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Yekkalam N, Novo M, Tyrberg MJ, Sipilä K. Risk factors associated with symptoms of temporomandibular disorders among women with hypermobile Ehlers-Danlos syndrome: Questionnaire-based study in Finland and Sweden. J Oral Rehabil 2024; 51:1390-1400. [PMID: 38661350 DOI: 10.1111/joor.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Generalized joint hypermobility as a characteristic feature of Ehlers-Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD). OBJECTIVE To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27- to 78-year-olds with diagnosed hypermobile EDS (hEDS). METHODS A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio-demographic, general health and oral health-related factors, comorbid symptoms and psychological distress for self-reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables. RESULTS Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27- to 50-year-olds participants were Finland as a country of birth, living alone and self-reported worst pain in the body (not the joints). The respective risk factors among the 51- to 78-year-olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives. CONCLUSIONS Among adult women with confirmed hEDS, socio-demographic and health-related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected.
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Affiliation(s)
- Negin Yekkalam
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Mehmed Novo
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Mårten J Tyrberg
- Centre for Clinical Research, Västmanland Hospital, Uppsala University, Västerås, Sweden
| | - Kirsi Sipilä
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Yekkalam N, Novo M, Wänman A. Treatments related to temporomandibular disorders among patients with prevalent types of Ehlers-Danlos syndrome in Sweden. Cranio 2024:1-12. [PMID: 38415674 DOI: 10.1080/08869634.2024.2319565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The aim of this study was to assess the received TMD treatment modalities and the perceived outcome among the frequent types of EDS. A digital questionnaire was sent to the member of the National Swedish EDS Association during January-March 2022. The subsamples of hypermobile and classical EDS were constructed. Almost 90% reported TMD symptoms. Bite splint therapy, counselling, jaw training and occlusal adjustment were reported as the most common treatments with no statistically significant difference in terms of good effect between the two subsamples. Hypermobile and classical EDS might consider as an entity with regards to TMD.
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Affiliation(s)
- Negin Yekkalam
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Mehmed Novo
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
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3
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Willich L, Bohner L, Köppe J, Jackowski J, Hanisch M, Oelerich O. Prevalence and quality of temporomandibular disorders, chronic pain and psychological distress in patients with classical and hypermobile Ehlers-Danlos syndrome: an exploratory study. Orphanet J Rare Dis 2023; 18:294. [PMID: 37726791 PMCID: PMC10510186 DOI: 10.1186/s13023-023-02877-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The Ehlers-Danlos syndromes are a group of clinically and genetically heterogeneous hereditary diseases affecting the connective tissue. They are characterized by hypermobility of the joints, hyperextensible skin and friable tissue. According to current classification, 13 subtypes can be distinguished, of which the hypermobile and the classical subtype are the most prevalent. This study aimed to evaluate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome regarding temporomandibular disorder (TMD), chronic pain, and psychological distress. METHODS Support groups from Germany, Austria, and Switzerland were contacted, and social media were used to recruit participants. Free text questions, the German version of the Depression Anxiety and Stress Scale (DASS), and the German version of the Graded Chronic Pain Status (GCPS) were used. RESULTS 259 participants were included (230 hEDS/29 cEDS). At least 49.2% of the participants had painful or restricted jaw movements, and at least 84.9% had pain in the masticatory muscles, with 46.3% already having a diagnosed TMD. Multivariate analysis showed a significant correlation between TMJ involvement and chronic pain with a 2.5-fold higher risk of chronic pain with a diagnosed TMD. 22.8% of participants had a critical score for depression, 53.3% had a critical score for anxiety, and 34.0% had a critical score for stress. CONCLUSION There is a high prevalence of TMD problems and chronic pain in patients with cEDS and hEDS. The lack of knowledge about these problems can create psychological distress. More research is needed to provide adequate treatment for patients with EDS.
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Affiliation(s)
- Leon Willich
- Department of Prosthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W30, Münster, D-48149, Germany
| | - Lauren Bohner
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Münster, 48149, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, Münster, D- 48149, Germany
| | - Jochen Jackowski
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, Witten, 58448, Germany
| | - Marcel Hanisch
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, Münster, 48149, Germany.
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, Witten, 58448, Germany.
| | - Ole Oelerich
- Department of Prosthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W30, Münster, D-48149, Germany.
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4
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Nilius M, Nilius MH, Müller C, Lauer G, Berit K, Marcus K. Multifocal periapical cemental dysplasia in periodontal Ehlers-Danlos syndrome combined with leukoencephalopathy in the mutation of c.890G > a, G297D [pEDS]. Clin Case Rep 2022; 10:e6490. [PMID: 36348983 PMCID: PMC9634265 DOI: 10.1002/ccr3.6490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Periodontal Ehlers-Danlos syndrome (pEDS) is a rare disorder caused by heterozygous mutations in complement 1 subunit genes C1R and C1S. To date, 148 cases have been described in the literature.We describe a case of a suspected de novo-mutation of pEDS with generalized Periapical cemental dysplasia (PCD) and cerebral leukoencephalopathy.
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Affiliation(s)
| | | | | | - Guenter Lauer
- Department of Oral and Maxillofacial SurgeryUniversity Hospital "Carl Gustav Carus", Technische Universität DresdenDresdenGermany
| | - Koch Berit
- Department of Internal Medicine, Cardiology, Preveo‐CenterDortmundGermany
| | - Kohlhaas Marcus
- Department of Ophthamology, ST.‐Johannes‐HospitalDortmundGermany
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5
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Bech K, Fogh FM, Lauridsen EF, Sonnesen L. Temporomandibular disorders, bite force and osseous changes of the temporomandibular joints in patients with hypermobile Ehlers-Danlos syndrome compared to a healthy control group. J Oral Rehabil 2022; 49:872-883. [PMID: 35694904 PMCID: PMC9544469 DOI: 10.1111/joor.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/09/2022] [Accepted: 06/02/2022] [Indexed: 12/02/2022]
Abstract
Background Ehlers‐Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Objective The aim was to investigate temporomandibular disorders (TMD), bite force, teeth in occlusal contact and osseous changes of the temporomandibular joints (TMJs) in 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls. Methods Clinical examination according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), radiological examinations of the TMJs by cone‐beam‐computed tomographic (CBCT) scans, registration of bite force and teeth in occlusal contact was performed. Statistical analyses included Fisher's Exact Test, multiple logistic and linear regression models adjusted for age, gender and Body Mass Index (BMI). Results Single symptoms and signs of TMD occurred significantly more often in hEDS (p = .002; p = .001; p = .003; p = <.0001; p = .012) and maximum mouth opening was significantly smaller in hEDS compared to controls (p = <.0001). The DC/TMD diagnosis myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement disorders and degenerative joint disease occurred significantly more often in hEDS compared to controls (p = .000; p = .008; p = .003; p = .000; p = <.0001; p = .010, respectively). No significant differences were found in bite force and in teeth in occlusal contact between the groups (p > .05). On CBCT of the TMJs, subcortical sclerosis occurred significantly more often in hEDS compared to controls (p = .005). Conclusion Symptoms and signs of TMD and osseous changes of the TMJs occurred significantly more often in hEDS. Bite force and teeth in occlusal contact were comparable to controls.
