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American Journal of  Medical 
Science and Innovation (AJMSI) 

Dravet Syndrome from Dental View: A Case Report
Maha Saleh Al-Qahtani1*

Volume 3 Issue 1, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i1.2574
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: April 03, 2024
Accepted: May 02, 2024
Published: May 08, 2024

Dravet Syndrome is a complex neurological disorder characterized by developmental delays 
and seizures caused by Gingival hyperplasia (gingival enlargement and frequent bleeding) in 
a paediatric, four-year-old girl for several years. This condition, often exacerbated secondary 
to medications used to manage DS, contributed to the development of  severe dental 
caries—the girl with severe dental caries and gingival hyperplasia presented to the clinic. A 
collaborative approach involving pediatric dentistry, neuro-paediatrics, general medicine, and 
anaesthesia was employed to extract affected primary teeth—this multidisciplinary effort 
streamlined management and treatment, leading to successful outcomes. Postoperatively, 
the patient showed satisfactory recovery and underwent regular follow-ups. Regular follow-
up appointments conducted every three months demonstrated signifi cant improvement in 
the girl’s oral health and overall well-being, including a positive impact on her emotional, 
cognitive, and motor functions.

Keywords
Dravet Syndrome, Gingival, 
Dental Problems, Seizures, 
Behavioral Problems

1 King Saud University Riyadh, Bachelor of  Dentistry And Maxillofacial Surgery Saudi Commission For Health Specialties Riyadh 
  11/2013, Saudi Arabia
* Corresponding author’s e-mail: dralmaha.ms@gmail.com

INTRODUCTION
Dravet syndrome (DS) is a rare form of  epilepsy; 
developmental and epileptic encephalopathy typically 
begins in infancy. (Meskis, 2022 ) The lifestyle of  DS 
patients is adversely affected, characterized by seizures, 
developmental delays, behavioural problems, emotional 
impairment, feeding problems, sleep problems and 
social isolation. (Stein et al., 2019) Children with DS 
show slow or no development in cognitive and motor 
skills. (Satta et al., 2020) Some children and adolescents 
show externalizing behaviour, aggression, activeness and 
harmful behaviour. Some adolescents and young adults 
have been reported to exhibit internalizing behaviours 
and routinized and compulsive habits. (Inácio, 2023) This 
syndrome also affects the patient’s parents and family, as 
there is no cure for DS, but treatment and support from 
family can help manage the symptoms and improve the 
quality of  the patient’s life. (Sinoo et al., 2019)
Patients are reported to experience various oral health 
problems: disruptive and delayed dental development, 
grinding of  teeth, pain and discomfort, usually due to 
several factors, including motor skills and coordination, 
epileptic seizures, oral motor skills and as a secondary 
to medications used to treat Dravet Syndrome. These 
complications can lead to nutrition defi ciency, gait 
abnormalities, and muscle functions such as diffi culty 
chewing and speaking; thus, overall health is affected. 
Therefore, such a patient presents a multifaceted threat 
to dental care: uncontrolled seizures, heightened pain 
sensitivity and potential behavioural challenges to smooth 
execution of  dental diagnostics and treatment. 
This case report highlights a dental view of  pediatric 
patients with DS. It includes dental diagnosis and 
treatment, and it later impacts the quality of  life of  a 
patient.

LITERATURE REVIEW
The uncommon and severe form of  epilepsy known as 
Dravet Syndrome poses considerable complications for 
dental therapy because of  its correlation with cognitive 
defi cits, behavioral abnormalities, and drug-related 
adverse effects (Sinoo et al., 2019). While the neurological 
aspects of  DS have been extensively studied, its dental 
implications remain relatively understudied in the 
literature. Limited research suggests that individuals with 
DS may present unique dental challenges and oral health 
considerations. For instance, prolonged or frequent 
seizures, common in DS, may increase the risk of  dental 
trauma, including tooth fractures or avulsion (Slayton 
et al., 2020). Currently, little research is available on the 
oral effects of  Dravet syndrome, emphasizing the value 
of  case studies in clarifying clinical presentations and 
treatment plans. Prior research has indicated that people 
with epilepsy are more likely to experience oral health 
problems, such as dental caries, periodontal disease, and 
malocclusions (Bakaev, 2023).
Additionally, gastrointestinal and eating diffi culties have 
been reported to be prevalent in Dravet Syndrome 
Patients, which poses a burden on caregivers and 
food management. Thus emphasizing the importance 
of  nutritional challenges caused by eating habits 
(Minderhoud et al., 2023). Oral care regimens are further 
complicated by the development of  gingival hyperplasia 
and xerostomia, which have been linked to the use of  
antiepileptic medications like phenytoin and valproic 
acid. Moreover, Comprehending the distinct obstacles 
presented by Dravet Syndrome from a dental standpoint is 
crucial to guaranteeing all-encompassing and customized 
treatment strategies. Further research in this area is needed 
to elucidate the specifi c oral health needs of  individuals 
with DS and to develop tailored dental management 



