Aims: The present historical case report aims to characterize the long-term orofacial repercussions of amyotrophic lateral sclerosis (ALS), a rare neurodegenerative disease with poor prognosis and relatively short life expectancy following initial diagnosis.

Methods: Here we focus on the long-term orofacial evolution seen in the example of Stephen Hawking, one of the greatest personalities in the scientific world, using publicly-available photographic documentation. The fact that Stephen Hawking lived several decades following his diagnosis of ALS presents one with a unique opportunity to characterize and follow-up the evolution of the ALS on the orofacial sphere. Through this article, we want to show him and his family, and all those living with this disease, our deepest respect, without intending in any way to intrude or misuse the privacy of the late universally-respected astrophysicist.

Results: Photographic documentation analyzed longitudinally shows changes towards the development of a Class III malocclusion, lower incisor protrusion, and a concave profile. Moreover, tooth wear has occurred, accompanied by posterior tooth loss and aberrant tongue and lip posture.

Conclusion: The causes of such changes remain speculative but could be due to changes in the soft tissue equilibrium, changes in head and tongue posture, loss of oral function, respiratory needs, and a general deterioration of dental health. Our sincere thanks to the Hawking family who took the time to read the article and approve its publication for scientific and educational purposes. We are also deeply grateful to them for providing us with some photographs from their family collection.