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Affiliation(s)
- Karen Bech
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frederikke Maria Fogh
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Fejerskov Lauridsen
- Resource Center for Rare Oral Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kotsanos N, Marks LAM, Arapostathis KN, Kubota K. Disabilities, Neuropsychiatric Disorders, and Syndromes in Childhood and Adolescence. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Demir F, Tüzüner T, Baygın Ö, Kalyoncu M. Evaluation of Dental Status and Temporomandibular Joint in Children With Generalized Joint Hypermobility. J Clin Rheumatol 2021; 27:e312-e316. [PMID: 32149927 DOI: 10.1097/rhu.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the dental status and temporomandibular diseases (TMDs)-related symptoms in children with generalized joint hypermobility (GJH) and compare them with healthy controls (HCs). METHODS This is a cross-sectional, observational study carried out between September 2016 and April 2017. A total of 124 children with GJH (n = 62) and HC (n = 62) were enrolled. The GJH was assessed with the Beighton hypermobility score. The subjects were screened for dental status and TMD-related symptoms. The assessment included the index for "decayed," "missing," and "filled teeth" (DMFT, dmft); plaque; gingival bleeding; tooth mobility; and temporomandibular joint (TMJ) evaluation. RESULTS The mean Beighton hypermobility score was 6.3 ± 1.2 in the GJH group. Visible plaque index and gingival bleeding index scores were found to be significantly higher in children with GJH then in the HC (p = 0.031, p = 0.023). No differences were found regarding the DMFT scores between the groups (p = 0.16). Temporomandibular disorder-related symptom frequencies were significantly higher in children with GJH (p < 0.001). The most common clinically determined sign of TMD was clicking with a maximum active mouth-opening. Combined TMJ symptoms and TMD were observed in approximately one third of the children with GJH. CONCLUSIONS The presence of GJH in a child may be indicative of future dental or TMJ problems, and it may cause dental problems due to increased gingival bleeding index and visible plaque index scores. Therefore, children with GJH require preventive dental and TMJ care.
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Affiliation(s)
- Ferhat Demir
- From the Department of Pediatric Rheumatology, Faculty of Medicine
| | - Tamer Tüzüner
- Department of Pediatric, Dentistry Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Özgül Baygın
- Department of Pediatric, Dentistry Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
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Lepperdinger U, Zschocke J, Kapferer-Seebacher I. Oral manifestations of Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:520-526. [PMID: 34741498 PMCID: PMC9298068 DOI: 10.1002/ajmg.c.31941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/24/2021] [Accepted: 10/16/2021] [Indexed: 11/16/2022]
Abstract
Ehlers‐Danlos syndromes (EDS) are a group of inherited connective tissue disorders. Patients with EDS exhibit distinct pathologies of the teeth and the oral cavity. Here, we summarize the current knowledge in the various EDS types, in particular regarding severe changes in oral health‐related quality of life, the differential emergence of periodontitis, characteristic yet highly cumbersome dental manifestations, apparent anomalies of oral soft tissues, and relevant issues related to dental implantology. Resolution of remaining open questions will primarily rely on the standardization of diagnostic criteria. Clinical centers that specialize on this rare pathology need to apply congruent approaches for exact characterization of clinical features in conjunction with genetic validation that should be reached without exception in all patients and relevant family members.
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Affiliation(s)
- Ulrike Lepperdinger
- University Hospital for Dental Prosthetics and Restorative Dentistry, Department of Dental and Oral Medicine and Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Zschocke
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ines Kapferer-Seebacher
- University Hospital for Dental Prosthetics and Restorative Dentistry, Department of Dental and Oral Medicine and Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Caliogna L, Guerrieri V, Annunziata S, Bina V, Brancato AM, Castelli A, Jannelli E, Ivone A, Grassi FA, Mosconi M, Pasta G. Biomarkers for Ehlers-Danlos Syndromes: There Is a Role? Int J Mol Sci 2021; 22:ijms221810149. [PMID: 34576312 PMCID: PMC8469247 DOI: 10.3390/ijms221810149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Ehlers-Danlos syndromes (EDS) are an inherited heterogeneous group of connective tissue disorders characterized by an abnormal collagen synthesis affecting skin, ligaments, joints, blood vessels, and other organs. It is one of the oldest known causes of bruising and bleeding, and it was described first by Hippocrates in 400 BC. In the last years, multiple gene variants involved in the pathogenesis of specific EDS subtypes have been identified; moreover, new clinical diagnostic criteria have been established. New classification models have also been studied in order to differentiate overlapping conditions. Moreover, EDS shares many characteristics with other similar disorders. Although distinguishing between these seemingly identical conditions is difficult, it is essential in ensuring proper patient care. Currently, there are many genetic and molecular studies underway to clarify the etiology of some variants of EDS. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. In this review, we focused on the study of two of the most common forms of EDS—classic and hypermobile—by trying to identify possible biomarkers that could be of great help to confirm patients’ diagnosis and their follow up.
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Affiliation(s)
- Laura Caliogna
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Viviana Guerrieri
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Salvatore Annunziata
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
- Correspondence: ; Fax: +39-0382-502806
| | - Valentina Bina
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Alice Maria Brancato
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Alberto Castelli
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Eugenio Jannelli
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Alessandro Ivone
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Federico Alberto Grassi
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Mario Mosconi
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
| | - Gianluigi Pasta
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (L.C.); (V.G.); (A.M.B.); (A.C.); (E.J.); (A.I.); (F.A.G.); (M.M.); (G.P.)
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10
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Osteoarthritis of the temporomandibular joint: A review of aetiology and pathogenesis. Br J Oral Maxillofac Surg 2021; 60:387-396. [PMID: 35307273 DOI: 10.1016/j.bjoms.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022]
Abstract
The aim of this review was to assess the level of evidence for genetic, biological, and functional predictive and predisposing factors for end-stage temporomandibular joint arthritis within the published literature. A comprehensive review based upon PRISMA guidelines was performed from all literature relevant to the topic. Case series and animal studies were included given the rare nature of the disease and goal of finding root-cause predictive factors. Clinical and radiographic measures were used specifically to identify factors which may have contributed to disease onset and progression. A total of 249 abstracts were identified based on search terms of major databases. After application of exclusion and inclusion criteria, 63 full-text articles were included in the analysis of this paper. There were few factors that could be reliably used to predict end-stage temporomandibular joint disease. Limited evidence is available to adequately predict end-stage temporomandibular joint osteoarthritis. No descriptive process exists that explains how and why this process can occur in younger adults. A better understanding of the aetiology and pathogenesis of TMJ-OA may lead to prevention and more effective management strategies that may reduce the need for drastic surgical intervention, particularly in young adults.
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11
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Starzyńska A, Adamska P, Adamski Ł, Sejda A, Wychowański P, Studniarek M, Jereczek-Fossa BA. Multiple odontogenic keratocysts in Ehlers-Danlos syndrome: a rare case report. BMC Oral Health 2021; 21:107. [PMID: 33750365 PMCID: PMC7941700 DOI: 10.1186/s12903-021-01472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An odontogenic keratocyst is a lesion characterized by aggressive and infiltrative growth. The lesion is characterized by the existence of satellite microcysts (microtumours) and frequent recurrence (up to 30%). Ehlers-Danlos syndrome is a condition in which collagen production or its post-translational modifications are affected. Defects in connective tissues cause symptoms, which range from mild joint hypermobility to life-threatening complications. CASE PRESENTATION We present an extremely rare case of an 11-year old girl with Ehlers-Danlos syndrome and coexistence of multiple odontogenic keratocysts. CONCLUSIONS This case shows mainly atypical or rare association between multiple odontogenic keratocysts and Ehlers-Danlos syndrome.
