We all want to have a smile as dazzling as our diagnoses (bah-duh-dum), but there are a number of dental issues that are common to people with Hypermobility Spectrum Disorders (HSD) and the Ehlers-Danlos Syndromes (EDS) that could make a great smile a short-lived treasure. Problems with collagen spell trouble for our teeth and their home, the jaw. Today we’ll cover the most common problems.
Future posts will cover going beyond the basic dental care guidelines for bendy zebras and some recommendations for improving gum health from massage to specialized toothpastes and rarely known dental tools so you can keep your teeth looking a little better than Gladys’:
Don’t have EDS or HSD? Take a look at our post Dental Care and Chronic Illness for a wide range of tips for other conditions.
Oral and mandibular issues are commonly reported by EDS patients of all types. Collagen defects can compromise oral health including, bone, teeth, gum tissue, nerve tissue, tendons and ligaments that help to hold our teeth in place, as well as our jaw. Poor dental outcomes can affect pain levels, functionality, nutrition and over all quality of life.
Bone Structure and Dentition
Tooth mobility is a common issue for many people with EDS and HSD and is thought to be related to the periodontal ligament, which has the sole job of holding each tooth in place. Several tooth abnormalities have been noted among EDS zebras. Posterior teeth are reported to have high cusps and deep fissures, making them difficult to clean and care for. The roots may also be shaped abnormally, elongated or fused. Pulp stones ( discrete calcifications that form within the pulp chamber) are seen in some. Congenital absence of teeth and microdontia (in which one or more teeth appear smaller than normal) have also been described in people with EDS.
Soft Tissue Abnormalities
The soft tissues of the mouth are particularly delicate and the oral mucosa can be particularly fragile. Mouth sores may be frequent for some with hypermobility. It is common for these tissues to be damaged with dental tools. We are also prone to early onset gum disease, which affects both soft tissues and eventually bone.
Early Onset Gum Disease
Since collagen is a component of teeth and gums, they can show the same weaknesses as any other collagen containing substance in our bodies. This is further complicated by the ligaments that hold our teeth in place, known as the periodontal ligament. Because of our collagen deficiency, ligaments can begin to stretch and fail over time, causing our teeth to become hypermobile, trapping more food in the gum line, creating the bacteria that leads to inflammation, gum loss and tooth decay.
If these issues aren’t enough to cause the beginnings of gum disease, it is believed that the structural defects in collagen or collagen-related proteins which are part of the immune system can increase susceptibility to degradation by bacterial pathogens. Given that the mouth is the perfect environment for bacteria, we’re often fighting a losing battle from the start.
People with hypermobility also tend to have poor blood flow and gums can easily become oxygen and nutrient deprived, adding to issues with the health of these tissues. I believe this also plays a role in numbing issues found in EDS, so I’ll discuss it in more detail when I talk more about gum massage and other therapies I’ve had success with, but it’s important to note that it can contribute to poor gum health.
Gum disease develops slowly over time and it’s common for EDSers to get early onset periodontal disease, which usually begins with gingivitis. Gingivitis is inflammation of the gums (gingiva) signaling early gum disease and is caused by a build up of plaque along the gum line, trapping bacteria and creating the perfect breeding grounds for infection.
Gingivitis is often a precursor for periodontal disease. In periodontitis, infection advances in the gums and spreads through the periodontal ligament and alveolar bone (the bony ridge containing tooth sockets), eating away at these structures and causing receding gums, bone loss, and even greater hypermobility of the teeth.
Temporomandibular Joint Dysfunction
The temporomandibular joint is very complex. It is best described as a sliding ball and socket joint worked by a series of muscles for chewing and talking. Because this complex network can affect the surrounding tissues, it’s important that the whole head and neck be examined and treated for TMD. In several studies, TMJ hypermobility and TMD have been linked to systemic joint hypermobility.
TMJ dislocation is noted to occur more often in women in the general population which mirrors that of EDS. The TMJ can relocate once hyperextended but cause the cartilaginous disc to stay dislocated resulting in pain, bony destruction, and limited mobility. The muscles of mastication can be overused, spasm, and cause referred face, head, and neck pain thus resulting in decrease functionality and quality of life.
In a recent study of 114 EDS patients comprising several types with an equal number of controls, a higher proportion of the EDS patients experi-enced hypermobile joints during extreme mouth opening, poor mouth opening ability when biting into thick food, clicking, crepitation, and permanent locking of the jaw open and closed. Many of the EDS patents reported decreased hypermobility of the joint with age.Mitakides and Tinkle
Though these problems sometimes feel as insurmountable as Mt. Everest, there are things we can do to improve and even prevent these problems before they get started. In our next post, we’ll talk about several tactics that may help with these issues, including products I’ve found to help me keep my wins bigger than my losses in the fight against gum disease and TMD.
There’s still a lot to cover regarding proper dental care and the prevention of common problems for people with hypermobility. My next post on oral care will cover what our basic dental care should cover and some great tools, special toothpastes and rinses. Then we’ll move onto issues of numbness and of course, TMD. I hope you join us!
In the meantime, what kind of dental problems are you experiencing? What are some of the best tools you’ve found that help? Let us know in the comments and I might include it in one of our future posts!
Resources and Further Reading
- John Mitakides and Brad Tinkle. The Ehlers-Danlos Society. Oral and Mandibular Manifestations in the Ehlers-Danlos Syndromes
- Emedicine Health. What is Gingivitis?
- Oral B. What is Periodontitis? Treatments, Signs, and Symptoms
- Science Direct. Pulp Stones: An Overview
- Winning Smiles Dental Care: What is Microdontia