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Dental Manifestations And Considerations
In Treating Patients With Ehlers-Danlos Syndrome
School of Dental Medicine - University of Connecticut
Originally published in Loose Connections Vol VIII, No.4 1993
When contemplating orthodontic treatment on a patient with Ehlers-Danlos
syndrome (EDS), there are a number of special precautions to be taken. Extreme
joint hypermobility in many EDS patients often leads to chronic dislocation of
the temporomandibular (jaw) joint. This makes the placement of complex orthodontic
appliances very troublesome for the patient and the clinician. In addition, the
oral surgeon must be extra cautious to prevent a dislocation of the mandibular
condyles (lower jaw joint) when performing a surgical procedure in preparation
for orthodontics. Because of tissue repair problems in EDS, there may be slow
healing after dental extractions, followed by soft tissue scarring. The
orthodontic appliance used on an EDS patient should be very smooth and
relatively simple in design. The oral mucosa, or mouth lining tissues, are very
fragile, liable to injury and particularly vulnerable to sharp objects such as
orthodontic appliances (braces) or partial dentures.
The dental anatomy of the posterior teeth occasionally have high cusps and deep
fissures. The roots may be dilacerated, (stunted, bent, fused or twisted in
shape). The pulps may become partly obliterated by the pulp stones in the crown
portions of the pulp, making root canal treatment difficult. The dentin may
have an unusual pattern and abnormal fine structure because of an aberrant
collagenous dental crown anatomy. Thus, there may be a right to left or upper
dental arch to lower dental arch tooth size discrepancy (difference) making
ideal dental interdigitation very difficult. Tooth movement might be expected
to be more rapid for a constant appliance activation because of the collagen
cross linkage defect. The mobility of teeth during tooth movement may be
greater than normal. This may be caused by stretching, tearing and slow repair
of the fibers. Similarly, the gingiva (gums) may be more prone to inflammation
and possible recession. There have been reports of early onset of some
periodontal defects (gum and tooth support). The old EDS type VIII, which is
similar to the Classical type, in particular, is characterized by extreme
periodontitis which can be quite debilitating. With the added dental mobility
of the teeth, slowed repair processes and poor organization of tooth supporting
tissue collagen, the need to wear retainers long after completion of the case
may be greater. Although anatomic defects in the root morphology have been
described in EDS, the detailed molecular composition of the dentin has not been
studied. If changes do exist, root resorption as a side effect of orthodontics
could be a problem. This has not been demonstrated clinically, however.
EDS is a connective tissue disorder which may have many effects on the
dentition of the patient. With suitable understanding of the underlying disease
manifestations and appropriate precautions by the orthodontist, orthodontic
treatment can be accomplished with the minimal undesirable side effects.
Dental Manifestations of EDS
1. Hypermobile temporomandibular joint (TMJ); high incidence of subluxation
2.
Fragile oral mucosa
3.
Early onset of periodontal defects
4.
High cusps and deep fissures on the crowns of teeth
5.
High incidence of enamel and dental fractures
6.
Stunted roots or dilacerations
7.
Coronal pulp stones
8.
Aberrant dentinal tubules
9.
Pulpal vascular lesions and denticles
10.
Teeth move readily in response to orthodontic forces
11. Orthodontic retention easier to
accomplish
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