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Affiliation(s)
- Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211, Gdańsk, Poland.
| | - Paulina Adamska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211, Gdańsk, Poland
| | - Łukasz Adamski
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211, Gdańsk, Poland
| | - Aleksandra Sejda
- Department of Pathomorphology, University of Warmia and Mazury, 18 Żołnierska Street, 10-561, Olsztyn, Poland
| | - Piotr Wychowański
- Department of Oral Surgery, Medical University of Warsaw, 6 St. Biniecki Street, 02-097, Warsaw, Poland
| | - Michał Studniarek
- Department of Radiology I, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-216, Gdańsk, Poland
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112, Milan, Italy
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12
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Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RA. Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Dev Dyn 2021; 250:318-344. [PMID: 32629534 PMCID: PMC7785693 DOI: 10.1002/dvdy.220] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
The Ehlers-Danlos syndromes (EDS) are a group of heritable, connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. There is phenotypic and genetic variation among the 13 subtypes. The initial genetic findings on EDS were related to alterations in fibrillar collagen, but the elucidation of the molecular basis of many of the subtypes revealed several genes not involved in collagen biosynthesis or structure. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. hEDS is the most common type of EDS and involves generalized joint hypermobility, musculoskeletal manifestations, and mild skin involvement along with the presence of several comorbid conditions. Variability in the spectrum and severity of symptoms and progression of patient phenotype likely depend on age, gender, lifestyle, and expression domains of the EDS genes during development and postnatal life. In this review, we summarize the current molecular, genetic, epidemiologic, and pathogenetic findings related to EDS with a focus on the hypermobile type.
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Affiliation(s)
- Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Randall Burks
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel P. Judge
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Lavallee
- Department of Family Medicine, Wellspan Health, York, Pennsylvania
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
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Baeza-Velasco C, Seneque M, Courtet P, Olié É, Chatenet C, Espinoza P, Dorard G, Guillaume S. Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders. Front Psychiatry 2021; 12:803614. [PMID: 35095619 PMCID: PMC8790080 DOI: 10.3389/fpsyt.2021.803614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The ability to move joints beyond the normal range of motion is called Joint Hypermobility (JHM). JHM has been associated with a plethora of physical problems and is a frequent sign of hereditary disorders of connective tissue. Neuropsychiatric conditions such as eating disorders (ED) have also been related to JHM. However, little is known about the clinical profile of people with ED and JHM. The aim of this study was to explore JHM in patients with ED and to compare the clinical characteristics of hypermobile ED patients with non-hypermobile ED patients. Method: Fifty-three outpatients diagnosed with ED were assessed using the Beighton score for JHM, the Eating Disorders Inventory 2, the Eating Disorder Examination, and the Detail and Flexibility Questionnaire. Information relating to patients' psychiatric and somatic comorbidities/symptoms was also collected. Results: Using the traditional Beighton score's cutoff of ≥4, 41.5% of the sample presented with JHM. Our results indicate that compared with non-hypermobile ED patients, those with JHM are significantly younger, suffer at a greater extent from joint pain and easy bruising, have a shorter duration of the ED, and have lower scores for cognitive rigidity. In addition, for those with anorexia nervosa, the restricting subtype represents a significantly lower proportion of hypermobile ED patients compared to non-hypermobile ED patients. Multivariate analyses showed that cognitive rigidity, age, and duration of the ED could predict the JHM status in this sample. Conclusion: These results suggest that JHM is frequent in patients with ED and is accompanied by signs of tissue fragility. Patients with ED and JHM seem to present a specific profile characterized by less cognitive rigidity and restricting behavior in the case of anorexia nervosa. Further research is needed in order to confirm these results.
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Affiliation(s)
- Carolina Baeza-Velasco
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Maude Seneque
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Émilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Charles Chatenet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
| | - Paola Espinoza
- Departament de Psicologia, Unitat d'Avaluació i Intervenció en Imatge Corporal, Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Géraldine Dorard
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
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Alawsi F, Sawbridge D, Fitzgerald R. Orthodontics in patients with significant medical co-morbidities. J Orthod 2020; 47:4-24. [PMID: 32985344 DOI: 10.1177/1465312520949881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A wide variety of patients with medical co-morbidities may present to general orthodontic practice. It is important for the treating clinician to have a general understanding of key medical conditions that may impact upon the treatment and management options. This clinical supplement provides a treatment-focused summative update for the orthodontist regarding significant medical co-morbidities, their general prevalence and an exploration of potential impacts upon orthodontic treatment. This review also discusses the significance of key medications and provides suggestions for the safe provision of orthodontic treatment.
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Affiliation(s)
- Fahad Alawsi
- Orthodontic Department, Royal Preston Hospital, Preston, UK
| | - David Sawbridge
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rhian Fitzgerald
- Orthodontic Department, Royal Preston Hospital, Preston, UK.,Alder Hey Children's Hospital, Liverpool, UK
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Oral Conditions and Oral Health-Related Quality of Life of People with Ehlers-Danlos Syndromes (EDS): A Questionnaire-Based Cross-Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56090448. [PMID: 32899664 PMCID: PMC7559544 DOI: 10.3390/medicina56090448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Background and objective: To date, there have only been a few studies on oral health-related quality of life (OHRQoL) of people with Ehlers-Danlos syndromes (EDS) and oral conditions. The aim of this study was, therefore, to analyze the OHRQoL of people with EDS from their own point of view as well as obtain information about their age at the time of the diagnosis, the period of time until diagnosis, and the presence of oral conditions (if any) and their association with oral health quality. Methods: The study was designed as an anonymous questionnaire-based cross-sectional study. We conducted a descriptive analysis of the Oral Health Impact Profile-14 (OHIP-14) scores, age of the participants, age at diagnosis, and the time-period between the first signs of the disease and the diagnosis of EDS. To verify the differences in OHIP-14 scores between patients with and without oral conditions, a Mann-Whitney U test was performed. A multivariate quantile (median) regression analysis was performed to evaluate the effect of different general characteristics (gender, age, and the presence of oral conditions) on the OHIP 14 scores. Furthermore, using a Mann-Whitney U test, the influence of different oral conditions was verified by testing the differences between patients without any oral conditions and patients with a specific diagnosis. Results: A total of 79 evaluable questionnaires from 66 female (83.5%) and 13 male (16.5%) participants were analyzed. On average, after the first condition, it takes 18.36 years before EDS are correctly diagnosed. Oral conditions were described by 69.6% of the participants. The median (interquartile range) OHIP-14 score was eight (ten) points for patients without oral conditions and 19 (15) for patients with oral conditions. The multivariable quantile regression shows a statistical notable association between OHIP-14 score and oral conditions (p < 0.001). OHIP-14 scores for dysgnathia, periodontitis, TMD (Temporomandibular dysfunction), a high-arched palate, malocclusion, and the anomaly of tooth formation were statistical notably different between the participants with and the participants without oral conditions. Conclusions: Long diagnostic pathways seem to be a typical problem in patients with EDS. Oral conditions associated with the underlying disease occurred regularly and showed a negative correlation with OHRQoL.
