ines kapferer -seebacher dental complications in eds...schubart et al. j dent anesthpainmed...

Ines Kapferer-Seebacher

Dental Complications in EDS

Austria

Innsbruck

I have no personal commercial interests!

I lose my teeth!

Symbolic picture

Healthy condition

WHAT IS PERIODONTITIS?

Symbioticbacteria

Periodontitis

Dysbioticbacteria

Mild immune reaction Inflammatory bone loss

Tooth-supporting

bone

Periodontal EDS (formerly EDS VIII)

Pretibial discolorations Specific gumsEarly severe periodontitisAge of diagnosis (mean): 12 years

Complete tooth loss (mean): 20 yearswithout periodontal treatment

Healthy siblings

Children with periodontal EDS

Kapferer-Seebacher et al. (submitted)

„Periodontal disease has also been suggested to arise in classical and vascular EDS.“

British EDS Society

Ehlers-Danlos Syndrome„Early-onset generalized periodontitis is one of the most

significant oral manifestations of the syndrome.“Letourneau et al. 2011

„Periodontitis also may occur in EDS type IV and to a lesser extent, in EDS Type I.“

Classification of periodontal diseases 2018

Increased Risk of Periodontitis with other EDS types ?

Early severe periodontitisis a feature of

periodontal EDSbut

not of other EDS types!

Shortened roots with classical EDS

Hakki et al. J Dent Oral Biol. 2017; 2(15): 1090.

Described in 9 individuals up to now

Pulp stones

classicalEDS

hypermobileEDS

dermatosparacticEDS

periodontalEDS

7 3 1 4

Supernumerary teeth Rotated teeth Tooth transposition

Single cases with hypermobile EDS and classical EDS

Are these manifestations of EDS?

Schubart et al. J Dent Anesth Pain Med 2019;19(5):261-270

MethodQuestionnaire: 980 EDS + 249 non EDS respondents

"Have you ever had a problem with a local anesthetic injectionnot working adequately or properly?"

ResultsEDS: 88% recalled inadequate pain preventionnon EDS: 33% recalled inadequate pain prevention

The agent with the highest success rate was articaine (30%), followed by bupivacaine(25%), and mepivacaine (22%).

Healthy condition

DENTAL IMPLANTS

Peri-Implantitis

There seems to be no increased risk for implant loss with other EDS typesone study on five individuals with hypermobile or classical EDS

Jensen et al. 2012

Three individuals included

All typesResistance to local anesthetics

periodontal EDSEarly severe periodontitisSpecific gumsPulp stonesIncreased risk of peri-implantitis

classical EDSPulp stonesShortened roots

vascular EDSExceeding roots

Conclusions

Striking lack of scientificevidence!

Clinical studies on oral manifestations of various EDS types

Periodontaldisease

Temporomandibularjoint

Enamel defectsRoot

deformities

Dental anaesthetics

Implantsuccess

Ines.kapferer@i-med.ac.at

Practical advice from a dentist!

Ines.kapferer@i-med.ac.at