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Importance of Fetal Alcohol Syndrome in Dentistry

Erin Taylor

Dental Hygiene IV

Lisa Hebl

November 29, 2022

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In choosing a special need to learn about, I was quickly interested in Fetal Alcohol

Syndrome. As someone who was raised in a family affected by the disease of alcoholism, this is

a topic close to my heart. Fetal Alcohol Syndrome is the most severe diagnosis of the Fetal

Alcohol Spectrum Disorders, commonly referred to as FASDs (CDC and Prevention, 2022).

Some of the less sever diagnosis are Alcohol-Related Neurodevelopmental Disorders (ARND)

and Alcohol-Related Birth Defects (ARBD). To definitively say that a child has Fetal Alcohol

Syndrome they must have documented central nervous system abnormalities, stunted growth,

and facial abnormalities. The facial abnormalities must include all three of the following: small

eye lid openings, a thin upper lip, and a smooth philtrum (National Center on Birth Defects and

Developmental Disabilities et al., 2004).

Fetal Alcohol Syndrome is unfortunately not a new problem. Even the ancient Greeks

and Romans linked drunkenness to birth defects (Calhoun & Warren, 2007). It has been said that

Aristotle was heard discussing how children born to often intoxicated mothers were different

than their peers. Depending on who you ask, you will hear different answers as to who officially

discovered Fetal Alcohol Syndrome. Some say it was Lemoine, some say Jones and Smith, while

others will argue it was Streissguth and Ulleland. While we may never come to a consensus of

who should take credit, it is clear that the congenital disease develops directly from the

teratogenic effects of alcohol through pregnancy. Just as alcoholism does not discriminate,

neither does its effects. Babies of all genders, races, and ethnicities are affected. There is a

higher incidence of Fetal Alcohol Syndrome in black, Alaskan-natives, and American Indian

communities which may be associated with data gathering methods rather than genetic risk

factors (Itthagarun et al., 2007).

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Depending on when and how much a mother drinks will determine when the fetus will be

affected. The only way to develop Fetal Alcohol Syndrome is with alcohol consumption during

pregnancy, the presence of that circumstance alone is what produces an effected population.

There has been no established safe zone of maternal drinking, nor a point which guarantees the

disorder. Newborns can show the consequences early on with irritability, tremors, low muscle

tone, and even withdrawal symptoms (Itthagarun et al., 2007). As the child ages, more symptoms

become apparent such as stunted height and weight, difficulty learning, and hyperactive behavior

(CDCand Prevention, 2022). While this disease effects fetuses, it is not curable and lasts a

lifetime.

Physically we see babies being born smaller, especially with reduced brain mass

according to John Olney (2004). While the facial abnormalities listed earlier define the

condition, there are other symptoms that can be present in addition to those. Vision problems,

hearing deficits, and orofacial clefts are some of the physical results (Munger, et al., 1996).

Phenotypically we see eyes that slope down, nose tips that point up, and a noticeable overjet.

(Itthagarun et al., 2007) Intellectual concerns are often seen associated with Fetal Alcohol

Syndrome such as difficulty speaking, learning, and reasoning. Lowered IQ, problems with

attention, memory issues, and hyperactivity are also prevalent. Since Fetal Alcohol Syndrome

does not have a treatable cure, all that can be done is to treat the symptoms. Stimulants,

antidepressants, neuroleptics, and anti-anxiety drugs are all methods of aiding in the day-to-day

management. These drugs are known to cause teeth grinding, dry mouth, and recession leading

to compromised oral health in some patients. Since Fetal Alcohol Syndrome is permanent, these

medications are often taken for life and can lead to liver problems as they are metabolized there.
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These medications also pose mental risks as they can increase thoughts of suicide and depression

(CDC and Prevention, 2022).