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Nguyen JP, Chandy TS, Sparks J, Driscoll CF, Masri R. Leveraging Digital Technology for Treatment of Young Patients with Congenital Conditions: A Clinical Report. J Prosthodont 2020; 30:150-157. [PMID: 32827231 DOI: 10.1111/jopr.13241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/28/2022] Open
Abstract
Young patients with ectodermal dysplasia and Ehlers-Danlos Syndrome present with unique characteristics and corresponding treatment challenges. Congenitally missing teeth or conditions leading to premature tooth loss may be exhibited. Underdeveloped or easily traumatized oral structures are commonly seen and must be rehabilitated with care. These oral features can have a negative impact on the patients' quality of life and may require special considerations during dental treatment. This report follows the initial treatments of a 6-year-old patient with ectodermal dysplasia and a 20-year-old patient with Ehlers-Danlos Syndrome, with the incorporation of digital technologies in their subsequent oral rehabilitation.
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Affiliation(s)
- Jennifer Pham Nguyen
- School of Dentistry, Division of Prosthodontics, University of Maryland, Baltimore, MD
| | - Tintu Sara Chandy
- School of Dentistry, Division of Prosthodontics, University of Maryland, Baltimore, MD
| | - Janine Sparks
- School of Dentistry, Division of Prosthodontics, University of Maryland, Baltimore, MD
| | - Carl F Driscoll
- School of Dentistry, Division of Prosthodontics, University of Maryland, Baltimore, MD
| | - Radi Masri
- School of Dentistry, Division of Prosthodontics, University of Maryland, Baltimore, MD
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Problems in the orofacial region associated with Ehlers-Danlos and Marfan syndromes: a case series. Br J Oral Maxillofac Surg 2019; 58:208-213. [PMID: 31859106 DOI: 10.1016/j.bjoms.2019.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022]
Abstract
Ehlers-Danlos syndrome (EDS) and Marfan syndrome (MFS) are characterised by hypermobility of joints and cardiovascular morbidity, and typical orofacial signs and symptoms are associated with both. Basic knowledge of these should prevent late-stage diagnosis and enable adequate management. This case series comprises all EDS and MFS patients who consulted the Department of Oral and Maxillofacial Surgery at University Hospitals Leuven between 2005 and 2017. Thirty patients had EDS or MFS, and in seven the diagnosis was made based on temporomandibular dysfunction or craniofacial dysmorphism. Non-facial symptoms led to diagnosis in the remaining patients. Twenty-five interventions were followed by two infections and one haemorrhage. One patient developed trismus. No major complications were reported. The complications we observed did not seem to differ from those often seen in patients who did not have EDS or MFS, possibly as a result of our strictly applied precautions and postoperative instructions. However, our study of relevant publications shows that patients with EDS and MFS are a vulnerable group.
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18
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Honoré MB, Lauridsen EF, Sonnesen L. Oro-dental characteristics in patients with hypermobile Ehlers-Danlos Syndrome compared to a healthy control group. J Oral Rehabil 2019; 46:1055-1064. [PMID: 31206735 DOI: 10.1111/joor.12838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility. OBJECTIVE The aim of the study was to investigate the oro-dental characteristics including measurements of tooth size of 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls. METHODS Interview, clinical and radiological examination on panoramic radiograph and cone-beam computed tomographic (CBCT) scan were performed. Statistical analyses included Fisher's exact test, paired t test and multiple logistic and linear models adjusted for age and gender. RESULTS The experience of xerostomia (P = 0.039), local anaesthetic insufficiency (P < 0.001) and tooth extraction complications (P < 0.003) were significantly higher in hEDS compared to controls. The debris index was significantly higher in hEDS (P < 0.001), and the distance between the cement-enamel junction (CEJ) and the bone level on the upper left first incisor and molar and the lower right first molar was significantly larger in hEDS compared to controls (P = 0.021, P = 0.024, P = 0.021, respectively). The crown heights of the upper and lower first incisors were significantly smaller (P = 0.001, P = 0.003, P = 0.002, P < 0.001, respectively) in hEDS compared to controls. When adjusting for debris index, only the distance between CEJ and the marginal bone level on the upper left and lower right molar was associated with hEDS. CONCLUSION The results indicate that xerostomia, resistance to local anaesthesia, tooth extraction complications, poor oral hygiene, larger distance between CEJ and marginal bone level and small crown heights can be found in patients with hEDS.
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Affiliation(s)
- Michelle Bornemann Honoré
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Fejerskov Lauridsen
- Resource Center for Rare Oral Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hein LC, DeGregory CB, Umari F. Ehlers-Danlos Syndrome: It’s Not Your Normal Hoofbeats. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Campbell SJ, Chegini S, Heliotis M. Condylectomy: treatment of recurrent unilateral dislocation of the temporomandibular joint in a patient with Ehlers-Danlos syndrome. Br J Oral Maxillofac Surg 2019; 57:76-78. [PMID: 30598319 DOI: 10.1016/j.bjoms.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022]
Abstract
We report the use of unilateral condylectomy to treat the recurrent dislocation of the temporomandibular joint (TMJ) in a 21-year-old woman with Ehlers-Danlos syndrome. Eighteen months after operation the patient had no further dislocation on full mouth opening, and no surgical complications.
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Affiliation(s)
- S-J Campbell
- Northwick park hospital, Watford Road, Harrow, Middlesex, HA1 3UJ.
| | - S Chegini
- Northwick park hospital, Watford Road, Harrow, Middlesex, HA1 3UJ
| | - M Heliotis
- Northwick park hospital, Watford Road, Harrow, Middlesex, HA1 3UJ
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Di Giacomo P, Celli M, Ierardo G, Polimeni A, Di Paolo C. Evaluation of Temporomandibular Disorders and Comorbidities in Patients with Ehler--Danlos: Clinical and Digital Findings. J Int Soc Prev Community Dent 2018; 8:333-338. [PMID: 30123766 PMCID: PMC6071363 DOI: 10.4103/jispcd.jispcd_103_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/02/2018] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study is to recognize representative cranio-cervico-mandibular features of patients with Ehler-Danlos syndrome and associated temporomandibular disorders (TMDs), to assess a targeted and integrated treatment plan. Materials and Methods After a diagnosis of disease, 38 individiuals with Ehler-Danlos syndrome and temporomandibular symptomatology referred were evaluated. Gnathological evaluation, according to the Diagnostic Criteria for TMDs, and radiographic imaging was performed. In addition, digital evaluation of occlusal and muscular balance, using surface electromyography of jaw muscles, was conducted. Statistical software for data analysis - STATA (StataCorp, College station, Texas, USA) - was used. Results Most common temporomandibular dysfunctions were arthralgia, myalgia, disc displacement with reduction and subluxation. Headache and neck pain were the most frequent comorbidities. Somatization, depression, anxiety, and obsessive-compulsive behavior were the most recurrent psychological disorders. Electromyographic analysis showed out of normal range data. Conclusion Early diagnosis and interception are requested to avoid injuries and repeated traumatism. Multidisciplinary treatments are available to approach all the aspects of the syndrome.
