Orofacial changes of patients with congenital Zika syndrome in Northeast Brazil: an integrative literature review


  • Marina Rosa Barbosa Faculdade de Odontologia do Recife
  • Sérgio Bartolomeu de Farias Martorelli Faculdade de Odontologia do Recife
  • Demóstenes Alves Diniz Universidade de Pernambuco
  • Jéssica da Silva Cunha Universidade de Pernambuco
  • Fernando de Oliveira Martorelli Centro Universitário Maurício de Nassau
  • Laís Azevedo Lins de Holanda Universidade de Pernambuco




Congenital zika syndrome , ZIKV infection, Zika virus


In 2015, in Northeast Brazil, cases of microcephaly associated with the outbreak of zika virus in South America were identified. This virus is transmitted by the biological vector Aedes aegypti, which also transmits dengue, yellow fever, and chikungunya viruses. The congenital Zika syndrome affected newborns with head circumference smaller than 32 cm, compromising their central nervous system. Besides ocular lesions, hyperexcitability, and hypertonia, newborns also showed intracranial calcifications in imaging exams. If children with congenital Zika syndrome suffer maxillofacial alterations during embryonic development, they could have delayed tooth eruption and malformations. This study aims to perform an integrative review of the current literature about the health conditions of children with congenital Zika virus infection and the possible alterations of their oral cavity. This integrative literature review was performed by searching scientific articles in the PubMed, SciELO, and MEDLINE electronic databases with the descriptors “Zika Virus Infection”, “Zika Virus”, and “Microcephaly”, which deal with clinical case reports and were indexed between 2016 and 2021. About 26 articles published entirely in English were analyzed after meeting the eligibility criteria. The studies contributed to better treatment conducts by showing the neurological, functional, and oral alterations in children with congenital Zika syndrome, including periodontal diseases, malocclusions, dental caries, bruxism, micrognathia, ankyloglossia, short labial frenum, dental trauma, and dysphagia.


Download data is not yet available.

Author Biographies

Marina Rosa Barbosa, Faculdade de Odontologia do Recife

Faculdade de Odontologia do Recife (FOR), Fundação Odontológica Presidente Castello Branco (FOPCB), Recife, PE, Brazil

Sérgio Bartolomeu de Farias Martorelli, Faculdade de Odontologia do Recife

Faculdade de Odontologia do Recife (FOR), Fundação Odontológica Presidente Castello Branco (FOPCB), Recife, PE, Brazil

Demóstenes Alves Diniz, Universidade de Pernambuco

Hospital da Restauração Governador Paulo Guerra (HR), Universidade de Pernambuco (UPE), Recife, PE, Brazil

Jéssica da Silva Cunha, Universidade de Pernambuco

Hospital da Restauração Governador Paulo Guerra (HR), Universidade de Pernambuco (UPE), Recife, PE, Brazil

Fernando de Oliveira Martorelli, Centro Universitário Maurício de Nassau

Centro Universitário Mauricio de Nassau (UNINASSAU), Recife, PE, Brazil

Laís Azevedo Lins de Holanda, Universidade de Pernambuco

Centro de Oncologia (CEON), Hospital Universitário Oswaldo Cruz (HUOC), Universidade de Pernambuco (UPE), Recife, PE, Brazil


Leal MC, van der Linden V, Bezerra TP, Valois L, Borges ACG, Antunes MMC, et al. Characteristics of dysphagia in infants with microcephaly caused by congenital Zika virus infection, Brazil, 2015. Emerg Infect Dis. 2017;23(8):1253-9. Doi: https://doi.org/10.3201/eid2308.170354

Haby MM, Pinart M, Elias V, Reveiz L. Prevalence of asymptomatic Zika virus infection: a systematic review. Bull World Health Organ. 2018;96(6):402-13D. Doi: https://doi.org/10.2471/BLT.17.201541

Subissi L, Dub T, Besnard M, Mariteragi-Helle T, Nhan T, Lutringer-Magnin D, et al. Zika virus infection during pregnancy and effects on early childhood development, French Polynesia, 2013-2016. Emerg Infect Dis. 2018;24(10):1850-8. Doi: https://doi.org/10.3201/eid2410.172079

Shakib K. Epidemic of Zika virus and maxillofacial surgery. Br J Oral Maxillofac Surg. 2016;54(4):355-7. Doi: https://doi.org/10.1016/j.bjoms.2016.02.001

Castanha PMS, Souza WV, Braga C, Araujo TVB, Ximenes RAA, Albuquerque MFPM, et al. Perinatal analyzes of Zika- and dengue virus-specific neutralizing antibodies: a microcephaly case-control study in an area of high dengue endemicity in Brazil. PLoS Negl Trop Dis. 2019;13(3):e0007246. Doi: https://doi.org/10.1371/journal.pntd.0007246

Panchaud A, Stojanov M, Ammerdorffer A, Vouga M, Baud D. Emerging role of Zika virus in adverse fetal and neonatal outcomes. Clin Microbiol Rev. 2016;29(3):659-94. Doi: https://doi.org/10.1128/CMR.00014-16

Duron RM, Herrera-Páz EF, Salgado Rodríguez AM, Castro Carías CE, Fernández-Rodríguez D, Cabrera JS, et al. Cephalic circumference curves and potential anthropometric differences in Latin America and the world. Rev Ecuat Neurol. 2019;28(1):47-55.

