By Sharon on Friday, April 06, 2001 - 03:54 am:

I was just wondering if anyone has the problems my neices and nephew have , i think that at least 1 of them is hypermobile, but htey all have really bad teeth, one neice had had all teeth pulled and she is only 7 and my nephew just had 4 pulled and he is only 2, of my sisters 4 children (she actually has 5 but cant count the newborn)they have ALL had teeh problems and had to have teeth pulled out due to Rotting etc. I was wondering if this could be related to HMS or EDS# or Hypermobility or if it is unrealated and something ELSE that runs in my family (by the way no diagnosis yet od HMS or EDS# but i am extremely hypermobile and Dislocation Quuen at moment) and hae had joint problems etc all my life
Thanx in advance for any help!

By Gwen on Friday, April 06, 2001 - 06:23 pm:

Haven't heard that rotten teeth are related to EDS/HMS. My teeth have their fair share of fillings, mainly because I had an aversion to dentists in my teens after a particularly bad experience with a real butcher. Once I got them treated they've stayed decay free.
Maybe your sister needs to look at what she gives her children to drink. Most decay in very young children is the result of being allowed to have a bottle of cordial to suck on all day and being put to bed with a filled bottle. The high-sugar fluid sits in their mouths and eats away at the tooth enamel. Have you seen the email doing the rounds, about the effects of coca-cola? It is corrosive and can be used to clean gunk off of car engines. Imagine what it can do to children's teeth. Children don't need to have a filled bottle all day and all night. If they need a pacifier an old-fashioned dummy is fine, as long as it's not coated with honey or chocolate spread as some Mums do.
Incidentally fruit juice is almost as harmful as cordials and fizzy drinks as it is also high in sugars.
Neither of my children are great on brushing their teeth but they've never been allowed unlimited quantities of soft drink- OK with a meal and extra on hot days or after sport- or lots of sweets. My daughter at twenty only has about five fillings and my eleven year old has none even though some days his teeth look decidedly furry and he needs to be reminded to clean them.
This of course may not be your nephew's and neice's problem but it is the most common reason for dental decay in pre=schoolers.

By Sharon on Sunday, April 08, 2001 - 01:21 am:

Thanx for the advice but this is not there problem there teeth have rotted since they came through and the worst of them (my 2nd neice) was actually born without the enamel coating on her teeth, so she has no teeth now at 7 years old (dentist has pulled them all due to rot)but all of her sisters and brothers have similar problems but not as bad. They are not allowed sugary drinks etc because ofthis problem and there teeth are cleaned regularly etc. Thanx anyway was just wondering if related is all

By Lin on Tuesday, April 10, 2001 - 07:17 am:

I have HMS, but have never ever had a cavity. I have realy good teeth in that sense. But, I have had braces for 3 years, and 2 oral surgeries, plus I am getting another one this summer, getting ym wisdom teeth out. But I have no fillings, or any other problems such as that. My father also has HMS, but he has never had a cavity either, so it must run in specific familys, and not be related to HMS, or be related and just didnt run in my family....
Lin

By Sheena on Wednesday, April 11, 2001 - 10:32 am:

Sharon,
My brother-in-law also had no enamel on his baby teeth. I think some of them fell out, and the ones that didn't were very dark brown. As far as I know his second teeth are normal. I don't know if he has any HMS symptoms - my husband (his brother) has some hyper-mobile joints and had mild "growing pains" problems when he was a teenager.

By Kati on Friday, January 11, 2002 - 04:13 pm:

i have read on an EDS site that it is common for people with EDS (type 3) to be missing some of their 12 year(?) molars. it isn't that they just haven't come in, it's that they aren't even in the gum. i am missing at least one (maybe two?) of mine. i am going to check with the genetist when i go later on this week, but was wondering if anyone else had heard of this.

By Sharon on Friday, January 11, 2002 - 05:15 pm:

Kati,
when i had my wisdom teeth out a few years ago it was found that i only had 3 one was missing totally from my jaw, it just never happened/grew etc. the dental surgeon said that they are finding this more and more often with the general population as our jaws are getting smaller (this is why so many kids etc need braces these days) so slowly we are evolving to have less teeth as we dont need some of them anymore with the diets we have now.

Hope this helps

By Kati on Sunday, January 13, 2002 - 09:17 am:

Sharon,
Thanks for the information, I never even thought about that. It sounds more likely than what I read. I'll let you know if I hear anything else.
Kati

By chris on Thursday, March 14, 2002 - 08:02 am:

is having overcrowded teeth anyhting to do with hypermobility.also bleeding gums,which i have had for years,yet it has never developed into gum disease. i get times where they bleed all the time and other times they dont.

By chris on Thursday, March 14, 2002 - 08:02 am:

is having overcrowded teeth anyhting to do with hypermobility.also bleeding gums,which i have had for years,yet it has never developed into gum disease. i get times where they bleed all the time and other times they dont.

