Dental Issues
Many people with Marfan syndrome have narrow jaws and high, arched palates, which can create dental and orthodontic problems. There is limited research regarding specific management of the orthodontic problems commonly seen in people with Marfan syndrome, but seeking orthodontic care is an important part of Marfan syndrome management, particularly in children.
In addition, people with mitral valve prolapse and artificial heart valves are at risk for endocarditis (infection of the heart and heart valves) when they have dental work, and should follow the recommendations regarding Endocarditis Prophylaxis. Following are answers to frequently asked questions regarding orthodontics and other dental concerns. When should children with Marfan syndrome visit an orthodontist?
According to the American Association of Orthodontists, children should see an orthodontist by the age of 7. This is particularly true for children with Marfan syndrome. Many treatment options are possible for a growing child. However, as a patient becomes a teenager and an adult, the number of treatment options becomes more limited. What is the most common orthodontic problem affecting children with Marfan syndrome)?
When a child is 7 or 8, it is possible to recognize a narrow upper jaw, which is a common characteristic in children with Marfan syndrome. A narrow upper jaw causes the upper teeth on the side of the mouth to be set inside the lower teeth creating a posterior crossbite. Normally, the upper teeth overlap the lower teeth. How is a posterior crossbite treated?
A posterior crossbite can be treated by widening the upper arch with an orthodontic expander. In a young child, the suture (where the bones of the palate come together) is not fused. As a child gets older, these areas become less flexible and fuse. Typically, when a child becomes a teenager, simple orthodontic expansion is not possible without surgical assistance to make the bones flexible again. However, due to the nature of Marfan syndrome and the continued growth that people with the disorder experience, the time frame for correcting the posterior crossbite with an orthodontic expander varies, and can extend beyond the pre-teen years. If expansion is done early to take advantage of the flexible palate, it is often beneficial to follow this treatment with full braces. If braces are not started right away, there are other options such as a transpalatal arch to hold the space until braces are appropriate.
It is important to consult with your orthodontist to determine the timing that is best for your situation and, if there is any question, get a second opinion from another orthodontist who has treated people with Marfan syndrome. If a posterior crossbite cannot be corrected with an expander, are there other options?
For people who are past the growth period, and not likely to benefit from the use of a skeletal orthodontic expansion appliance, a surgical procedure can assist in the widening of the upper arch. Any surgical procedure introduces certain risks to people with Marfan syndrome who already have cardiovascular complications. The patient’s cardiologist should be consulted to evaluate the risk-benefit for this elective surgical procedure. If the cardiologist and the patient do not deem it to be worth the potential risks, the posterior crossbite cannot be treated. Then, the orthodontist will separately - and nonsurgically - address other orthodontic issues, such as a crowding, overbite or underbite. Is the extraction of teeth an option to correct orthodontic problems for people with Marfan syndrome?
Extractions of teeth for orthodontic treatment can be done safely in people with Marfan syndrome as long as antibiotic medication is given one hour before the procedure. A prescription for the antibiotic can be obtained from a cardiologist or pediatrician. The usual one-time, high dose of antibiotics should be double-checked with the patient’s cardiologist. What are some of the other orthodontic concerns facing people with Marfan syndrome?
If orthodontic bands (rings) are fitted over the molar teeth, then meticulous oral hygiene is needed to prevent dental plaque accumulation around the gum line. Plaque around the gums is a source of bacteria that could enter the blood stream and potentially infect the heart. Regular tooth brushing in a circular motion around the gums can prevent gum inflammation and bleeding. Flossing with floss threaders and brushing after every meal is the minimum care needed to maintain good oral hygiene. Oral irrigators can also help to keep braces and orthodontic expanders clean.
Patients who are at risk of developing infections from dental procedures need antibiotic coverage during band placement and band removal procedures. If it is possible, bands should be avoided and replaced with brackets that are placed above the gums. If a child has a posterior crossbite, then usually two to four teeth will need orthodontic bands to make an orthodontic expander. What is endocarditis?
Endocarditis is the inflammation of the lining of the heart cavity and valves. People with mitral valve prolapse or an artificial heart valve can develop endocarditis during dental procedures and other medical situations where there is an increased likelihood that bacteria can enter the blood stream. Endocarditis is a terrible complication for anyone, but particularly so in a patient who has had surgical reconstruction of the aorta with placement of an artificial valve. This is a condition that is almost incurable by medicine alone, and nearly always requires surgery to remove the artificial valve and dacron graft. Not only is the operation itself of much higher risk than the original operation, but there remains a substantial chance that not all of the infected tissue will be removed, and that recurrent endocarditis will occur. Endocarditis prophylaxis is the prevention of endocarditis before it occurs. How can I prevent infections of the heart and valves (endocarditis)?
Precautions must be taken prior to any procedure that may introduce bacteria into the bloodstream. This includes routine dental work. Many dental procedures go below the gum line and provide an opportunity for bacteria to enter the blood stream. People with Marfan syndrome should advise their dentist of their heart problems so that the dentist can consult with the cardiologist about the need for antibiotics prior to beginning the dental work. For more information, see Endocarditis Prophylaxis. Is TMJ (Tempromandibular Joint Syndrome) associated with Marfan syndrome?
TMJ disease is common in Marfan syndrome because TMJ is a joint. People with Marfan syndrome have deficiency of elastic fiber in many joints in the body, and the tempromandibular joint, which connects the jaw to the skull, is no exception. The TMJ is also more pronounced in Marfan syndrome. A prosthodontist should be consulted for TMJ and jaw problems. Are people with Marfan syndrome more likely to get cavities?
There is no evidence that people with Marfan syndrome are more likely to get cavities than the general population. For more information, see Dental and Orthodontic Concerns.
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