Eickmann SH, Carvalho MDCG, Ramos RCF, Rocha MAW, van der Linden V, Silva PFS. Zika virus congenital syndrome. Cad Saude Publica. 2019;32(7):e00047716. Doi: https://doi.org/10.1590/0102-311X00047716

Feitosa IML, Schuler-Faccini L, Sanseverino MTV. Important aspects of congenital Zika syndrome for the pediatrician and the neonatologist. Bol Cient Pediatr. 2016;5(3):75-80.

Fonteles CSR, Ribeiro EM, Santos MSA, Leite RFP, Assunção GS, Monteiro AJ, et al. Lingual frenulum phenotypes in Brazilian infants with congenital Zika syndrome. Cleft Palate Craniofac J. 2018;55(10):1391-8. Doi: https://doi.org/10.1177/1055665618766999

Aragón N, Díaz C, Contreras A. Dental, occlusal, and craniofacial features of children with microcephaly due to congenital Zika infection: 3 cases report from Valle del Cauca, Cali – Colombia – 2020. Cleft Palate Craniofac J. 2021;58(10):1318-25. Doi: https://doi.org/10.1177/1055665621990978

Carvalho IF, Alencar PNB, Andrade MDC, Silva PGB, Carvalho EDF, Araújo LS, et al. Clinical and x-ray oral evaluation in patients with congenital Zika virus. J Appl Oral Sci. 2019;27:e20180276. Doi: https://doi.org/10.1590/1678-7757-2018-0276

Nunes ML, Carlini CR, Marinowic D, Kalil Neto F, Fiori HH, Scotta MC, et al. Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil. J Pediatr (Rio J). 2016;92(3):230-40. Doi: https://doi.org/10.1016/j.jped.2016.02.009

Roma JHF, Alves RC, Silva VS, Ferreira MJ, Araújo C, Pavoni JHC. Descriptive study of suspected congenital Zika syndrome cases during the 2015-2016 epidemic in Brazil. Rev Soc Bras Med Trop. 2019;52:e20190105. Doi: https://doi.org/10.1590/0037-8682-0105-2019

Trigueiro SA, Neves BF, Aguiar MSB, Araújo JSS. Correlation between cephalic circumference at birth and ocular alterations in patients with microcephaly potentially associated with Zika Virus infection. Rev Assoc Med Bras. 2019;65(6):909-13. Doi: https://doi.org/10.1590/1806-9282.65.6.909

Ventura CV, Maia M, Ventura BV, van der Linden V, Araújo EB, Ramos RC, et al. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol. 2016;79(1):1-3. Doi: https://doi.org/10.5935/0004-2749.20160002

Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res. 2019;8:1433. Doi: https://doi.org/10.12688/f1000research.19918.1

Rice ME, Galang RR, Roth NM, Ellington SR, Moore CA, Valencia-Prado M, et al. Vital signs: Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection – U.S. Territories and Freely Associated States, 2018. MMWR Morb Mortal Wkly Rep. 2018;67(31):858-67. Doi: https://doi.org/10.15585/mmwr.mm6731e1

Cavalcanti AFC, Aguiar YPC, Oliveira Melo AS, Freitas Leal JIB, Cavalcanti AL, Cavalcanti SDLB. Teething symptoms in children with congenital Zika syndrome: a 2-year follow-up. Int J Paediatr Dent. 2019;29(1):74-8. Doi: https://doi.org/10.1111/ipd.12431

Carvalho IF, Alencar PNB, Carvalho de Andrade MD, Silva PGB, Carvalho EDF, Araújo LS, et al. Clinical and x-ray oral evaluation in patients with congenital Zika Virus. J Appl Oral Sci. 2019;27:e20180276. Doi: https://doi.org/10.1590/1678-7757-2018-0276

Silva MCPM, Arnaud MA, Lyra MCA, Alencar Filho AV, Rocha MAW, Ramos RCF, et al. Dental development in children born to Zikv-infected mothers: a case-based study. Arch Oral Biol. 2020;110:104598. Doi: https://doi.org/10.1016/j.archoralbio.2019.104598

Ribeiro RA, Mattos A, Meneghim MC, Vedovello SAS, Borges TMD, Santamaria M Jr. Oral and maxillofacial outcomes in children with microcephaly associated with the congenital Zika syndrome. Eur J Orthod. 2020;43(3):346-52. Doi: https://doi.org/10.1093/ejo/cjaa036

Oliveira AMM, Melo EGM, Mendes MLT, Santos Oliveira SJG, Tavares CSS, Vaez AC, et al. Oral and maxillofacial conditions, dietary aspects, and nutritional status of children with congenital Zika syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130(1):71-7. Doi: https://doi.org/10.1016/j.oooo.2020.02.019

D’Agostino ES, Chagas JRLP, Cangussu MCT, Vianna MIP. Chronology and sequence of deciduous teeth eruption in children with microcephaly associated to the Zika virus. Spec Care Dentist. 2020;40(1):3-9. Doi: https://doi.org/10.1111/scd.12435

Silva Sobrinho AR, Ramos LFS, Maciel YL, Maurício HA, Cartaxo RO, Ferreira SJ, et al. Orofacial features in children with microcephaly associated with Zika virus: a scoping review. Oral Dis. 2021:1-7. Doi: https://doi.org/10.1111/odi.13804





Literature review