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protocols to improve their oral health outcomes. As the 
dental profession continues to recognize the importance 
of  interdisciplinary collaboration in managing complex 
medical conditions, including epilepsy, efforts to integrate 
dental care into the comprehensive management of  DS 
patients are essential to optimize their overall health and 
quality of  life.

METHODS
Patient’s Information
A Darvet syndromic four-year-old girl appeared at a 
dentist clinic on January 10, 2021. She had a major 
complaint of  severe dental caries on her primary teeth, 
causing pain and intra and extra-oral swelling. Previously, 
the patient was reported to have gingival enlargement for 
a few years, causing malocclusion, diffi culty in chewing 
and frequent gingival bleeding. Despite these problems, 
the patient always had regular dental checkups and 
cleanings. 

Physical Examination
The patient’s face was asymmetrical and seemed swollen 
from the region of  the lower jawline, chin and cheek.

Clinical and Radiographic Examination
Extra orally, both the right and left sides of  the 
submandibular region were swollen and tender. Intra-
orally, several dental concerns were noticed, including 
Generalized severe dental caries, erythematous 
(infl ammation), bleeding gums, and no signs of  
periodontal disease. Radiographs of  the patient’s teeth 
showed caries on primary teeth with radiolucent lesions 
(abnormal tissue, i.e. enlargement of  gums) on the 
furcation area (roots of  the multi-rooted tooth branch 
out). No bone loss or periapical pathology was found.

RESULTS
Figures 1, 2 and 3 are evidence of  pre-operative X-rays 
scanned in 2021.

Figure 1: Pre-operative x-ray (2021)

Figure 2: Pre-operate x-ray (2021)



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Am. J. Med. Sci. Innov. 3(1) 86-90, 2024

Diagnosis
Gingival hyperplasia and dental carries occurred as 
a potential complication due to Dravet Syndrome’s 
medication side effects.

Treatment Plan and Method
Due to complexities, the patient was referred to a 
collaborative approach of  a pediatric dentist, neuro-
pediatric, general and anaesthesia teams. They assisted the 
pediatric dentist in providing a dental treatment, which 
included pulp therapy, composite restoration, crowning 
for primary and permanent teeth, and extraction of  
defected primary teeth.
While ensuring painless treatment to extract all the 
affected primary teeth and managing uncontrollable 
seizures and behaviour, the pediatric patient booked an 
appointment to undergo general anaesthesia on January 
27, 2021, for the procedure. After getting clearance from 
the collaborative team, the patient was admitted to the 
hospital a day before the operation. During treatment, the 
patient was placed in a supine position, nasal intubation 
was performed, all primary teeth were extracted, and 
bleeding was controlled. The child was sent to the ward, 
where she was kept under observation. Once stable, she 
was discharged by a general paediatrician the other day 
after the operation.

Follow-up and Outcome
A postoperative follow-up visit was scheduled after two 
weeks, and a satisfi ed patient’s health status was observed. 
Further, the child was kept under observation every three 
months until 2024.

First Follow-up Visit
The child had her lower molars erupted, and some caries 
were noticed, which were restored at the clinic.

Second Follow-up Visit
The child’s permanent teeth erupted earlier than usual.

Third Follow-up Visit
The girl had a smile on her face. She was seen recognizing 
the clinic and her dentist. Moreover, the patient’s mother 
reported that the child’s motor action was improved as 
she asked neuro-pediatric to discontinue medication for 
Dravet syndrome. 

