Dental Care Crucial to Children with PWS Due to Inadequate and Acidic Saliva, Study Says

Children with Prader-Willi syndrome (PWS) secrete less saliva and more acidic saliva than do their healthy peers. These changes put them at a higher risk of tooth decay (caries) and oral disorders like gingivitis (inflammation of gums), a study reported.

Good dental care should be an “essential part” of PWS care, its researchers concluded.

The study, “Oral disorders in children with Prader-Willi syndrome: a case control study,” was published in the Ophanet Journal of Rare Diseases.

Typical symptoms of PWS range from short stature and weak muscle tone, to behavioral problems and hyperphagia (excessive hunger). They are also at a greater risk of oral disorders such as enamel hypoplasia (thin or underdeveloped enamel), tooth decay, periodontal (gum) disease, candidiasis (oral thrush), and poor salivary flow.

In particular, inadequate salivation — caused by atrophy (shrinkage) of the salivary glands — causes the saliva to become sticky, sparse, and unable to perform tasks essential to maintaining a healthy oral environment.

Researchers in Spain assessed the oral health of 30 children with PWS and 30 healthy children serving as controls for comparison. The mean age for all was 10.2.

Among patients, 26 (86.6%) followed a dietary regime — low calorie and low sugar — prescribed by their endocrinologist to avoid obesity. All with PWS were taking growth hormones.

Researchers used several tests to evaluate oral health, including the Decayed Missing Filled Teeth (DMFT) index and a caries index, measures of oral health based on plaque buildup and cavities. The presence and extent of gingivitis was evaluated using the Löe and Silness gingival index, and salivary acidity (its pH) was measured via the GC Saliva Check Buffer Kit. (Lower pH values are more acidic.)

The DMFT index, which works on a zero to three point scale (with zero indicating no plaque in the gingival area, and three “an abundance”) was 2.5 for patients and 0.93 for children without PWS.

Those with PWS had an average caries index of 53.3% compared to 43.3% among control children. Gingivitis was present in 53.3% of PWS patients and 40% of controls, a difference that was not statistically significant.

A mean salivary secretion rate of 0.475 ml/min with a pH of 6.15 was found in PWS children. Those without this disease had a significantly higher salivary secretion (0.848 ml/min) and pH (7.53).

PWS children also had a higher plaque index (above 2, indicating moderate accumulation of soft deposits visible with the naked eye) compared to controls, but again difference was not statistically significant.

“Pediatric patients with Prader-Willi syndrome have an increased risk of caries and gingivitis,” the researchers wrote.

“[C]hildren with this syndrome have a decreased salivary flow and a more acidic salivary pH. In these patients, dental care is an essential part of their multidisciplinary medical treatment,” they added.