While a thin upper lip and the lack of a philtrum are not inherently a problem, some of

the secondary symptoms can be more problematic. The orofacial clefts seen in many children

with Fetal Alcohol Syndrome produce lifelong problems with speech and eating. Children with

Fetal Alcohol Syndrome also experience dental crowding, malocclusion, and caries at a higher

rate than nonaffected children. Some researchers suggest the figure is five times more likely

(Auger et al., 2022). These problems are compounded because having crowded teeth alone is

enough to increase the occurrence of dental caries. Not being able to easily clean between tight

spaces increases the risk of decay, then it is intensified by the coordination difficulties and the

reduced intellectual capability often seen in children with the disease. Caretakers often are

responsible entirely for daily oral home care which can become very difficult when paired with

the behavioral problems and intellectual disabilities seen in patients with Fetal Alcohol

Syndrome. With the increased incidence of facial clefts seen in these patients, the problem of

caries is once again exacerbated. The medications discussed previously can contribute to the

caries problem if the side effect of xerostomia becomes more prominent than the excessive

drooling that can be present with Fetal Alcohol Syndrome.

Throughout appointments with children effected with Fetal Alcohol Syndrome it is likely

to see the patient experiencing difficulty sitting in the chair for extended periods of time. The

hyperactivity often seen with the disorder can make appointments difficult to progress. The child

may become aggravated easily and lash out. The short attention span may also pose an issue with

appointments. Modifications can be made to accommodate these challenges such as keeping the

operatory clean and quiet to avoid distraction. Some children may have extreme difficulty
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staying in the dental chair and general anesthesia might be required. At home the same difficulty

may be experienced with daily oral hygiene, resulting in a large accumulation of plaque as tooth

brushing may be inadequate. The crowding of teeth that is often seen is also a contributing factor

to the difficulty keeping these patients’ oral hygiene adequately taken care of.

An important consideration that should be present in the minds of dental care providers is

that children who suffer from Fetal Alcohol Syndrome are at a higher risk of being abused by an

alcoholic. This may present as fearfulness or shyness in a child. This type of patient may need to

be advocated for by contacting the proper social agencies for assistance. Another time that Fetal

Alcohol Syndrome can alter our appointment is when an expectant mother is in our chair. Not

only should we be individualizing our appointments for patients effected with Fetal Alcohol

Syndrome, but it is part of our role to educate patients on the dangers of drinking while pregnant.

Along with that, it is also our role to educate the parents on resources to help their children.

Spending time throughout the appointment to teach the importance, as well as technique for

home care is not something that should be overlooked with caretakers.

Caretakers are often a necessity to maintain oral health at home for these patients. While

not every patient suffers with symptoms that leave them unable to effectively complete brushing

and flossing, it is often the case. In these instances, dental hygienists are key in identifying where

improvements need made and educating on how to enact those changes. If a patient is

intellectually incapable of understanding or remembering tooth brushing instruction, the dental

hygienist should ensure a caretaker is informed of how to administer homecare properly and

safely.

Depending on the specific needs of each patient will determine what modifications can be

helpful. If a patient presents with no intellectual disability, but struggles only with coordination,
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then they may be a candidate for independent care with the help of floss aids or a water flosser. If

a patient instead stuffers with difficulty understanding, then a caretaker can be appointed at home

to take responsibility for daily oral care. Some patients may suffer from merely memory

difficulty. This would be a great opportunity to discuss aids they can keep at home to remind

them of daily tasks to be completed. As dental hygienist, we can offer resources like routine

reminder charts that can help our special needs patients. Routine reminder charts can be helpful

for many intellectual disabilities including autism, downs syndrome, and

Attention-deficit/hyperactivity disorder (ADHD.) Hygienists can help cater the information to be

added on the chart to be most helpful for each patient. Patients with more independence may

only need the words “tooth brushing” added to their daily schedule on a poster at home while

other more dependent patients may need images provided to indicate the steps to follow to

complete the task.

Dental aides can be used to help the patient function independently, but also should not

be overlooked for helping caretakers. It may be appropriate to recommend a power brush to

caretakers who struggle with completing effective toothbrushing. Being able to hold a vibrating

brush against the gumline may help remove more plaque than would be possible with trying to

correctly adapt the toothbrush while moving back and forth. Floss aids may help caretakers reach

to the back of the patients’ mouth while keeping their fingers safely out of the mouth to protect

from unexpected closing.

Knowing that dental caries is an increased risk for this population, we want to consider

how to help prevent this in patients. Recommending toothpaste with fluoride is a good place to

start but importance should also be placed on nutritional counseling with caretakers. Patients

with behavioral issues may be receiving sugary treats to help correct behaviors. Ensuring care
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takers are educated about the risks is an important conversation to include in the appointment

time.

