In Turner Syndrome it is common to see abnormal dental health development. At the time of diagnosis, a complete dental and orthodontic examination will screen for any such abnormalities. Skeletal malocclusion is caused by distortion of proper mandibular and/or maxillary growth during fetal development which, if untreated, may lead to dental deformities, bruxism, teeth-crowding, trismus, mastication difficulties, breathing obstruction and disturbed digestion. Therefore, dental/orthodontic evaluation at diagnosis if no previous dental/orthodontic care was established. Future management and follow-up should be based on the standard of dental/orthodontic care, individual clinical findings, and patient needs.
Commonly seen dental health features in girls/women with Turner Syndrome:
- Variation in tooth eruption
- Changes in crown and root development
- Increased risk for root absorption or tooth loss during orthodontic treatment
- Retrognathic lower face (including a recessed and small mandible)
- Increased cranial base angle and abnormal palate (382)
- Distal molar occlusion
- Large overjet and lateral cross-bite
- Anterior and lateral open bite
- Smaller primary and permanent teeth with two-rooted mandibular first and second premolars (383)
- Permanent dentition often erupts 12 months earlier than that in controls (range 6 months–3.5 years).
- The teeth have thinner enamel and abnormal dentin (384).
- The palatal and gingival indices are abnormal and there is higher- than-normal tooth mobility (385).
- Decreased crown width is commonly found (386)
Paradoxically, the prevalence of caries is significantly lower despite the findings of poorer oral hygiene when compared with controls (385).
Females with 45,X or with 45,X/46isoXq mosaicism have more severe oral and dental anomalies, while those with a 45,X/46,XX karyotype tend to have abnormalities in line with the general population (386).
Historically, it was believed that females with TS have a ‘high-arched palate’. Recent research indicates that palatal height is not affected, as a narrower dental maxillary arch with the presence of lateral palatal ridges gives the false illusion of increased palatal height (387). A low tongue position may further contribute to oral and dental pathology (388).
Cleft palate is occasionally reported in females with TS; thus, early diagnosis and treatment are recommended to minimize adverse effects on speech development (389). Reference- 2017 International Guidelines
Dental Health Considerations & Solutions in Patients with Turner Syndrome
Robert Korwin, D.M.D.
Post Graduate Certificate in General Practice
Master, Academy of General Dentistry
Master, International College of Oral Implantologists
Member, Board of Directors, American Society for the Advancement of Anesthesia in Dentistry New Jersey Sedation Permit
Graduate, Progressive Orthodontic Seminars
Dental Turner Syndrome Korwin
Oral Manifestations of Turner Syndrome
Kimberly Ann Bailey Walker, RDH, BS, BSN
August 2014 Course – Expires August 31st, 2017
American Dental Hygienists’ Association
Early steps to good oral health in your child:
- Clean your child’s mouth twice a day even if he/she does not have teeth yet. Wipe his/her gums with gauze. Anything that touches someone else’s mouth should not be allowed to touch his/her mouth.
- Once the first tooth appears, use a soft-bristled toothbrush and water to brush your child’s teeth.
- Children should have their first dental visit around the time of their first tooth eruption and no later than age 1.
- There should be 20 teeth in your child’s mouth by age 3.
- Never put your child to sleep with a bottle containing anything but water.
- Routine exams should occur every six months or as determined by your child’s dentist.
- Once your child learns not to swallow toothpaste, brush his/her teeth with a rice-sized speck of fluoride toothpaste.
Dental Health In Turner Syndrome, Children’s Hospital at Montefiore, Aug. 2013
Dr. Farrah Alam, DDS
Director, Special Care Dentistry
Rose F. Kennedy Center
Albert Einstein College of Medicine
Dental Turner Syndrome Presentation
To read more about dental, scroll to page(s) G37 in the Clinical Guidelines found here.