Ehlers-Danlos syndrom og lokalbedøvelse ved dento-alveolær kirurgi
Ehlers-Danlos syndrom (EDS) er en gruppe af arvelige bindevævssygdomme karakteriseret ved hyperelastisk hud, hypermobilitet af led og vævsskørhed.
Lidelsen skyldes en mutation i et af generne, der styrer dannelsen af bindevævets kollagen. Symptomatologien varierer mellem de seks undergrupper af EDS.
Odontologiske symptomer forekommer i varierende grad i form af skrøbelige slimhinder, parodontale sygdomme, underudviklet emalje og unormale pulpae med kalcifikationer samt kæbeledsdysfunktion.
Manglende virkning af lokalbedøvelse ved tandbehandling opleves ofte af personer med EDS.
Materiale og metode
10 personer kendt med EDS fik i lokalbedøvelse foretaget dento-alveolær kirurgi. Efter afsluttet behandling skulle patienterne angive en vurdering af smerteintensiteten under behandlingen ved hjælp af en visuel analog skala, hvor 0 var ingen smerter, og 10 var den værst tænkelige smerte.
Resultater
Samtlige patienter vurderede smerteintensiteten, under den kirurgiske behandling, fraset anlæggelse af lokalbedøvelse, til 0 på visuel analog skala. En patient angav smerte under luksation af en kindtand vurderet til 5 på visuel analog skala. Udover forventelig hævelse, ømhed og smerter var det postoperative forløb komplikationsfrit.
Konklusion
Dento-alveolær kirurgi i lokalbedøvelse kan foretages smertefrit hos personer med EDS ved at anvende tilstrækkelig mængde lokalbedøvelse, brug af beroligende medicin før det kirurgiske indgreb samt opdele behandlingen successivt.
Klinisk relevans:
Ehlers-Danlos syndrome (EDS) is a group of hereditary disorders affecting the connective tissue. EDS is characterized by skin hyperextensibility, joint hypermobility, and connective tissue fragility. The disorder is caused by a genetic mutation in the formation of connective tissue collagen. The symptomatology and clinical findings varies between the six subgroups of EDS. Oral manifestations occur to varying degrees and may include fragile mucous membranes, periodontitis, underdeveloped enamel, pulp stones, and temporomandibular joint problems. Many patients with EDS have reported that local anaesthetic is often ineffective for dental treatment. Material and methods – 10 patients with EDS underwent dentoalveolar surgery local anaesthesia. After completion of the treatment, the patients assessed the pain intensity during the treatment by means of a visual analogue scale. Where 0 was no pain and 10 was the worst pain you can imagine. Results - All patients rated pain intensity during the surgical treatment, other than the injection of local anaesthetic to 0 on the visual analog scale. One patient reported pain during dislocation of a molar, rated as five on the visual analog scale. Besides anticipated swelling, tenderness, and pain the postoperative recovery was without complications. Conclusion – Oral surgery under local anaesthesia can be performed painlessly in patients with EDS by using sufficient amount of local anaesthesia, use of sedatives before surgery, and divide the treatment sequentially.
