WILLIAMS SYNDROME- A CASE REPORT
Figure 4. Upper Occlusal Figure 5. Lower Occlusal
Figure 6. Right Lateral View
23, 36 and 44 had brownish discoloration on the facial surfaces, indicative of enamel hypoplasia, which is commonly seen in patients with WS. 6 Recurrent caries were detected on teeth 25, 26 and 36 and deep fissures were noted on teeth 34, 35, 44, 45, 17, 27, 37 and 47. Vitality tests revealed all the teeth to be vital. There was no previous history of trauma reported( Figs 3-7). The patient had very poor oral hygiene and brushed only once a day. Her diet consisted of sugary snacks throughout the day. She had been treated by a general dentist for the existing restorations prior to being evaluated by the authors. The treatment was accomplished under local anesthesia. According to the dental history reported by the parent, the patient had sporadic dental care through out and had not seen a dentist for the past two years. The family was very keen to reestablish dental care for the patient and decided to continue long term care with the European University College dental clinic.
2.3. Radiographic A panoramic and bitewing radiographs were taken at the first visit. The panoramic radiograph revealed no signs of supernumerary teeth or of any pathology. The third molars were all present. No interproximal decay was noted on the bitewing radiographs.( Fig. 8) Due to the systemic complications associated with the syndrome, the patient was referred to her physician for a medical consult prior
Figure 7. Left Lateral View
to proceeding with any dental treatment. A cardiologist was also consulted as the patient had a history of supravalvular aortic stenosis; no antibiotics were required for SBE prophylaxis. An informed consent was obtained from the parents of the patient for the dental treatment. A comprehensive dental treatment plan was formulated. The short term dental plan included dental prophylaxis, scaling and fluoride varnish( Duraphat, 22600ppmF) application on all the teeth. Composite restorations were planned for teeth 25, 26, 36 and on the buccal surface of 44. Resin sealants were recommended for teeth 34, 35, 44, 45 and all second permanent molars. The patient was very concerned about the brownish discolorations on her front teeth( 12, 23) which were planned to be treated with microabrasion. The treatment was accomplished using local anesthesia. An individualized preventive plan was put in place that included frequent follow ups every 3 months for dental prophylaxis and fluoride varnish application. Twice daily brushing with fluoridated toothpaste( 1450ppm F) and flossing was recommended. Diet and nutrition counseling was provided. An orthodontic consultation was recommended due to the Class 3 malocclusion. The behavior of the patient was rated as ++ on the Frankl behavior scale. 7
88 STOMA. EDUJ( 2016) 3( 1)