By Sheena on Thursday, March 14, 2002 - 02:57 pm:

Kati,
My son and I, both with HMS, are missing a pair of molars in the lower jaw.

By Kati on Monday, March 25, 2002 - 09:40 pm:

Sheena-

That's intersting to hear - I was beginning to think the site I read it on was completely bogus. Also, when I went to the geneticist she said she would check into it - I still haven't heard back from her yet.

-Kati

By Sally on Wednesday, December 04, 2002 - 06:05 am:

I am a qualified Dental Nurse and a long-term sufferer of HMS and can honestly say on both a professional and personal bases that HMS does not affect oral health or teeth. However, as diagnosed patients of HMS you may find you are more susceptible to other conditions, which could be the cause of dental problems. Overcrowding is very common and not due to HMS, it is because the jaw is too small for all your teeth and this can be corrected easily with extractions and braces.
With regards to the missing teeth - this is also very common - especially with wisdom teeth and what are known as you 7's (the back molars b4 the wisdom's) and 5's (the second premolar). Sometimes they are there and just never erupt - other times they never develop - not even in the gum. I'm happy to answer any q's if anybody has any. Sally x

By Patty on Wednesday, December 04, 2002 - 05:32 pm:

I have lots of materials on dental problems and EDS. There are problems with nerves not responding to local anesthetics. My gums bleed and have bled from the time I was little. So do the gums of my two EDS kids and my EDS dad. We all use extra soft tootbrushes (given to us by the dentists) so we don't damage the gums. All of us have teeth that easily decay and break. Our teeth are malformed with extra roots or twisted roots. It took two dentists over an hour to get my son's wissie out - and the local never did work. When I went to the dental schools for dental work, the profs were very specific in how we should be worked on. Check out some web sites on this.

By Sally on Thursday, December 05, 2002 - 03:01 am:

EDS is a more serious condition than HMS, and has more conditions connected with it. This may be why your gums aren't healthy. A soft toothbrush is a must, ad you should make sure you brush the tooth where it connects to the gum well to avoid further aggravation - you may find this makes them bleed more at first but that will subside. Wisdom teeth can often be a real problem to extract - I've had 3 out - 2 were fine, whilst the other one took over 3 hours, and there is still a root rest left! Local anaesthetics not working is also common with wisdom teeth that are buried far under the gum this is because the root lies too close to the mandibular nerve. The main problem with HMS sufferers is TMJ (temporomandibular joint syndrome) unsurprisingly really...

By Patty on Saturday, December 07, 2002 - 09:30 am:

hi, Sally. The gums stop bleeding in normal people, but mine will not. They may stop for a while, but before you know it, the bleeding is back. My dentist back when I was a kid had me applying mechurichrome (or however you spell it) twice a day. No change. I was using a special mouthwash. No change. CoQ10 has made a significant improvement, but not complete. I also have pain between two teeth that comes and goes. They even did root canals to try to cure that...not gone. My daughter has TMJ and they are doing her wissies under general in the hospital this month - to make sure they don't further damage her jaw. When they x-rayed her, the jaw came dislocated completely - both sides. THAT was fun!!! We are dental nightmares.

By Sally on Wednesday, December 11, 2002 - 07:46 am:

Patty, I am sorry to hear that you have such tooth trouble, obviously you've spoken with a dentists and got the best advice there is. I hope that your daughters extractions go problem free. Best wishes, Sal xx

By Az on Friday, November 21, 2003 - 04:28 pm:

Teeth:
Clinical examination may show smaller crowns than normal, with a tendency to a more conical morphology, especially in the upper lateral incisors. High cusps and deep fissures are described in the molar and pre molar regions. Enamel hypoplasia is commonly seen.

Radiographic examination, especially now that OPG techniques are widely available, may demonstrate the classical lesions of EDS. Root lengh may be reduced and irregularity of formation seen, together with the grossly dilated mid - root malformations and general pulp stone formation in the coronal pulp chamber.

Histological examination of any extracted teeth and associated soft tissue should be performed to aid confirmation of the syndrome.
The following microscopic features may be seen:-
a) Abnormailities of the amelo - dentinal and cemento - dentinal junctional area.
b) Irregular and ill- formed secondary dentine tubules.
c) vascular dentinal inclusions.
d) Fibrinoid gingival deposits.
_______________________________Dental
Implications for dental treatment:
Prevention.
As much as the dental relevance of EDS lies in the consequences of surgery, early recognition of the condition will give priority to primary preventitive measures against destructive caries and peridontal disease. Regular and frequent advice should be given on diet with emphasis on the limitation in freuency of sugar ingestion and flouride supplementation by drops, tablets or mouthwash advised where appropriate.

