CHALLENGES IN DENTAL MANAGEMENT OF A PATIENT WITH SYNDROMIC FEATURES AND UNDEFINED DIAGNOSIS: A CASE REPORT

Abstract

Dental care for people with special health care needs may require individualized clinical and behavioral adaptations, particularly when systemic, functional, and phenotypic alterations are present without a defined etiological diagnosis. This article reports the longitudinal dental management of a 12-year-old female patient presenting clinical features suggestive of a syndromic condition and previous diagnostic hypotheses of Congenital Rubella Syndrome, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder, without conclusive etiological confirmation. The patient was referred to the Special Care Dentistry Clinic of the Faculty of Dentistry, Federal University of Rio Grande do Sul, Brazil. Follow-up began in 2024, while the therapeutic phase described in this study was developed from 2025 onward. Initial assessment revealed unsatisfactory oral conditions, including generalized biofilm accumulation, calculus, gingival inflammation, bleeding, carious lesions, retained roots, and developmental and dental positioning abnormalities. Behavioral management was a central component of treatment and included clear verbal communication, anticipation of clinical procedures, gradual desensitization, adapted tell-show-do strategies, positive reinforcement, distraction, scheduled breaks, and respect for the patient's responses and preferences. Preventive, restorative, and surgical procedures were performed without the need for physical restraint or sedation. Progressive improvement in oral conditions and adaptation to the dental environment was observed. This case demonstrates that the absence of a definitive etiological diagnosis should not prevent individualized, safe, person-centered dental care.