FETAL ALCOHOL SYNDROME

Resident’s Name: Joanne Lewis Date: October 10, 2008

FETAL ALCOHOL SYNDROME
What is affected in the syndrome?
• Growth deficiency
• Facial features – three diagnostically significant features:
o Smooth philtrum
o Thin upper lip
o Small palpebral fissures – decreased eye width
(note: these facial features strongly correlate with brain damage)
• Central nervous system damage
o Structural abnormalities of the brain – microcephaly
o Neurological impairments – seizure disorders, poor hand-eye coordination, poor fine motor skills
o Functional impairments – learning disabilities, poor impulse control, poor judgment, attention and hyperactivity problems (ADHD), poor social skills, mental retardation
• Heart murmur by 1 year of age
• Joint anomolies, small distal phalanges
• Renal problems – horseshoe, aplastic, or dysplastic kidney
• Decreased visual acuity
• Secondary disabilities
o Mental health problems
o Disrupted school experience
o Trouble with the law
o Confinement
o Inappropriate sexual behavior
o Alcohol and drug problems
How? Fetal alcohol exposure is the leading known cause of mental retardation in the Western world, with a prevalence rate of 0.2 to 2.0 cases per 1,000 live births. There is no clear consensus as to what level of exposure is toxic.
How is the diagnosis made? Criteria for a FAS diagnosis are:
• Growth deficiency – prenatal or postnatal height or weight at or below the 10th percentile
• All three FAS facial features present
• Central nervous system damage
• Prenatal alcohol exposure

Why are we interested? The first step in the management of a dental patient with FAS is recognition of the condition. This is best accomplished via the medical history and open discussion with the patient or family members. Once a patient with FAS is identified, the dental practitioner must learn as much as possible about the history of the patient, including type and extent of systemic manifestations and any current medications. Dental treatment will have to take into account:
• Consultation with physician to determine if the patient needs antibiotics prior to dental treatment due to heart murmur
• Behavior problems
• Orofacial manifestations including cleft lip/palate, dental malocclusions, poor muscular tone around the mouth (excessive drooling), deficient maxilla or mandible
• The ability of the patient to metabolize medications


Items of interest: Many patients with FAS have sensory integration dysfunction, a neurological condition that causes sights, sounds, and physical sensations to be over or under exaggerated. Think about the dental office!