Dental anomalies have been observed in patients with EDS, most notably in the classical and hypermobile forms. These include premolar and molar teeth with prominent cusps and deep fissures, crowns with short or oddly shaped roots with stones in the pulp, and enamel hypoplasia (under development) with scientific proof of various enamel and dentine anomalies. It is likely that enamel defects predispose a patient to rapid loss of crown material (attrition), resulting in decreased enamel calcification and an increased risk of caries.
Let’s take a deeper look at Ehlers-Danlos syndrome (EDS), a condition that can impair oral function and, as a result, the general quality of life. This connective tissue disorder can affect dental health, as well as the temporomandibular joint; however, many persons with EDS do not experience apparent dental problems as a result of their illness. Additionally, the systemic difficulties associated with EDS may occasionally make it difficult to give routine dental care.
The purpose of this article is to offer an overview of the influence of EDS on oral health and dental treatment.
Indeed, the majority of oral difficulties encountered by people with symptomatic hypermobility are likely to be comparable to those experienced by healthy persons (e.g., tooth decay and periodontitis) as a consequence of dental plaque’s effects on the oral mucosa and gingiva. Due to the scarcity of research, including large numbers of persons with well-characterized EDS, it is hard to determine the exact prevalence of oral and dental issues caused by EDS. Each kind of EDS has its unique set of oral and dental features, but on average, the more loose the skin and mucosa are, the more likely it is that the patient will exhibit orodental characteristics.
Dental symptoms of hypermobility
Clinical signs of the biochemical collagen deficit are visible from birth in affected patients, although the biochemical collagen problem does not reveal itself until later. The presence of dental pathology is widespread among these people. The presence of hypodontia of permanent teeth delayed eruption, and dentin dysplasia is usually found in hypermobile patients. A general loss of connected gingiva may be a pathognomonic characteristic in the development of the disease. As a result, dentists may play an essential role in the early detection of it.
Consideration for different dental issues (If you have hypermobile EDS)
- Dental Implants
Although comprehensive research on the use of dental implants in patients with EDS is lacking, it is thought that there would be few adverse consequences. Given that implant installation is a surgical procedure, the same level of care should be used with antibiotic prophylaxis and post-operative bleeding as with dental surgery.
- Gum Diseases
Good oral hygiene decreases the risk of periodontal disease. Furthermore, those with periodontal illness (independent of their medical problem) should consult a periodontist who can clean their teeth and gums and, if required, do surgery to repair their gum issue.
When teeth are extracted, germs from the gums are introduced into the circulation, resulting in infection. In persons with heart valve abnormalities, germs may cling to the valve(s), resulting in inflammation (endocarditis). Thus, it was previously recommended that all patients with valvular anomalies must receive antibiotics before tooth extraction to avoid bacterial infection.
But now, the recent advancement in hypermobility treatment states that frequent antibiotic prophylaxis may no longer be required in dental issues. Prophylaxis is usually necessary or advised after the dental surgeon consults with the patient’s doctor/GP.
Due to the increased risk of developing mouth ulcers in specific individuals with EDS, dentures must be appropriately fitted and examined periodically by a dentist. Also, discuss with dentists to ensure that the tension is not there due to a loose denture.
Root canal therapy (endodontics) may be more challenging in EDS if there are pulp stones or if the root is shaped differently. A qualified specialist (an endodontist) should address endodontic issues in some cases.
- Wound healing/Bleeding after surgery
Patients with hemorrhagic EDS may have significant bleeding following extraction, which should be avoided. However, the dentist would often inject a hemostatic material into the socket, suture the gum gently, and maybe provide a mouthwash to prevent the clot from disintegrating further in the mouth.
In EDS, there is little proof that extraction sites do not heal properly; however, if healing appears to be abnormal (e.g., persistent discomfort or swelling after extraction, bad taste after extraction), the patient should be referred to an oral and maxillofacial surgeon who will clean the area and, if necessary, administer local or general antibiotics.
Advice on oral hygiene for patients
If you have hypermobile EDS, here are some dental hygiene suggestions for you.
- Make use of mouthwash
In order to prevent the danger of gum and tooth decay, as well as the occurrence of bad breath, patients are encouraged to use an antimicrobial mouthwash once per day.
- Make sure to brush your teeth thoroughly
Brush your teeth at least twice a day using fluoride-containing toothpaste to help protect the surface of your teeth against decay and other problems. Soft-bristled toothbrushes should be used. You can brush in whatever manner you like, but horizontal brush strokes should be avoided since they can cause harm to exposed gums and dental roots. When brushing your teeth, avoid opening your mouth too wide since this increases the chance of dislocating your jaw.
It’s possible that you’ll have to experiment with cleaning between your teeth. Flossing might be extremely painful for some people because it causes harm to the delicate area between their teeth. Tooth sticks or floss sticks may be more gentle than just flossing your teeth.
- Avoid high-sugar meals and beverages
Avoiding sugar in your diet will help you maintain good oral health while also lowering your chances of developing infections. You do not need to eradicate all sugar from your diet, but reducing it and maintaining proper oral hygiene might be beneficial.
- Visit your dentist regularly
Dentists can assist you in maintaining proper dental hygiene. If your dentist or orthodontist has never handled a patient with EDS/hypermobility before, you may want to put them in touch with your general practitioner to ensure that they have the most up-to-date information so that they can treat you effectively.