PMC4313064_01
The healthy patient at 9 years of age.
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The center specializes in dental care for special needs patients. The patient presented with neonatal icterus; however, the patient was a full-term baby, underwent a normal delivery, and reached normal milestones until 9 years of age (Figures 1(a) and 1(b)).
The patient's clinical appearance at 11 years of age included neuropsychomotor delay, dystonic posture of the hands and feet, and vertical supranuclear gaze palsy (VSGP).
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Subsequently, the patient presented with learning difficulties and progressive intellectual decline (Figure 2).
Oral findings revealing marked overjet and skeletal malocclusion angle class II, division I.
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Furthermore, the patient had halitosis, excessive salivation, enamel cracking of the maxillary central incisors, an incisal fracture in the right central incisor, marked overjet, skeletal malocclusion angle class II, division I (Figure 3), narrow palate, mobility in the upper primary molars, and caries in the first left and right permanent mandibular molars and first left premolar. 
Periapical radiographic examination showing the presence of the first permanent molar with extensive caries and periodontal ligament thickening (a). An intraoral radiographic film enclosed in a plastic bag (4 x 23 cm) (b).
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Periapical radiographs showed extensive caries on the occlusal surface of the right permanent mandibular first molar accompanied by a slight thickening of the periodontal ligament (Figure 4(a)). The radiograph film was placed within a 4 x 23 cm plastic bag (Figure 4(b)) to control its position and to avoid the risk of swallowing or possible suffocation.