Patients with EDS have specific oral implications that must be understood in order to safely treat them in the dental practice.
EDS gives rise to a spectrum of features affecting the mouth and teeth that may lessen one’s quality of life,
and can have a significant impact upon oral health and mouth function.
About 50% of individuals with EDS have the ability to touch the tip of the nose with their tongue (Gorlin’s sign) – this
is especially likely with classical and hypermobile EDS.
The oral mucosa may be thin, can easily tear and give rise to mouth ulcers (classical and hypermobile EDS). Dislocation
of the jaw joint (temporomandibular joint) is a possible feature of classical, hypermobile EDS and possibly some subtypes of the arthrochalasia EDS.
An increased predisposition to gum disease (gingivitis and periodontitis) have been described in Type VIII
disease, this having the potential to cause early tooth loss in adults.
Periodontal disease has also been suggested to worsen in classical and vascular EDS.
Implications for oral health
EDS has the potential to lessen oral
health by virtue of increasing the risk of dental decay, as a
consequence of the dental anomalies, as these can
trap food and dental plaque.
Caries initially gives rise to painless
white and darkened areas of the crowns, but without treatment will cause painful pulpitis (‘toothache’ with hot, cold and sweet foods) and likely pulp death requiring
root canal treatment or extraction of the tooth and
painful abscess formation (periapical periodontitis). Additionally, patients with some types of EDS may have an increased predisposition to gum disease (especially periodontitis).
Inflammation of the superficial gums
(ginigivitis) causes swelling and bleeding, which can cause an unpleasant taste and oral malodour (halitosis).
Inflammation of the deeper tissues (the
periodontium) also causes bad taste and breath, but additionally will ultimately lead to mobility and migration of teeth, and potentially early loss of teeth.
It must also be recalled that some
patients with EDS may have gums that bleed more easily as part of their underlying connective tissue disorder. Prevention of tooth decay and gum disease is essential for all those affected as this can avoid the need for complex
and invasive dental treatment in future years.
Surgical treatments may be further
complicated by poor wound healing and possibly increased post-surgical bleeding. Thus, there is a need for all individuals with EDS to have a diet that aims to prevent the development of
dental caries, as well as maintaining a high standard of oral hygiene that will lessen the risk of caries and gum disease.