Wernicke-Korasakoff Syndrome (WKS) is a serious neurological disorder caused by thiamine (vitamin B1) deficiency. It’s frequently associated with alcohol abuse but can also be associated with chronic eating disorders. The classic symptoms of WKS are primarily neurological, although there are several associated oral manifestations due to alcohol abuse that result in malnutrition. Dental hygienists need to be aware of this syndrome, the associated oral manifestations, and best treatment regimens.
The effects of WKS
Researchers found that several psychiatric illnesses are exacerbated by thiamine deficiencies. These include depression, anxiety disorders, bipolar disorders, schizophrenia, Wernicke’s encephalopathy, and Korsakoff’s psychosis. Thiamine is critical for brain health as it plays a vital role in energy production and neurotransmitter synthesis in the brain.
Thiamine acts as a coenzyme in glucose metabolism, which provides the brain with energy to function. Also, thiamine is necessary for the synthesis of neurotransmitters, which are necessary for nerve cell communication and cognitive functions of memory and mood regulation.
WKS damage occurs in several regions of the brain, including the thalamus, hippocampus, hypothalamus, and cerebellum. These control a wide range of functions such as vision, movement, language, sleep, memory and motivation.
Diagnosis of WKS is based on a history of chronic alcohol abuse and can be confirmed by MRI scans of the person’s brain. MRI scans in WKS patients show less brain volume and larger cavities in the brain. The prevalence of WKS is not well established, and researchers estimate that it could be undiagnosed in almost 80% of patients.
WKS first presents as a condition called “wet brain,” which affects cognitive and motor functions. If left untreated it progresses to Wernicke Encephalopathy, resulting in confusion, abnormal eye movements, and an unsteady gait. The last stage progresses to Korsakoff Psychosis, resulting in permanent brain damage.
Thiamine deficiency aids with cell function, and if left untreated can result in serious and life-threatening conditions such as brain damage, cognitive impairment, coma, congestive heart failure, loss of coordination, nerve damage, and permanent memory loss. Failure to diagnose this disease results in death in 20% of cases, while 75% of cases are left with permanent brain damage, and 25% require long-term institutionalization since they’re unable to care for themselves.
Without prompt diagnosis of WKS followed by thiamine treatments, the progression to Korsakoff’s Psychosis is inevitable. People with Korsakoff’s Psychosis may have irreversible memory impairments, remember events incorrectly, confabulate stories to fill in memory gaps, experience hallucinations, have repetitious speech and actions, and have problems making decisions, planning, organizing, and completing daily tasks. They also lack motivation and emotional apathy.
Associated oral manifestations of WSK
Oral manifestations include inflammation of the tongue, which may appear swollen, flattened, mushroom shaped, intensely red, or with papillae atrophy. There may be ulcerations or cracks at the corners of the mouth, inflammation of the gingiva, or necrotic areas at the tips of the interdental papillae.
Difficulty swallowing is evident, which leads to malnutrition issues and progression of the disease. Individuals may experience dry mouth since alcohol is a diuretic and can lead to dehydration, which reduces saliva production and increases the risk of dental caries and periodontal disease.
Chronic alcohol abuse can alter the delicate balance of bacteria in the oral cavity, causing increased prevalence of necrotizing gingivitis and periodontitis and stomatitis. Oral cancer is more prevalent with alcohol abuse, and this causes a high risk of developing squamous cell carcinoma on the tongue and on the floor of the mouth. All these oral manifestations can be present in patients who abuse alcohol, but the malnutrition and thiamine deficiency in patients with WKS exacerbates all these issues.
Treatment considerations for WKS
Dental hygienists should be aware of the oral manifestations and neurological symptoms of WKS with their patients they suspect might be abusing alcohol. If WKS is diagnosed in the early stages, prompt thiamine treatments can prevent the disease from progressing to Korsakoff’s Psychosis and can potentially prevent irreversible neurological deficiencies or even death.
Author’s note: This article was written in loving memory of Mark E. Travelpiece. The critical diagnosis of Wernicke-Korsakoff Syndrome in his final days helped provide understanding, forgiveness, unconditional love, and closure for his two sisters before he entered a vegetative state and passed away.
