The following information is intended to help someone understand more about the general dental concerns of a child with Moebius syndrome. Each person is different and, of course, more specific information is best found in consultation with a dentist who has evaluated the patient. Most of the dental concerns for people with Moebius syndrome are basically the same as all people.

1) Neonatal Period:

When a child is born with Moebius syndrome, there may be difficulty in closing the mouth or swallowing.

• The tongue may be hypotonic (low muscle tone) or faciculate (quiver).
• The tongue may be larger or smaller than average.
• There may be low tone of the muscles of the soft palate, pharynges, and the masticatory system.
• The palate may be arched excessively (a high palate) since the tongue does not form a suction that would normally shape the palate down further.
• The palate may have a groove (this may be partially due to intubation early on if it was for an extended period of time) or may be incompletely formed (cleft palate).
• The opening to the mouth may be small.

Feeding problems may become a critical issue early on if adequate nutrition is difficult. If the infant can close and suck but needs assistance, the Mead-Johnson Soft Bottle can help. If the infant can suck just minimally, the SpecialNeeds® Feeder from Medela can be used to express milk for the baby. If the infant tends to aspirate, a gastrostomy feeding tube may be required. Often this is in combination with a tracheostomy breathing tube if the infant can’t control salivary secretions.

2) Primary Dentition:

The primary (baby) teeth have generally started coming in by a child’s first birthday and all 20 teeth may be in by their second birthday. Eruption timing varies widely.

Several possible scenarios may occur:

• There may be an incomplete formation of the enamel on the teeth called enamel hypoplasia that makes the teeth more vulnerable to caries (cavities).
• There may be missing teeth.
• The lower jaws become more noticeably deficient (micrognathia or retrognathia) if the infant is not closing down properly.
• The front teeth may not touch when the child closes down because the back teeth have overerrupted. This condition is called an anterior open bite and has facial/skeletal implications.
• The saliva may be thick or the infant may have a dry mouth.

As soon as the first tooth comes in, parents can start to gently brush their child’s teeth each day. Minimal toothpaste is needed, or just a wet toothbrush is acceptable if the child tends to aspirate. As more teeth come in, it becomes important to start flossing between teeth. Babies should not be put to bed with a bottle of milk or juice as the residual nutrients in the mouth allow bacteria to proliferate and cause a condition called Bottle Caries.

The first appointment with a dentist should come between 18 months and 2 years of age. This should probably be with a pediatric dentist, though there may be a need for a dental team to be involved as the child grows. The team may include the general dentist, orthodontist, and oral and maxillo-facial surgeon.

Examinations and professional cleaning should be performed at least every six months. Fluoride treatments can be applied in the office, or it may be prescribed as a gel to be applied at home. In addition, fluoride tablets or drops may be prescribed to help prevent dental caries (cavities) if the patient lives in an area that doesn’t have an optimal amount of fluoride in the water supply. Sealants can be applied to the deep grooves of the back teeth as another effective prevention method.

3) Transitional Dentition:

Between ages 5 and 7, most children start losing their primary teeth. Occasionally, some primary teeth are slow to exfoliate (fall out), and the dentist will have to remove that tooth. There are other reasons that a dentist may want to remove a primary tooth early to prevent orthodontic problems.

Likewise, premature loss of primary teeth may create orthodontic problems later. Removable or fixed spacers may be needed to prevent the shifting of teeth when a tooth is lost prematurely.

Interceptive orthodontic treatment may be initiated at this stage of development to help with crowding or to help relate the upper and lower jaws. Consistent with a high palate is a narrow arch shape of the upper teeth as they line up in the mouth. This may cause the upper front teeth to flare out and become more prone to fracture if accidentally hit.

Interceptive orthodontics has an important role in this situation. Appliances that expand the upper arch tend to bring the front teeth back into a more normal position. Some appliances can even help allow the front teeth to close to normal in an open bite situation.

The mouth and lips may tend to get dry with Moebius patients. Lack of a good oral seal (lips together) allows the gingiva (gums) to get dry and may become inflamed and irritated. Oral products such as Oral Balance, Xerolube, or Salvert Spray may be helpful.

4) Permanent Dentition:

After the last primary tooth is lost, usually around age 12, final orthodontic treatment can be initiated.

A patient who has not been able to close their lips or swallow well will probably have an open bite, deficient lower jaw growth, a narrow archform with crowded teeth and upper anterior flaring of teeth.

Orthognathic (jaw) surgery may be indicated. This should be completed in most situations before a surgeon would do the smile surgery where the Gracilis Muscle is grafted to the face.

Good home care of the mouth and teeth includes brushing with a fluoride toothpaste and flossing. There are floss holders available that are easy to hold. In addition, water irrigation devices can be very helpful. Regular check-ups at the dental office are also important to help maintain a healthy mouth for a lifetime.