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      The oral phenotype and dental management in patients with maple syrup urine disease; case report and scoping review

      case-report

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          Abstract

          Background and objectives

          The literature about oral manifestations and dental management in maple syrup urine disease (MSUD) is sparse. The aim of this report is to present a new case of MSUD with special emphasis on oral findings and to review the relevant literature.

          Method

          A case report of a 4-year-old boy with MSUD was described according to the CARE guidelines for describing case reports. Scoping review of relevant literature was performed, according to the PRISMA-ScR guidelines, by searching PubMed, Medline, Embase, and the grey literature for articles describing dental management and/or oral manifestations in MSUD.

          Results

          The initial search identified 219 articles, but only 4 met the inclusion criteria. Rampant caries and plaque induced gingivitis were the main oro-dental findings in MSUD. Other oral findings included enamel hypoplasia, skeletal abnormalities, and abnormal oral behaviors. Disease-related factors appeared to play a major role in the development of the observed oral phenotype.

          Conclusion

          Oral health in MSUD seems to be influenced by the reliance on semi-synthetic diet and associated neurocognitive complications. Tailored oral health promotional interventions should be included in the multidisciplinary management of patients with MSUD.

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          Most cited references31

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          • Article: not found

          Oral health of patients with intellectual disabilities: a systematic review.

          A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.
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            • Article: not found

            Breastfeeding and the risk of dental caries: a systematic review and meta-analysis.

            To synthesise the current evidence for the associations between breastfeeding and dental caries, with respect to specific windows of early childhood caries risk.
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              • Abstract: found
              • Article: not found

              Maple syrup urine disease: mechanisms and management

              Maple syrup urine disease (MSUD) is an inborn error of metabolism caused by defects in the branched-chain α-ketoacid dehydrogenase complex, which results in elevations of the branched-chain amino acids (BCAAs) in plasma, α-ketoacids in urine, and production of the pathognomonic disease marker, alloisoleucine. The disorder varies in severity and the clinical spectrum is quite broad with five recognized clinical variants that have no known association with genotype. The classic presentation occurs in the neonatal period with developmental delay, failure to thrive, feeding difficulties, and maple syrup odor in the cerumen and urine, and can lead to irreversible neurological complications, including stereotypical movements, metabolic decompensation, and death if left untreated. Treatment consists of dietary restriction of BCAAs and close metabolic monitoring. Clinical outcomes are generally good in patients where treatment is initiated early. Newborn screening for MSUD is now commonplace in the United States and is included on the Recommended Uniform Screening Panel (RUSP). We review this disorder including its presentation, screening and clinical diagnosis, treatment, and other relevant aspects pertaining to the care of patients.

                Author and article information

                Contributors
                y.hassona@ammanu.edu.jo
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                21 March 2024
                21 March 2024
                2024
                : 24
                : 362
                Affiliations
                [1 ]Oral Medicine and Special Care Dentistry Faculty of Dentistry, Centre for Oral Diseases Studies (CODS), Al-Ahliyya Amman University, ( https://ror.org/00xddhq60) Amman, Jordan
                [2 ]School of Dentistry, The University of Jordan, ( https://ror.org/05k89ew48) Amman, Jordan
                [3 ]School of Medicine, The University of Jordan, ( https://ror.org/05k89ew48) Amman, Jordan
                Article
                4135
                10.1186/s12903-024-04135-7
                10956203
                38515181
                d1ca886a-bb28-45cc-96e4-345b8af41d72
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 January 2024
                : 12 March 2024
                Categories
                Case Report
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Dentistry
                maple syrup,branched chain amino acids,ketonuria,oral,anesthesia
                Dentistry
                maple syrup, branched chain amino acids, ketonuria, oral, anesthesia

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