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Affiliation(s)
- Paola Di Giacomo
- Department of Oral and Maxillofacial Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Celli
- Department of Rare Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Gaetano Ierardo
- Department of Oral and Maxillofacial Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Di Paolo
- Department of Oral and Maxillofacial Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Pezaro S, Pearce G, Reinhold E. Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.4.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sally Pezaro
- Midwife, researcher and lecturer, Faculty of Health & Life Sciences, Coventry University
| | - Gemma Pearce
- Senior research assistant, Centre for Advances in Behavioural Science, Coventry University
| | - Emma Reinhold
- Portfolio GP; Clinical Champion for the Ehlers Danlos Syndromes, Royal College of GPs; Primary Care Advisor, EDS UK
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Bhattarai KR, Junjappa R, Handigund M, Kim HR, Chae HJ. The imprint of salivary secretion in autoimmune disorders and related pathological conditions. Autoimmun Rev 2018; 17:376-390. [DOI: 10.1016/j.autrev.2017.11.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
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Kapferer-Seebacher I, Lundberg P, Malfait F, Zschocke J. Periodontal manifestations of Ehlers-Danlos syndromes: A systematic review. J Clin Periodontol 2017; 44:1088-1100. [PMID: 28836281 DOI: 10.1111/jcpe.12807] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/26/2022]
Abstract
AIM Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders, characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Periodontal EDS (pEDS) is a specific EDS subtype caused by heterozygous mutations in complement 1 subunit genes C1R and C1S, with early severe periodontitis as predominant clinical feature. We aimed to systematically assess the spectrum of periodontal abnormalities in all EDS subtypes. MATERIALS AND METHODS An electronic and manual search was conducted in three databases (Medline, LIVIVO, CENTRAL). Publications of all study designs written in English/German without date restriction evaluating periodontal features in EDS were included. RESULTS Thirty articles on pEDS and thirteen articles on other EDS subtypes were analysed. In pEDS, early severe periodontitis (98.4%) and gingival recession (87.1%) are the predominant features. Reports on periodontal manifestations in other EDS subtypes are rare. Described were severe gingival enlargement in dermatosparaxis EDS, and localized periodontal breakdown related to teeth with shortened roots in classical EDS (n = 3, respectively). CONCLUSION Early severe periodontitis is the hallmark of pEDS; there is no evidence that it is part of the clinical phenotype of other EDS subtypes. Stringent analyses of periodontal manifestations in most EDS subtypes are missing. Prospero registration number CRD42017056889.
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Affiliation(s)
- Ines Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Pernilla Lundberg
- Department of Molecular Periodontology, Umeå University, Umeå, Sweden
| | - Franziska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Johannes Zschocke
- Division of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
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Bowen JM, Sobey GJ, Burrows NP, Colombi M, Lavallee ME, Malfait F, Francomano CA. Ehlers-Danlos syndrome, classical type. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:27-39. [DOI: 10.1002/ajmg.c.31548] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:48-69. [PMID: 28145611 DOI: 10.1002/ajmg.c.31538] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder. © 2017 Wiley Periodicals, Inc.
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Gazit Y, Jacob G, Grahame R. Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J 2016; 7:RMMJ.10261. [PMID: 27824552 PMCID: PMC5101008 DOI: 10.5041/rmmj.10261] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS)-hypermobility type (HT) is considered to be the most common subtype of EDS and the least severe one; EDS-HT is considered to be identical to the joint hypermobility syndrome and manifests with musculoskeletal complaints, joint instability, and soft tissue overuse injury. Musculoskeletal complaints manifest with joint pain of non-inflammatory origin and/or spinal pain. Joint instability leads to dislocation or subluxation and involves peripheral joints as well as central joints, including the temporomandibular joints, sacroiliac joints, and hip joints. Soft tissue overuse injury may lead to tendonitis and bursitis without joint inflammation in most cases. Ehlers-Danlos syndrome-HT carries a high potential for disability due to recurrent dislocations and subluxations and chronic pain. Throughout the years, extra-articular manifestations have been described, including cardiovascular, autonomic nervous system, gastrointestinal, hematologic, ocular, gynecologic, neurologic, and psychiatric manifestations, emphasizing the multisystemic nature of EDS-HT. Unfortunately, EDS-HT is under-recognized and inadequately managed, leading to neglect of these patients, which may lead to severe disability that almost certainly could have been avoided. In this review article we will describe the known manifestations of the extra-articular systems.
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Affiliation(s)
- Yael Gazit
- Internal Medicine F and the Institute of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giris Jacob
- Internal Medicine F and the Institute of Rheumatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- J. Recanati Autonomic Dysfunction Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rodney Grahame
- Hypermobility Unit, London and Centre for Rheumatology, Division of Medicine, University College London, London, UK
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Diep D, Fau V, Wdowik S, Bienvenu B, Bénateau H, Veyssière A. [Temporomandibular disorders and Ehlers-Danlos syndrome, hypermobility type: A case-control study]. ACTA ACUST UNITED AC 2016; 117:228-33. [PMID: 27522240 DOI: 10.1016/j.revsto.2016.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is a rare genetic disease. Diagnosis is based on a combination of clinical criteria described in the classification of Villefranche. Diagnosis is difficult to make because of the lack of specific clinical signs and the absence of genetic testing. The EDS-TH manifests itself manly by musculoskeletal pain and joint hypermobility. Temporomandibular disorders (TMD) are also reported. Our aim was to objectify the presence and to qualify the type of TMD associated with the EDS-HT in order to propose an additional diagnostic argument. MATERIAL AND METHODS A prospective, monocenter case-control study, comparing a cohort of patients suffering from EDS-HT to a paired control group of healthy volunteers has been conducted. Clinical examination was standardized, including a general questioning, an oral examination and a temporomandibular joint examination following the TMD/RDC (temporomandibular disorders/research diagnostic criteria). RESULTS Fourteen EDS-HT patients and 58 control patients were examined. The prevalence of TMDs (n=13; 92.9% vs. n=4; 6.9%; P=10(-11)) was significantly higher in the EDS-HT group. TMDs occurring in the EDS-HT group were complex, combining several mechanisms in contrast to the control group, where only one mechanism was found in all the patients (n=13; 92.9% vs. n=0; 0.0%). DISCUSSION TMDs are strongly associated with RDS-HT. TMDs could therefore be used in the diagnosis of this disease.
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Affiliation(s)
- D Diep
- Service de chirurgie maxillo-faciale et plastique, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - V Fau
- Service de chirurgie maxillo-faciale et plastique, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - S Wdowik
- Service de chirurgie maxillo-faciale et plastique, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Bienvenu
- Service de médecine Interne, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - H Bénateau
- Service de chirurgie maxillo-faciale et plastique, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Laboratoire EA 4652 microenvironnement cellulaire et pathologies, équipe BioconnecT, université de Caen-Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France; Faculté de médecine de Caen, université de Caen-Basse-Normandie, 2 rue des Rochambelles, 14032 Caen cedex 5, France
| | - A Veyssière
- Service de chirurgie maxillo-faciale et plastique, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Laboratoire EA 4652 microenvironnement cellulaire et pathologies, équipe BioconnecT, université de Caen-Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France; Faculté de médecine de Caen, université de Caen-Basse-Normandie, 2 rue des Rochambelles, 14032 Caen cedex 5, France
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Difficulty eating and significant weight loss in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type. Eat Weight Disord 2016; 21:175-83. [PMID: 26506923 DOI: 10.1007/s40519-015-0232-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/03/2015] [Indexed: 02/06/2023] Open
Abstract
Joint Hypermobility Syndrome, also known as Ehlers-Danlos Syndrome Hypermobility Type (JHS/EDS-HT), is a heritable disorder of connective tissue, common but poorly known by the medical community. Although generalized joint hypermobility and fragility of tissues have been described as core features, recent research highlights the multisystemic nature of JHS/EDS-HT, which presents with a wide range of articular and extra-articular symptoms. Among these, gastrointestinal problems, temporomandibular disorders, and smell and taste abnormalities are common among those affected, having significant implications for eating. The present work reviews the literature linking JHS/EDS-HT and eating problems. Two illustrative case reports, in which JHS/EDS-HT manifestations contribute to developing and maintaining disturbed eating behaviors and significant weight loss, are presented.
