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Dental Care

Dental Care

Patients with vascular EDS have specific oral implications that must be understood in order to safely treat them in the dental practice.

Oral signs of vascular EDS
  • Gingival (gum) fragility
  • Gingival translucency
  • Easy gingival bleeding
  • Gingival recession
Signs of vascular EDS visible on Xray
  • The adult molar teeth of people with vascular EDS seem to have longer than average roots, particularly in the lower jaw.
  • The second permanent molars of people with vascular EDS seem to be fused together more often than would be seen in the average adult population.
Implications of vascular EDS for Oral Health Care
  • Patients with vascular EDS should be under the care of a specialist dentist who can liaise with their medical professionals and who has the skills, experience and medical support to manage their condition. 
  • For children this would be a specialist or a consultant in Paediatric Dentistry, For Adults it would be a specialist or a consultant in Special Care Dentistry. 
  • Patients with vascular EDS are more likely to bleed from their gums even with good brushing, as their gums are very fragile.
  • More likely to get gingival recession. 
  • May be at an increased risk of bleeding following even routine dental procedures such as a filling, due to the fragility of their capillaries. 
  • May be at an increased risk of poor wound healing following surgical procedures, such as dental extractions or biopsies of the oral mucosa. 
Dental Care for patients with vascular EDS
  • Good oral hygiene and a low sugar diet are very important for patients with vascular EDS.
  • Dental treatment in patients with vascular EDS is complicated by their increased bleeding risk, as well as the desire to avoid peaks and troughs in blood pressure due to stress to avoid unnecessary damage to major vessels. Therefore the very best option is to avoid the need for dental treatment by preventing dental disease.
  • If you do need dental treatment don’t worry your specialist will be able to liaise with your medical team to manage the risks.  
  • Your specialist in Paediatric Dentistry or Special Care Dentistry may consider regular enhanced prevention options such as 3-4 monthly fluoride varnish application, high fluoride toothpaste for adults and children over 10 years old or a high fluoride mouthwash (to be used at a separate time to brushing). 
  • Reducing sugar in the diet by drinking only milk and plain water, keeping sugary treats to meal times only and swapping high sugar foods for low sugar alternatives are also advised to reduce the risk of dental decay.
  • Tranexamic acid (sometimes shortened to TXA) is a prescription medicine that controls bleeding. It helps your blood to clot. If you're having a tooth taken out, using tranexamic acid mouthwash can help stop bleeding. For more information on TXA visit: https://www.nhs.uk/medicines/tranexamic-acid/

Brush DJ

Brush DJ is an award-winning, free toothbrush timer app that plays 2 minutes of music taken from the user’s device to encourage brushing for an effective length of time. 

The app also allows users to set reminders to brush twice a day, floss, use a mouthrinse and when next to see their dentist, hygienist, therapist or orthodontist. Evidence-based age specific information is given as per the Public Health England toolkit ‘Delivering Better Oral Health’.

The free, award-winning Brush DJ app makes brushing your teeth fun! Watch the video to see all its features : )
View Website
Oral phenotype and scoring of vascular Ehlers–Danlos syndrome: a case–control study
The goal was to assess oral features of vEDS. Gingival recession is the only oral sign recognised as a minor diagnostic criterion. The authors aimed to check this assumption since bibliographical search related to gingival recession in vEDS proved scarce.

Participants
17 consecutive patients with genetically proven vEDS, aged 19–55 years, were compared with 46 age- and sex-matched controls.
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RMCH Dental Health Unit
Dental advice for vascular EDS patients is kindly provided by the RMCH Dental Health Unit. A dedicated & dynamic Dental team at Royal Manchester Children's Hospital - sharing toothy top tips and flying the flag for kids' oral health.

Our gratitude to Dr Kay Hood, Lead Paediatric Dental Consultant and Dr Ciara Feeney, Paediatric Dental Consultant for supporting Annabelle's Challenge and raising awareness of vascular EDS.

Ciara is also the winner of the R A Medical Services sponsored Clinical Case Prize at the BSPD annual conference 2018 with her presentation entitled: VEDS, VWD and ADHD: Multidisciplinary care for a complex child. 
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