Dentists may spot EDS signs during routine exams, study finds
Gum inflammation, other changes may point to condition, researchers say
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Dentists may help diagnose Ehlers-Danlos syndrome (EDS) by identifying certain oral changes during routine examinations.
EDS patients were significantly more likely to have inflamed gums, underdeveloped mouth tissues, jaw joint pain, jaw joint movement and dislocations, and unusual changes in their tooth roots and inner tooth structure, according to a study from France.
“These oral findings commonly observed in [EDS] patients can aid in diagnosis and underscore the need for specialized dental care,” the researchers said in the study, “Oral Manifestations of Non Vascular Ehlers-Danlos Syndrome Cross-Sectional Study,” published in the journal Oral Diseases.
EDS is a group of inherited genetic disorders that affect connective tissue, which gives structure and support to the skin, joints, blood vessels, and other tissues and organs. Key EDS symptoms include soft, stretchy skin and unusually mobile joints. Many dental professionals may be unfamiliar with EDS, given the condition’s rarity. If dentists knew what signs to look for during a routine checkup, such as changes in the gums, teeth, or jaw, they could identify EDS sooner and refer patients to the proper specialists, the researchers said.
“It is essential to systematically document oral manifestations in genetically confirmed patients to improve diagnostic accuracy and patient management,” the researchers wrote. They provided a thorough oral description of a group of patients with genetically confirmed EDS.
Study details EDS signs dentists can use
The single-center study involved 14 EDS patients and 30 healthy controls matched for age and sex. Nine of the patients were diagnosed with classical EDS, three with classical-like EDS, and one each with kyphoscoliotic EDS and periodontal EDS. All underwent complete clinical and radiological oral examinations. The study excluded those with vascular EDS.
The researchers found that EDS patients were significantly more likely to have gingivitis (gum inflammation) than the control group (85.7% vs. 56.7%).
No differences were found between the two groups in other gum-related tests. This included the gingival index, a measure of gum inflammation severity, the rate of periodontitis, a gum disease that affects the bone, and gingival thickness, or the amount of gum tissue anchored to the jaw. Still, thick gingiva was found in all of those with classical EDS.
Markedly more EDS patients had an underdeveloped or reduced lingual frenulum (85.7% vs. 10%), the small band of tissue connecting the underside of the tongue to the floor of the mouth. This difference was also noticed for the inferior labial frenulum (78.6% vs 20%), which connects the inner lower lip to the gum. No difference was found for the superior labial frenulum, which connects the upper inner lip to the upper gum.
A significantly higher proportion of EDS patients had temporomandibular disorders (TMDs), which affect the jaw joint and surrounding muscles (64.3% vs. 16.7%).
Group 1 TMDs, characterized by jaw muscle pain, were more than 15 times more common among EDS patients (50% vs. 3.3%). Likewise, group 4 TMDs, marked by the excessive movement of the jaw joint, were found in 21.4% of EDS patients and in none of the controls. A history of jaw dislocation was similarly more frequent in the EDS group (21.4% vs. 0%).
Habits involving abnormal tongue movements or positioning, known as lingual parafunctions, were significantly more frequent among EDS patients (57.1% vs. 16.7%). Headaches were also markedly more common in EDS patients (42.9% vs. 3.3%), including migraines and tension-type headaches.
Imaging analysis showed no differences in joint structure, and there was no difference between groups in the prevalence of a high-arched palate, or a narrow and elevated roof of the mouth.
Shorter tooth roots were observed nearly three times more often in EDS patients than in controls (57.1% vs. 20%). Pulpal retraction, a reduction in the size of the inner part of the tooth containing nerves and blood vessels, was also more common in EDS patients (61.5% vs. 27.6%).
Researchers found no differences between groups for pulp stones (small, calcified deposits inside the tooth), radiculomegaly (abnormally large tooth roots), or tooth agenesis (absence of one or more teeth that never developed).
“These oral signs could serve as accessible indicators to aid in diagnosis, highlighting the need for close collaboration between dentists and physicians for comprehensive care,” the team wrote. “Given the limitations imposed by our small sample size, larger, multicenter studies are essential to validate these observations and determine their specificity across different EDS subtypes.”