Deeply fissured posterior teeth should be sealed. Plaque-related dental disease should be monitored through frequent regular examination possibly aided by dentocult and labratory aids.
As there is a general tendency to gingival bleeding, good patient education in an effective brushing technique is essential motivated by disclosing solution when patient compliance is in doubt. Chlorhexidine gluconate mouthwash is an effective adjunct to plaque control, suitable for long-term use.
Monitering of bone loss especially in the incisor and first molar regions is prudent and where observed, consideration should be given to the addition of anti-microbial treatment on the lines suggested for idiopathic juvenile peridontosis. Teeth which are excessively mobile or have deep pocketing should be extracted as peridontal treatment in EDS should be conservative, and the danger of bacterial endocarditis borne in mind.
________________________________
Treatment
Endodontic:
Deep occlusal fissures will be caries-prone sites. If endodontic treatment is necessary, thought should be given to the shortened root length which may be encoutered and accurate long-coneradiographs obtained to ascertain length prior to treatment. The large pulp stones may limit prognosis.
__________________
Extractions and surgery
The dilated root formation should be anticipated when surgical treatment is contemplated. The terminal root portion may be iregular and poorly formed. Both these anatomical features may create difficulty in tooth removal. Prolonged post extraction haemorrhage should be anticiapted because of the poor vascuolar retraction. Providing that there is not history of excessive bruising or haemorrhage from other sites, one or two dental extractions should not prove a problem if the tissue is handled with care. Suturing may be difficult due to tissue friability, causing the sutures to pull out when tration is applied. Oxidised cellulose gauze is helpful in achieving haemostasis, and a post-surgical acrylic plate retained by Adams clasps to cover wounds or retain muco-periosteal flaps, has been advocated by some authorities. The necessity for antibiotics must be considered.
(Studies have shown the insufficient effect of local anaesthetics in some types of EDS. Patients have been characterised a having hysterics. This is not the case.)
__________________-
Orthodontics
Some authors have noted narrow maxillary arch in EDS which may be considered for rapid maxillary exapansion, but this should be undertaken only in specialist hands where tissue friability and haemorrhage might be anticipated. The foreshortened roots and abnormal root anatomy may require moidification to treatment and limitation of prognosis. The cemento-dentinal lesions may have a bearing on the advisability of tooth movement particulary where fixed aplliance therapy is contemplated
_________________________
Restoritive
The abnormalities of the amelo-dentinal junction may show as areas of absent or of hypoplastic enamel. This and the greater tendency to "peg" lateral incisors may be treated by porcelain veneers where necessary.

Dental anaesthesia should, where possible be given by infilitration or intra-ligamentory techniques. The depth and vascularity encountered in inferior and posterior superior dental block injections should be considered where there is a history of easy bruising or ready haemorrhage because of the well recognised complications of haematoma formation at these sites. NB A 1992 BDJ reports a bacteraemia followng intraligamentoy injection through the gingival crevice. An approach to the crestal bone via the interdental papilla might avaoid this hazard of injecting into plaqu-contaminated area.

Recurrent subluxation of the TM joint should be anticipated, where joint laxity can be demontarted elsewhere, during prolonged work to the posterior teeth. Reduction, provided it is achieved prior to the onset of masseteric spasm, should prove little problem.
_____________________________
Prophylatic antibiotic needs.
Cardiac valvular abnormalities are frequently encountered in cases of ES, particulary mitral incompetence (The so called "floppy mitral") which may exist asymptomatically for many years. There is little doubt that bacterial endocarditis can develop even in cases where the heart murmers are trivial as the result of minor cardiac defects. An uncertain history should be regarded as positive need for antibiotic cover until further clarification by a cardiologist.
Amoxycillin is the antibiotic of choice given 3 grams orally 1 hour prior to surgery with follow up dose 6 hours later in adult patients with suitable dose modification in children. In cases of penecillin hypersensitivity Erythromycin stearate should be given orally 1.5 grams 1 hour prior to and 500mg 6 hours after surgery.
Patients whose disease is complicated by valvular lesion should be advised to report to their physician any symptoms however trivial which arise in the month after dental treatment.
Provided that early dental advice is sought and regular preventitive care given both at home and in the surgery, there is little reason that the patient with EDS cannot possess a healthy dentition uncomplicated by interventive and mechanistic dentristry which will only be necessitated by neglect
________________________
Temporomandibular joint (TMJ)
management in Ehler danlos syndrome
Pain and clicking of the TMJ (Jaw joint) is common in the general population affecting at least 30%. It is none the less common in people with EDS. Though it is essential that the treatment is more conservative. Often these pains can be managed with medication which is designed to alleviate pain in the joint and help with clicking. Surgery is by and large not a good idea, but may be possible to use a new minimally invasive technique of arthroscopy to examine and treat problems with the jaw joint
___________________________________
Quoted from prof Birds book. Must say my dentist was not very impressed that I took this info in, but then again she also wasnt impressed that I mentioned the two sets of stairs I had to climb were annoying. Of course I can take this info to the new dentist I will be finding
Hope this helps a bit

By sugarcube on Monday, December 15, 2003 - 10:33 am:

I have a quick question!? My (hypermobile)daughter went and had x-rays taken at the dentists office last week and he said that there were no traces of her (4?) wisdom teeth. No teeth had ever started to form and they never will. Is this connected with hypermobility?