Figure 3: Pre-operative x-ray (2021)

Figure 4: Follow-up evidence (2024)

Figure 5: Follow-up evidence (2024)



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Am. J. Med. Sci. Innov. 3(1) 86-90, 2024

Figures 4, 5, and 6 show sound tooth structure; there 
are no caries, and the restored primary tooth remained 
satisfactory.

DISCUSSION
Dravet Syndrome is a rare type of  epilepsy that occurs 
due to SCN1A gene mutation, and key characteristics 
are seizure onset in infancy, developmental delay, 
and behavioural problems (Clayton et al., 2022). It 
affects various regions of  the brain, specifi cally the 
hippocampus (involved in epilepsy), prefrontal cortex 
and hippocampal dentate gyrus (regions associated with 
emotions and memory). Thus, the interplay of  cognition, 
emotional impairments and behavioural patterns 
contributes to comorbidities as a salient feature of  this 
syndrome (Makiello et al., 2023). Common examples 
include muscle impairment, sleep problems, and gait 
impairment; among these, feeding diffi culties and weight 
loss are frequently reported (Meskis, 2022 ). Despite the 
prevalence of  feeding diffi culties, the underlying factors 
are still in pipe of  exploration. On the other hand, dental 
problems are becoming popular and common among DS 
individuals primarily due to frequent seizures, which, if  
uncontrollable, can damage teeth and gums (Madaan & 
Sahu, 2022).
Individuals with Dravet Syndrome may experience various 
oral effects, gingival hyperplasia and submandibular 
swelling should be regarded as secondary concerns, 
given the signifi cant implications for the submandibular 
region in saliva production, sensory and motor function, 
and lymphatic drainage (Zapoozhets et al., 2019). These 
conditions can infl uence oral issues such as tooth decay, 
dry mouth, diffi culty swallowing, and speech problems. 
Moreover, orofacial dyspraxia can be challenging for DS 
individuals to maintain a simple oral hygiene regime, such 
as brushing or fl ossing teeth (Minderhoud et al., 2023).
It is highly recommended to have early interventions, 
regular dental checkups and cleanings to prevent serious 
dental complications and facilitate individuals to have 
a better life (Inácio, 2023). Furthermore, individuals 
should know the signs and symptoms that cause dental 
complications. 
In addition to the oral manifestations previously 
discussed, there are further considerations regarding 
the dental health of  individuals with Dravet syndrome. 

The process of  teeth eruption itself  may present 
unique challenges, chewing, bite and speech problems 
and gingival hyperplasia frequently complicating this 
normal developmental stage. These factors underscore 
the importance of  tailored dental care strategies for 
individuals with Dravet syndrome to mitigate associated 
risks and promote optimal oral health outcomes.

CONCLUSION
In conclusion, this case report highlights the challenges 
and successful diagnosis and treatment of  a pediatric 
patient suffering from severe dental caries on primary 
teeth along with intra and extra-oral swelling, causing 
overall pain and discomfort with Dravet Syndrome. 
Implementing a collaborative approach to parents’ 
continuous support, integrated with the thorough dental 
history of  a patient, led to favourable outcomes. It proved 
to be an emerging dental treatment of  a DS patient, yet 
the patient’s regular checkups and timely actions were 
instrumental. The permanent teeth erupted earlier than 
usual time. The girl’s smile and recognition of  her dentist 
and clinic indicated permanent teeth erupted than earlier, 
improved emotional health and cognition. Parents also 
reported improved performance and motor skills of  the 
child at school. Overall, the case highlights the importance 
of  dental care in overcoming dental challenges in Dravet 
Syndrome patients.

Future Recommendation
Further research can explore different dental dimensions 
of  Dravet Syndrome pediatric patients; a database can be 
collected to develop awareness for common signs and 
symptoms, tackle other interconnected factors which arise 
due to dental problems, assess oral health complications, 
and develop targeted preventive measures that can come 
into existence.
This case report aims to enhance understanding and 
treatment of  Dravet Syndrome concerning dental health, 
contributing to medical knowledge and emphasizing the 
signifi cance of  tailored dental approaches for optimal 
patient outcomes.

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Figure 6: Follow-up evidence (2024)



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