The Effects of Sturge Weber on Mouth and Teeth

The mouth can also be affected by SW. Symptoms can be malformations (benign excess growth) of blood vessels which are visible as purple or red spots, or bumps, on gums, lips, tongue, or palate.  They usually occur on one side of the mouth.  This excessive growth of blood vessels can not only be uncomfortable but can also cause deformation of the jaws as well as make proper dental hygiene more difficult. Improper dental hygiene can cause an increased risk of infections in the mouth as well as elsewhere.  Minor traumas can also result in more bleeding of the gums.  This syndrome is often treated with anti-epileptics although these medicines have secondary effects and excessive growth of the gums.  Proper dental hygiene is extremely important in order to prevent secondary effects such as cavities and inflammation of the gums by gingivitis.  Insufficient oral hygiene over a long period of time can even result in periodontitis. Proper dental hygiene, together with assistance by a dentist and/or dental hygienist, is extremely important.

The literature concerning SW’s and orthodontics is scarce and includes only a few case reports.  Except for correcting the alignment of teeth, an orthodontist only observes the growth and development of the teeth and jaws.  There is often a difference observed between the “normal” and affected side in the mouth as to when the teeth come out, and also their development.  The teeth can come out too late or too early.  Just as by patients without birth disorders, teeth can be skewed, have spaces between them, and also be misaligned. Other abnormalities of the mouth are hypertrophy (abnormal excess growth) of the alveolus (the section of the jaw where the teeth grow) and hypertrophy of the jaw bone.  The malformation of the jaw is the reason for the misalignment of the teeth and the asymmetrical growth of the jaw.  The position of the teeth can also be influenced by the pressure caused by the excess growth of the blood vessels. This abnormal growth can put pressure on the teeth and cause the teeth to be pushed out of position, just like when children suck their thumbs and push their teeth forward.

It can be helpful to have the orthodontist inspect the milk teeth when SW is indicated.  Possible problems can then be detected earlier and be simply treated, and prevented, in a timely fashion.  Having SW is not a contra-indication for orthodontic treatment, and it is advisable to check for proper oral hygiene.  The presence of braces makes cleaning the teeth more difficult and, as mentioned earlier, oral hygiene is more difficult because of the presence of hypertrophy of the gums. For older patients, orthodontics is sometimes combined with oral surgery.  It is important to have realistic expectations when braces are placed.  The results can be less stable and braces, as well as night braces (and splints behind the teeth), can be needed for a longer period.

It is possible that the vascular malformations can cause an unfavorable growth of the jaw, as discussed in the section Orthodontics.  If braces do not give sufficient results, the orthodontist, together with the oral surgeon, can make a plan to correct the abnormalities.

Oral surgery and orthodontic corrections can have a very positive effect on the self-confidence (and aesthetics) of an SW patient.  However, we wish to emphasize the importance of a dental follow-up by a dentist and dental hygienist.  This is fundamental for the health and quality of life of the patient.  This can prevent the necessity of invasive dental treatments.

Thanks to the Dutch Association for People with Wine Stain or Sturge-Weber Syndrome (Nv WSWs) and Dr. M.J. Koudstaal & Drs. S.T.H. Tjoa (Erasmus Medical Center Rotterdam, the Netherlands).