The Smith-Lemli-Opitz syndrome and dentofacial anomalies diagnostic: Case reports and literature review

Int Orthod. 2019 Jun;17(2):375-383. doi: 10.1016/j.ortho.2019.03.020. Epub 2019 Apr 17.


Objective: Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disorder. It is due to a deficiency of 7-dehydrocholesterol reductase (DHCR7) that catalyses the reduction of 7-dehydrocholesterol (7-DHC) to cholesterol. The aim of this review is to gather all information, concerning diagnostic characteristics of this syndrome, with an emphasis on intraoral symptom presentation.

Materials and methods: We conducted a review of the literature, including articles between 1964 and 2017. Data was collected regarding the clinical diagnosis, pathophysiology and treatment of SLOS patients. Moreover, two clinical cases are described, illustrating the oral and facial anomalies of SLOS patients, at the regional university hospital of Lille, France.

Discussion: Low cholesterol levels provoke a broad spectrum of clinical presentations, from mild to lethal forms. They can cause mental retardation, growth deficiency and congenital malformations. The SLOS features are often present at birth. Moreover, all the patients have facial anomalies. The dento-maxillofacial symptoms consist of crowded teeth, widely spaced incisors, oligodontia, polydontia, premature tooth eruption, enamel hypoplasia, a bifid uvula, broad alveolar ridges, bifid tongue, and Pierre-Robin syndrome symptoms (glossoptosis, retrognathia and cleft palate). These symptoms are warning signs and should increase the awareness of clinicians.

Conclusions: All healthcare professionals can contribute to the SLOS patient diagnostics. The dento-maxillofacial anomalies, illustrated by two case reports, could help to detect undiagnosed patients. An early detection might improve the outcome of these patients, as cholesterol supplementation can improve symptoms. This study can benefit orthodontists by enabling them to recognize the clinical signs of SLOS in order to refer these young patients to a specialist if the diagnosis has not been established.

Keywords: Dentofacial deformities; Diagnosis; Diagnostic; Malformations dento-faciales; Smith–Lemli–Opitz Syndrome.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cholesterol
  • Cleft Palate
  • Dehydrocholesterols
  • Dentofacial Deformities / diagnosis*
  • Dentofacial Deformities / physiopathology*
  • Female
  • Humans
  • Male
  • Orthodontic Appliances, Fixed
  • Oxidoreductases Acting on CH-CH Group Donors
  • Phenotype
  • Smith-Lemli-Opitz Syndrome / diagnosis*
  • Smith-Lemli-Opitz Syndrome / physiopathology*
  • Tooth Movement Techniques


  • Dehydrocholesterols
  • Cholesterol
  • 7-dehydrocholesterol
  • Oxidoreductases Acting on CH-CH Group Donors
  • 7-dehydrocholesterol reductase