successive  appointments – risk of forgetting previously accepted steps
  • Compliance – initially Frankl 2; progressed to Frankl 3-4; sudden changes of mood
  • At second visit patient shows fractured of 11
  • Mental challenge limits orthodontic approach


Treatment (chronologic order):

  • Professional cleaning; stimulate nasal breathing (exercises - home routine)
  • Glass-ionomer (Fuji Triage) restoration on erupting 16 (with moderate MIH lesions)
  • Glass-ionomer restorations on deciduous molars
  • Glass-ionomer sealants on subsequently erupted 26, 36, 46
  • Composite restoration on fractured 11 (enamel-dentin fracture, no pulp involvement)
  • Start myofunctional therapy (LM removable device)



Fractured 11 – favoured by occlusion