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Abstract
Teeth are housed in mandible and maxilla and are known to undergo variations in clinical presentation depending on the degree of abnormality during growth and development. It is essential to identify these variations in normal anatomy so that appropriate treatment can be initiated to address the anomaly. Some normal anatomic variations are harmless and best left alone, whereas others require intervention. Radiology plays a vital role in identification of such anomalies. This article focuses on the diagnostic radiographic interpretation and strategies to include pertinent differential diagnosis. Also discussed is the importance of advanced imaging and its appropriateness in the diagnosis and interpretation.
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Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, Chisnoiu R. Factors involved in the etiology of temporomandibular disorders - a literature review. ACTA ACUST UNITED AC 2015; 88:473-8. [PMID: 26732121 PMCID: PMC4689239 DOI: 10.15386/cjmed-485] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/27/2015] [Accepted: 08/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM This review aims at presenting a current view on the most frequent factors involved in the mechanisms causing temporomandibular disorders (TMD). METHOD We conducted a critical review of the literature for the period January 2000 to December 2014 to identify factors related to TMD development and persistence. RESULTS The etiology of TMD is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. Occlusal overloading and parafunctions (bruxism) are frequently involved as biomechanical factors; increased levels of estrogen hormones are considered biological factors affecting the temporo-mandibular-joint. Among bio-psychosocial factors, stress, anxiety or depression, were frequently encountered. CONCLUSIONS The etiopathogenesis of this condition is poorly understood, therefore TMDs are difficult to diagnose and manage. Early and correct identification of the possible etiologic factors will enable the appropriate treatment scheme application in order to reduce or eliminate TMDs debilitating signs and symptoms.
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Affiliation(s)
- Andrea Maria Chisnoiu
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Monica Picos
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sever Popa
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Petre Daniel Chisnoiu
- Department of Oral and Maxillofacial Surgery, Alba Iulia Emergency Regional Hospital, Romania
| | - Liana Lascu
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Picos
- Department of Prosthodontics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Chisnoiu
- Department of Odontology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Horton LM, John RM, Karibe H, Rudd P. Jaw disorders in the pediatric population. J Am Assoc Nurse Pract 2015; 28:294-303. [PMID: 26485343 DOI: 10.1002/2327-6924.12322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/01/2015] [Indexed: 11/07/2022]
Abstract
PURPOSE This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics. DATA SOURCES A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015. CONCLUSIONS Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided. IMPLICATIONS FOR PRACTICE TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.
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Affiliation(s)
| | - Rita Marie John
- Department of Clinical Nursing at Columbia University's School of Nursing, New York, New York
| | - Hiroyuki Karibe
- Department of Pediatric Dentistry at the Nippon Dental University, Tokyo, Japan
| | - Patricia Rudd
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, California
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Robinson LJ, Durham J, MacLachlan LL, Newton JL. Autonomic function in chronic fatigue syndrome with and without painful temporomandibular disorder. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2015. [DOI: 10.1080/21641846.2015.1091152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miedel EL, Brisson BK, Hamilton T, Gleason H, Swain GP, Lopas L, Dopkin D, Perosky JE, Kozloff KM, Hankenson KD, Volk SW. Type III collagen modulates fracture callus bone formation and early remodeling. J Orthop Res 2015; 33:675-84. [PMID: 25626998 PMCID: PMC4406871 DOI: 10.1002/jor.22838] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/19/2015] [Indexed: 02/04/2023]
Abstract
Type III collagen (Col3) has been proposed to play a key role in tissue repair based upon its temporospatial expression during the healing process of many tissues, including bone. Given our previous finding that Col3 regulates the quality of cutaneous repair, as well as our recent data supporting its role in regulating osteoblast differentiation and trabecular bone quantity, we hypothesized that mice with diminished Col3 expression would exhibit altered long-bone fracture healing. To determine the role of Col3 in bone repair, young adult wild-type (Col3+/+) and haploinsufficent (Col3+/-) mice underwent bilateral tibial fractures. Healing was assessed 7, 14, 21, and 28 days following fracture utilizing microcomputed tomography (microCT), immunohistochemistry, and histomorphometry. MicroCT analysis revealed a small but significant increase in bone volume fraction in Col3+/- mice at day 21. However, histological analysis revealed that Col3+/- mice have less bone within the callus at days 21 and 28, which is consistent with the established role for Col3 in osteogenesis. Finally, a reduction in fracture callus osteoclastic activity in Col3+/- mice suggests Col3 also modulates callus remodeling. Although Col3 haploinsufficiency affected biological aspects of bone repair, it did not affect the regain of mechanical function in the young mice that were evaluated in this study. These findings provide evidence for a modulatory role for Col3 in fracture repair and support further investigations into its role in impaired bone healing.
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Affiliation(s)
- Emily L. Miedel
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Becky K. Brisson
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Todd Hamilton
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hadley Gleason
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gary P. Swain
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Luke Lopas
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek Dopkin
- Department of Small Animal Clinical Science and Department of Physiology, Michigan State University, East Lansing, MI
| | - Joseph E. Perosky
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Kenneth M. Kozloff
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | - Kurt D. Hankenson
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Small Animal Clinical Science and Department of Physiology, Michigan State University, East Lansing, MI
| | - Susan W. Volk
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Colombi M, Dordoni C, Chiarelli N, Ritelli M. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2015; 169C:6-22. [DOI: 10.1002/ajmg.c.31429] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022]
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Volk SW, Shah SR, Cohen AJ, Wang Y, Brisson BK, Vogel LK, Hankenson KD, Adams SL. Type III collagen regulates osteoblastogenesis and the quantity of trabecular bone. Calcif Tissue Int 2014; 94:621-31. [PMID: 24626604 PMCID: PMC4335719 DOI: 10.1007/s00223-014-9843-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/26/2014] [Indexed: 11/25/2022]
Abstract
Type III collagen (Col3), a fibril-forming collagen, is a major extracellular matrix component in a variety of internal organs and skin. It is also expressed at high levels during embryonic skeletal development and is expressed by osteoblasts in mature bone. Loss of function mutations in the gene encoding Col3 (Col3a1) are associated with vascular Ehlers-Danlos syndrome (EDS). Although the most significant clinical consequences of this syndrome are associated with catastrophic failure and impaired healing of soft tissues, several studies have documented skeletal abnormalities in vascular EDS patients. However, there are no reports of the role of Col3 deficiency on the murine skeleton. We compared craniofacial and skeletal phenotypes in young (6-8 weeks) and middle-aged (>1 year) control (Col3(+/+)) and haploinsufficient (Col3(+/-)) mice, as well as young null (Col3(-/-)) mice by microcomputed tomography (μCT). Although Col3(+/-) mice did not have significant craniofacial abnormalities based upon cranial morphometrics, μCT analysis of distal femur trabecular bone demonstrated significant reductions in bone volume (BV), bone volume fraction (BV/TV), connectivity density, structure model index and trabecular thickness in young adult female Col3(+/-) mice relative to wild-type littermates. The reduction in BV/TV persisted in female mice at 1 year of age. Next, we evaluated the role of Col3 in vitro. Osteogenesis assays revealed that cultures of mesenchymal progenitors collected from Col3(-/-) embryos display decreased alkaline phosphatase activity and reduced capacity to undergo mineralization. Consistent with this data, a reduction in expression of osteogenic markers (type I collagen, osteocalcin and bone sialoprotein) correlates with reduced bone Col3 expression in Col3(+/-) mice and with age in vivo. A small but significant reduction in osteoclast numbers was found in Col3(+/-) compared to Col3(+/+) bones. Taken together, these findings indicate that Col3 plays a role in development of trabecular bone through its effects on osteoblast differentiation.
