Oral manifestations of congenital Zika virus infection in children with microcephaly: 18‐month follow‐up case series

Abstract

To describe oral manifestations in children born with microcephaly attributed to congenital Zika virus syndrome (CZS). Methods: Data was collected in semiannual intervals from 2017 to 2019, by oral exams of the children and interview with caregivers at a Public Dental Center in Rio de Janeiro, Brazil. A single calibrated examiner performed clinical examinations. Results:Of 38 eligible children, 34 were followed-up from 12 to 30 months of age, 20 boys and 14 girls. The mean age of emergence of their first primary tooth was 12.4 months (SD = 2.9). By 30 months of age only 14.7% (n = 5) had complete primary dentition. Alteration in the sequence of tooth emergence was observed in 41.1% (n = 14). Radiographic examination demonstrated dental agenesis (14.7% n = 5). Dental developmental alterations (38.2%, n = 13), enamel defects (14.7%, n = 5), eruption cysts/hematoma (23.5%, n = 8), gingival bleeding (55.8%, n = 19), narrow palate, and bruxism (64.7%, n = 22) were also observed. No child had dental caries. Conclusion:Children with microcephaly attributed to CZS presented oral manifestations early in life.

Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

“…In this study, one of the children had a severe delay in the eruption of the first deciduous tooth, occurring only in the 17th month of life. Overall, the pattern of delay is consistent with previous studies [7][8][9][10]24,[32][33][34]. In cases 2 and 5, alteration in the sequence of eruption of deciduous teeth was observed, as the maxillary central incisors were the first teeth to erupt; in addition, the event occurred beyond the expected time, at 13 and 15 months, respectively.…”

“…Delays in the chronology of eruption of deciduous teeth, alterations in the emergence sequence in the oral cavity [7][8][9], and the occurrence of disturbances in the development of the dental organ in number, shape, and structure indicate a possible role of ZIKV in odontogenesis [8]. Defects in dental enamel development, such as demarcated opacities and hypoplasia, have been reported in the deciduous dentition of children with CZS, evaluated for a period of 18 [9] to 36 months [8]. The distribution of occurrences was more frequent in the anterior teeth of the upper and lower arches, as well as in the posterior teeth located in the mandibular dental arch [8].…”

Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta‐analyses

“…The studies involved a total of 795 children (178 were normotypic control children) ranging in age from 0 to 59 months. Seven studies reported data related to prematurity 10,12,14,18,19,31,32 and four related to birth weight 10,14,19,32 …”

“…Thirteen studies reported the criteria used for the diagnosis of microcephaly, 10,13–16,18,19–22,31–34 10 studies performed or had access to the result of the test used to detect ZIKV 10,16–20,22,31,33,34 and, 12 studies diagnosed the CZS by combining clinical, radiographic, and serological findings 10,15–20,22,31–34 (Appendix 3). Seven studies were funded by a government or university grant, 10,12,15,16,19,20,34 and 13 declared no conflicts of interest 10,13,14,17,18,20,21,31–35 …”

“…Some of the most frequently reported alterations in children with CZS‐associated microcephaly, such as increased salivation, bruxism, gingivitis, and dental caries, can also be seen in individuals with variety of others neurological disturbances 52–55 . Regarding increased salivation and bruxism in these patients group, authors claim that such alterations are bi‐directional related to central nervous system compromise 56 ; others argue that certain drugs that these individuals who take continuous use may contribute 57,58 ; and, still, there are those who believe that they have multifactorial causes, including psychological and behavioral factors 32,59,60 . Although there is no consensus on the triggering factor, fact is that such alterations are challenging in their management.…”