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

Anamnesis:

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