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Affiliation(s)
- Susan W Volk
- Department of Clinical Studies-Philadelphia, University of Pennsylvania School of Veterinary Medicine, 312 Hill Pavilion, 380 S. University Ave, Philadelphia, PA, 19104-4539, USA,
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Munemasa T, Idaira Y, Fukada T, Shimoda S, Asada Y. Histological Analysis of Dentinogenesis Imperfecta in Slc39a13/Zip13 Knockout Mice. J HARD TISSUE BIOL 2014. [DOI: 10.2485/jhtb.23.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Previously undescribed pulpal and periodontal ligament calcifications in systemic sclerosis: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e47-51. [DOI: 10.1016/j.oooo.2012.09.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/28/2012] [Accepted: 09/19/2012] [Indexed: 12/18/2022]
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Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN DERMATOLOGY 2012; 2012:751768. [PMID: 23227356 PMCID: PMC3512326 DOI: 10.5402/2012/751768] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/14/2012] [Indexed: 12/20/2022]
Abstract
Ehlers-Danlos syndrome, hypermobility type, constituting a phenotypic continuum with or, perhaps, corresponding to the joint hypermobility syndrome (JHS/EDS-HT), is likely the most common, though the least recognized, heritable connective tissue disorder. Known for decades as a hereditary condition with predominant rheumatologic manifestations, it is now emerging as a multisystemic disorder with widespread manifestations. Nevertheless, the practitioners' awareness of this condition is generally poor and most patients await years or, perhaps, decades before reaching the correct diagnosis. Among the various sites of disease manifestations, skin and mucosae represent a neglected organ where the dermatologist can easily spot diagnostic clues, which consistently integrate joint hypermobility and other orthopedic/neurologic manifestations at physical examination. In this paper, actual knowledge on JHS/EDS-HT is summarized in various sections. Particular attention has been posed on overlooked manifestations, including cutaneous, mucosal, and oropharyngeal features, and early diagnosis techniques, as a major point of interest for the practicing dermatologist. Actual research progresses on JH/EDS-HT envisage an unexpected link between heritable dysfunctions of the connective tissue and a wide range of functional somatic syndromes, most of them commonly diagnosed in the office of various specialists, comprising dermatologists.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, San Camillo-Forlanini Hospital, Sapienza University, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
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Castori M, Morlino S, Celletti C, Celli M, Morrone A, Colombi M, Camerota F, Grammatico P. Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): principles and proposal for a multidisciplinary approach. Am J Med Genet A 2012; 158A:2055-70. [PMID: 22786715 DOI: 10.1002/ajmg.a.35483] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/15/2012] [Indexed: 02/03/2023]
Abstract
Joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) hypermobility type (EDS-HT), is a underdiagnosed heritable connective tissue disorder characterized by generalized joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive dysfunctions. Deterioration of quality of life is mainly associated with pain and fatigue. Except for the recognized effectiveness of physiotherapy for some musculoskeletal features, there are no standardized guidelines for the assessment and treatment of pain and fatigue. In this work, a practical classification of pain presentations and factors contributing in generating painful sensations in JHS/EDS-HT is proposed. Pain can be topographically classified in articular limb (acute/subacute and chronic), muscular limb (myofascial and fibromyalgia), neuropathic limb, back/neck, abdominal and pelvic pain, and headache. For selected forms of pain, specific predisposing characteristics are outlined. Fatigue appears as the result of multiple factors, including muscle weakness, respiratory insufficiency, unrefreshing sleep, dysautonomia, intestinal malabsorption, reactive depression/anxiety, and excessive use of analgesics. A set of lifestyle recommendations to instruct patients as well as specific investigations aimed at characterizing pain and fatigue are identified. Available treatment options are discussed in the set of a structured multidisciplinary approach based on reliable outcome tools.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy.
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41
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Hemorrhagic bullae of the oral mucosa as an early manifestation of vascular-type ehlers-danlos syndrome. J Clin Rheumatol 2012; 17:383-4. [PMID: 21946467 DOI: 10.1097/rhu.0b013e31823266a7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ferré FC, Frank M, Gogly B, Golmard L, Naveau A, Chérifi H, Emmerich J, Gaultier F, Berdal A, Jeunemaitre X, Fournier BPJ. Oral phenotype and scoring of vascular Ehlers-Danlos syndrome: a case-control study. BMJ Open 2012; 2:e000705. [PMID: 22492385 PMCID: PMC3323826 DOI: 10.1136/bmjopen-2011-000705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Vascular Ehlers-Danlos syndrome (vEDS) is a rare genetic condition related to mutations in the COL3A1 gene, responsible of vascular, digestive and uterine accidents. Difficulty of clinical diagnosis has led to the design of diagnostic criteria, summarised in the Villefranche classification. The goal was to assess oral features of vEDS. Gingival recession is the only oral sign recognised as a minor diagnostic criterion. The authors aimed to check this assumption since bibliographical search related to gingival recession in vEDS proved scarce. DESIGN Prospective case-control study. SETTING Dental surgery department in a French tertiary hospital. PARTICIPANTS 17 consecutive patients with genetically proven vEDS, aged 19-55 years, were compared with 46 age- and sex-matched controls. OBSERVATIONS Complete oral examination (clinical and radiological) with standardised assessment of periodontal structure, temporomandibular joint function and dental characteristics were performed. COL3A1 mutations were identified by direct sequencing of genomic or complementary DNA. RESULTS Prevalence of gingival recession was low among patients with vEDS, as for periodontitis. Conversely, patients showed marked gingival fragility, temporomandibular disorders, dentin formation defects, molar root fusion and increased root length. After logistic regression, three variables remained significantly associated to vEDS. These variables were integrated in a diagnostic oral score with 87.5% and 97% sensitivity and specificity, respectively. CONCLUSIONS Gingival recession is an inappropriate diagnostic criterion for vEDS. Several new specific oral signs of the disease were identified, whose combination may be of greater value in diagnosing vEDS.