Retaining independence is an important part of quality of life that should not be

overlooked. It is important to remember that not every patient with Fetal Alcohol Syndrome will

require a caretaker. We should take care to prevent blindly expecting every patient to need the

assistance just because they have this diagnosis. Many patients will be full capable of caring for

themselves and should be educated with information on maintaining their oral health at home

independently. These patients can grow old and always remain on a six month recall without

problems. Others may need more support and shorter recall, but that should be decided based on

each individual’s needs, just as everything in health care and dentistry should be.
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References

Auger, N., Low, N., Lee, G., Ayoub, A., & Nicolau, B. (2022). Prenatal substance use disorders and dental

caries in children. Journal of Dental Research, 395-401.

Calhoun, F., & Warren, K. (2007). Fetal alcohol syndrome: historical persepctives. Neuroscience &

Biobehavioral Reviews , 168-171.

Center for Disease Control and Prevention. (2022, January 11). Fetal alcohol spectrum disorders (FASDs).

Retrieved from Center for Disease Control and Prevention:

https://www.cdc.gov/ncbddd/fasd/facts.html#:~:text=To%20diagnose%20FASDs%2C

%20doctors%20look,average%20height%2C%20weight%2C%20or%20both

Itthagarun, A., Nair, R. G., Epstein, J. B., & King, M. M. (2007). Fetal alcohol syndrome: case report and

review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and

Endodontology, 20-25.

May, P. A., & Gossage, J. (2001). Estimating the prevalence of fetal alcohol syndrome. A summary.

Alcohol Research & Health, 159-167.

Munger, R., Romitti, P., Daack-Hirsch, S., Brns, T., Murray, J., & Hanson, J. (1996). Maternal alcohol use

and risk of orofacial cleft. Teratology, 27-33.

National Center on Birth Defects and Developmental Disabilities; Center for Disease Control and

Prevention; Department of Health and Human Services. (2004). Fetal alcohol syndrome: guide

for referral and diagnosis.

Olney, J. W. (2004). Fetal alcohol syndrome at the cellular level. Addiciton Biology, 137-149.
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Dental Hygiene IV Disabilities (Special Needs) Research Paper Criteria Sheet

64 Points Possible Due: DUE DATE: 12/01/2022
Research in depth, a disability that has oral implications. The disability can be one studied in
lecture or other DHYG courses or something you are interested in learning more about.
This research paper must be typed, double-spaced in written form. The paper should be a
minimum of 5 pages in length, with a cover page…Include rubric. Can also be sent
electronically
Site a minimum of 5 peer reviewed references. (These 5 references will be your log of
literature requirement)
Limit of 1 reference from the Internet (.org or hospital website). Source must be a
professional organization. Make sure all resources are professional and credible.
CONTENT TO INCLUDE:
Topic: Disability of choice (3 points/question) 15 POINTS
*What is the disability?
*History of disability: When was it first recognized? By whom?
*Predisposing factors of the disability. (Congenital, acquired)
*Whom does the disability effect? (Male/female, ethnicity?)
*When is population effected?
Effects on the body (3 points/question) 15 POINTS
*How does the disability affect the body physically?
*Are there intellectual concerns that effect the disability?
*Medications prescribed to help disease or symptoms.
*Do medications adversely affect the body (physically or intellectually)?
*Is the disease progressive, does it have a state of remission, is it a lifelong condition?
Effects on the oral cavity (3points/question) 12 POINTS
*How does the disability affect the oral cavity physically?
*Incidence of decay due to disability.
*Incidence of periodontal disease, alignment, malformation considerations.
*Medications effect on the oral cavity (xerostomia, dysplasia etc.)
Dental Treatment/appointment modifications (3 points/question) 12 POINTS
*Is there a need for caretaker? Discuss why or why not.
*Tooth brush modifications (Large handle, power brush etc.)
*Dental aides (floss holder, special brushes etc)
*Appointment modifications (OHI concerns, operator or patient positioning etc.)
Format of paper 10 POINTS
*Spelling (2 points)
*Grammar (2 points)
*Bibliography format (2 points)
*Sources cited correctly in paper (2 points)
*Required length, 5 pages (2 points)
References
See APA style research paper references