Dental Signatures as a Potential Biomarker of FASD

Abstract

Fetal alcohol spectrum disorder (FASD) is the most common cause of neurodevelopmental disorders in children, affecting approximately 2–5% of the population, or as many as 700,000 Canadians. Sentinel craniofacial features present in children with FAS include a smooth or long philtrum, a thin upper lip, and short palpebral fissures, all of which are midline features and important clinical biomarkers of FAS. Developmental origins of midline craniofacial and dental malformations in individuals with FASD rest in important developmental pathways such as SHH, retinoic acid, cholesterol, and WNT. Furthermore, an association between midline craniofacial and neurodevelopmental malformations exists in FASD due to these developmental pathways. FASD sentinel facial features are developmentally based maxillary malformations. Teeth and jaw malformations, including cleft lip or cleft palate, are consistently reported among mouse models of prenatal alcohol exposure (PAE) and have also been casually observed in children with FASD, including a high incidence of maxillary malocclusions. Here, we examine whether dental (oral) signatures in the form of dental aberrations can be used collectively – such as in an index score – as a biomarker of FASD. This would create an interesting opportunity for dentists and other dental professionals to join front-line healthcare providers in a broadly reaching surveillance and early intervention of children with FASD. In this chapter we will review the shared craniofacial pathways that pattern the face, brain, and oral structures such as the teeth, jaws, and palate during development, examine the evidence supporting dental (oral) signatures of FASD, and consider the impact of the use of dental signatures as a potential biomarker for FASD.