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Affiliation(s)
- François Côme Ferré
- A.Chenevier-H.Mondor hospital, Dental department, Créteil, France
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
| | - Michael Frank
- Centre de Référence des Maladies Vasculaires Rares, HEGP, Paris, France
| | - Bruno Gogly
- A.Chenevier-H.Mondor hospital, Dental department, Créteil, France
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
| | - Lisa Golmard
- Centre de Référence des Maladies Vasculaires Rares, HEGP, Paris, France
| | - Adrien Naveau
- A.Chenevier-H.Mondor hospital, Dental department, Créteil, France
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
| | - Hafida Chérifi
- A.Chenevier-H.Mondor hospital, Dental department, Créteil, France
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
| | - Joseph Emmerich
- Centre de Référence des Maladies Vasculaires Rares, HEGP, Paris, France
- INSERM U765, Paris, France
| | | | - Ariane Berdal
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
| | - Xavier Jeunemaitre
- Centre de Référence des Maladies Vasculaires Rares, HEGP, Paris, France
- INSERM U970, P.A.R.C.C., Paris, France
| | - Benjamin P J Fournier
- A.Chenevier-H.Mondor hospital, Dental department, Créteil, France
- Université Paris Descartes, Sorbonne Paris Cité, UMR S872, France
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UMR S872, Paris, France
- INSERM U872, Paris, France
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Celletti C, Castori M, La Torre G, Grammatico P, Morico G, Camerota F. Reassessment of oral frenula in Ehlers-Danlos syndrome: a study of 32 patients with the hypermobility type. Am J Med Genet A 2011; 155A:3157-9. [PMID: 22065619 DOI: 10.1002/ajmg.a.34330] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/02/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Claudia Celletti
- Department of Physical Medicine and Rehabilitation, Sapienza University, Umberto I Hospital, Rome, Italy
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Donta C, Kavvadia K, Panopoulos P, Douzgou S. Generalized pulp stones: report of a case with 6-year follow-up. Int Endod J 2011; 44:976-82. [PMID: 21718334 DOI: 10.1111/j.1365-2591.2011.01903.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To present a mildly mentally retarded patient with generalized pulp stone formation and the six-year follow-up and to discuss the differential diagnosis of the case. SUMMARY Pulp stones were radiographically detected in the pulp chamber of all permanent teeth in a 25-year-old woman with mild mental retardation who presented for endodontic treatment on tooth no 11 (FDI). The patient's medical, dental and family history was noncontributory. The pulp stone in the pulp chamber of tooth no 11 was removed during canal filing, and root canal treatment completed uneventfully. Six years later, the patient was re-evaluated and the pulp stones were unchanged radiographically. The patient's family history, facial phenotype and karyotype as well as the radiographic, laboratory and physical examination were not consistent with any of the known genetic syndromes associated with generalized pulp stones. Molecular analysis for the DSPP gene proved negative. The aetiology of this case remains unknown. KEY POINTS Generalized pulp stones occur rarely; Such patients should be referred for genetic evaluation because pulp stones are mostly associated with genetic dentine defects; Pulp stones may hinder root canal treatment; Pulp stones may remain unchanged overtime.
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Affiliation(s)
- C Donta
- Department of Oral Diagnosis and Radiology, School of Dentistry, University of Athens, Athens, Greece
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Abstract
Classic Ehlers-Danlos syndrome is a heritable connective tissue disorder characterized by skin hyperextensibility, fragile and soft skin, delayed wound healing with formation of atrophic scars, easy bruising, and generalized joint hypermobility. It comprises Ehlers-Danlos syndrome type I and Ehlers-Danlos syndrome type II, but it is now apparent that these form a continuum of clinical findings and differ only in phenotypic severity. It is currently estimated that approximately 50% of patients with a clinical diagnosis of classic Ehlers-Danlos syndrome harbor mutations in the COL5A1 and the COL5A2 gene, encoding the α1 and the α2-chain of type V collagen, respectively. However, because no prospective molecular studies of COL5A1 and COL5A2 have been performed in a clinically well-defined patient group, this number may underestimate the real proportion of patients with classic Ehlers-Danlos syndrome harboring a mutation in one of these genes. In the majority of patients with molecularly characterized classic Ehlers-Danlos syndrome, the disease is caused by a mutation leading to a nonfunctional COL5A1 allele and resulting in haploinsufficiency of type V collagen. A smaller proportion of patients harbor a structural mutation in COL5A1 or COL5A2, causing the production of a functionally defective type V collagen protein. Most mutations identified so far result in a reduced amount of type V collagen in the connective tissues available for collagen fibrillogenesis. Inter- and intrafamilial phenotypic variability is observed, but no genotype-phenotype correlations have been observed. No treatment for the underlying defect is presently available for Ehlers-Danlos syndrome. However, a series of preventive guidelines are applicable.
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Klingberg G, Hagberg C, Norén JG, Nietzsche S. Aspects on dental hard tissues in primary teeth from patients with Ehlers-Danlos syndrome. Int J Paediatr Dent 2009; 19:282-90. [PMID: 19486377 DOI: 10.1111/j.1365-263x.2009.00970.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a rare hereditary condition affecting connective tissues and dental hard tissues. HYPOTHESES Primary enamel and dentine from EDS patients were expected to differ from those of healthy subjects regarding morphology and chemical composition. DESIGN Forty-seven exfoliated primary teeth from 25 patients with EDS were investigated. Morphology was studied using a polarized light microscope, scanning electron microscope, and X-ray microanalysis. Comparisons were made with 36 primary teeth from 36 healthy patients. RESULTS Morphological analysis of enamel in EDS teeth showed a high frequency of postnatally hypomineralized enamel and postnatally located incremental lines, whereas dentine was normal in all patients. Chemical analysis could not reveal any differences between EDS and control patients except for lower content of C and a higher Ca/P ratio in the enamel in the EDS teeth, indicating porous enamel. Regarding dentine, EDS teeth had a lower content of C, and a higher content of Ca, P, and O. Ratios for Ca/C and Ca/O were also higher compared with controls. CONCLUSIONS There are several aberrations of booth enamel and dentine in primary teeth from patients with EDS. These could explain the occurrence of both more dental caries and tooth fractures in patients with EDS.
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Affiliation(s)
- Gunilla Klingberg
- Mun-H-Center, National Orofacial Resource Centre for Rare Disorders, Göteborg, Sweden.
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Bauss O, Neter D, Rahman A. Prevalence of pulp calcifications in patients with Marfan syndrome. ACTA ACUST UNITED AC 2008; 106:e56-61. [DOI: 10.1016/j.tripleo.2008.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 06/29/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- J M Armas
- Department of Periodontology, Glasgow Dental Hospital and School, Glasgow, UK
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Oakley M, Vieira AR. The many faces of the genetics contribution to temporomandibular joint disorder. Orthod Craniofac Res 2008; 11:125-35. [PMID: 18713149 DOI: 10.1111/j.1601-6343.2008.00426.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Review the literature on candidate genes for temporomandibular joint disorder (TMD). Setting and Sample Population - Literature review. MATERIALS AND METHODS Two basic approaches were used to obtain literature in any language regarding genes and TMD. First, Medline, Embase, and Science Citation Index databases were searched using the keywords 'temporomandibular joint disorder' and 'temporomandibular joint dysfunction' for studies published from 1966 to 2007. Then, the references list of the studies obtained in the database was also considered. RESULTS Candidate genes for TMD include genes for individual variations in pain perception, gender and ethnicity, proinflammatory cytokines, female hormones, breakdown of extracellular matrix, and syndromic forms of TMD. CONCLUSION Most of the studies on genetic variation contributing to TMD are approaching the disease mainly from an immune-inflammatory perspective. Recent investigations of the genetic variables which may predict identifiable levels of pain perception may uncover new approaches to our traditional treatment modalities for the chronic pain patient.
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Affiliation(s)
- M Oakley
- Department of Restorative Dentistry/Comprehensive Care, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Mataix J, Bañuls J, Muñoz C, Bermejo A, Climent J. Periodontal Ehlers–Danlos syndrome associated with type III and I collagen deficiencies. Br J Dermatol 2008; 158:825-30. [DOI: 10.1111/j.1365-2133.2008.08434.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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