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*This content is provided for informational purposes only and is not intended to be a substitute for the advice of your personal dentist or other health care provider, nor should it be used to seek help in a medical emergency. If you have any questions, please consult your dentist or other health care provider.

Dental care can be a stressful, complicated process for parents of children with EB. We asked a dental specialist, Mark L. Cannon, D.D.S. M.S., of Long Grove, IL, for some guidance about what families should make their biggest priorities in selecting a specialist and understanding what precautions should be taken with an EB dental patient.

EB Resource (EB): What is the greatest concern parents express about their children’s oral health?

Dr. Mark L. Cannon (Dr. C): The most important component of oral care for children with Epidermolysis Bullosa is prevention. Both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend the first dental visit to be at age one. This is true for the general population; however, children who have medical conditions or other special needs should consult with a specialist as soon as the incisors start to erupt.

EB: What type of dental specialist should parents look for?

Dr. C: Most pediatric dentists are hospital trained and have completed their residency at a major pediatric medical center. They have received extensive training in the total care of young patients with virtually all medical conditions. My own first exposure to patients with EB was during my residency at Children’s Memorial Hospital in Chicago, Illinois.

EB: Are there specific preventive treatments for patients with EB?

Dr. C: Indeed, there are many preventive procedures now available that weren’t around when I was in my residency. MI Paste, minimum intervention paste, is a cream that is applied to the teeth every night. The cream contains high levels of amorphous calcium phosphate (calcium and phosphate that is bioavailable, actively benefiting the patient) and casein phosphopeptide (a pre-protein from dairy sources that inhibits cavities as effectively as fluoride). MI Paste is safe if accidentally swallowed, unlike many high fluoride products, so it is ideal for little children. Our EB patients are all using MI Paste and so far we have not experienced any enamel breakdown!

Fluoride varnishes replace many of the old ways of topically applying fluoride. It adheres well to the teeth and the dose to the patient is no more than what happens when brushing with fluoride toothpaste. Older methods of fluoride application often required the use of a foam tray that could irritate the inside of the mouth. Fluoride varnish helps the enamel to become more acid resistant and is well tolerated by almost all patients.

Therapeutic sealants release fluoride or calcium phosphate into the surrounding teeth. Also, therapeutic sealants are easier to apply than the older types of sealants because they do not require a perfectly dry tooth surface prior to placement. The ease of application is important because that potentially reduces oral structure manipulation and should minimize the formation of bulla following sealant application.

There are so many wonderful xylitol products that help prevent decay. Xylitol is a naturally occurring sweetener that is found in birch trees, plums and many berries. Xylitol is not digested by pathogenic bacteria so it inhibits their growth. Xylitol is used in lollipops, candy, sprays, varnishes and other dental applications to help prevent decay. The lollipops also may contain Chinese licorice root, another natural inhibitor of cavity producing bacteria.

The use of probiotic supplements is also important. Whenever there are any changes to the oral environment the type of bacteria found in the oral microflora is also changed. Many medications have also been associated with saliva reduction that not only decrease the saliva’s buffering and antibody capability but may increase the growth of unhealthy (pathogenic) bacteria. Probiotics is defined by the World Health Organization as “live microorganisms which when administered in adequate amounts confer a health benefit on the host”. Probiotics has created a great amount of interest and has resulted with a “surge” in published research. InI2006 there were 528 hits in the Pub Med data base for the Key word “probiotic” and 47 human studies reported. Articles on Probiotics Therapy have been published in numerous refereed Medical Journals, including the Archives of Disease of the Child, Pediatrics, Journal of Pediatrics, Journal of Clinical Immunology and Allergy, Lancet and many others too numerous to mention. The preponderance of the publications reported positive results for Probiotic Therapy as an important adjunct in the treatment of a host of pathologic processes.

EB: How do Probiotics work?

Dr. C: Beneficial bacteria work by preventing the growth of pathogens; with competitive displacement of pathogens, by regulating gut microbial ecosystems, with improving gut function/nutritional uptake and by modulating immune responses to improve health. By augmenting the natural L. reuteri colonization in humans positive health effects have been reported. A Swedish company, BioGaia, has produced probiotic supplements for Dental applications. The Probiotic Lactobacilli reuteri is available in the following formats; as a Probiotic chewing gum, Probiotic Drops, Probiotic chewables, Probiotic straws and lozenges. These convenient application formats allows for the Probiotic Therapy of all types of patients; infants, disabled, teen or adult. These applications contain Lactobacillus reuteri strain ATCC 55730, an extensively studied strain that colonizes the stomach and intestine after ingesting the tablets. The colonization results in a significant boost to the immune system and has been reported as significantly reducing the level of pathogenic (bad) bacteria and significantly decreasing the effects of periodontal (gum) disease. Many of our patients utilize probiotic supplements to reduce the risk of dental disease.

EB: What diagnostic testing is recommended for the development of a proper preventive regimen for EB patients?

Dr. C: The CRT bacteria (Caries Risk) Test allows the pediatric dentist to categorize the patient’s plaque and saliva as to the quantity of disease causing bacteria. It does not however distinguish between the many Lactobacilli species some of which are beneficial. It also takes 48 hours for the cultured colonies to develop on the test agar delaying diagnosis. Saliva Check mutans test takes 15 minutes for results. This is a distinct advantage as the test may be accomplished during hygiene or sealant visits for patients, encouraging the use of such a test by dental auxiliaries, for example, dental hygienists. The Cariescreen Test from Oral Biotech is the simplest test to perform and also the quickest. It does not measure any specific pathogenic marker. Instead, the test measures the amount of ATP, adenosine tri-phosphate, in the plaque. High levels of ATP are associated with pathogenic bacteria because the acid environment requires a higher cell metabolism rate, hence higher levels of ATP. The Cariescreen test only takes 15 seconds to perform after calibration.

EB: What happens if the patient starts to get cavities?

Dr. C: Small cavities may be treated with ART, atraumatic restorative technique, whereas the patient does not require an anesthetic. The surface of the cavity is gently removed and a re-mineralizing filling material is bonded into the cavity. The remaining decay is hardened and the decay process stopped or reversed with this technique. This technique is very useful with small children and patients with a history of previous negative medical experiences.

EB: What precautions should the pediatric dentist take doing treatment?

Dr. C: The gloves should be lubricated to reduce friction on the patient’s oral area. If a rubber dam is used for a filling procedure, the rubber dam should also be lubricated. A rubber dam is a sheet of rubber that holds the cheek and lips away from the area the dentist is working on. The rubber dam also protects the airway, which is vitally important!

EB: What happens if it too late to start the preventive care and some of the teeth have already become carious?

Dr. C: Restoration of the child’s dentition (teeth) may be accomplished with either sedation or general anesthesia. Treatment under either sedation or general anesthesia should be performed in a Pediatric Medical Facility by experienced Pediatric Dentists working with Pediatric Anesthesiologists. This will ensure the safest treatment method possible.

A special thanks to Dr. Cannon for sharing his insight with our readers.

Mark L. Cannon D.D.S.M.S.
Associated Dental Specialists
Grove Medical Center, Suite 308 – RFD 4160
Long Grove, IL 60047
Tel: (847)634-6166
specialdental@comcast.net