Many people with Marfan syndrome and related disorders have narrow jaws and a high palate arch. This can cause dental and orthodontic problems. In addition, people with artificial valves or a sagging mitral valve are at risk of infection to the heart or valves (endocarditis) during surgery on the teeth. Prevention of endocarditis is recommended in such a case.
What are common problems with teeth in Marfan syndrome?
Dental problems that can develop include: Orthodontic problems, jaw joint complaints and derived problems that can arise from (treatment of) the teeth.
In the Marfan syndrome, the bone in the upper jaw is often very narrow. This can lead to a considerable lack of space for the teeth.
The narrow, high shape of the palate can also cause a crossbite. In the case of a crossbite, the teeth or teeth of the upper teeth close within the lower teeth. Normally, the upper teeth and teeth should just slightly over the lower teeth to close. Due to the narrow, high upper jaw, the back top teeth fall within the bottom teeth. This is called a ‘posterior crossbite’ (crossbite).
The upper and lower teeth do not touch each other completely when the jaws are closed.
Dysfunction of the temporomandibular joint
The jaw joint is the hinge that connects the lower jaw to the upper jaw. A deformed joint or weak ligaments (ligaments that hold this joint in place) can cause various problems known as ‘Temporo Mandibular Dysfunction TMD’. In all likelihood, people with the Marfansyndroon are more susceptible to TMD problems, but this has not been thoroughly investigated.
TMD can lead to:
- locking the jaw when opened wide,
- pain when chewing,
- to snap one or both joints when the mouth is opened,
- a persistent pain that can lead to headaches.
- The dentists who deal with these specific jaw joint problems are the gnathologists.
Endocarditis is an inflammation of the mucous membrane of the heart cavity and valves. In people with mitral valve prolapse or a heart valve prosthesis, endocarditis can develop during procedures where there is a greater chance that bacteria will enter the bloodstream. Before any intervention involving the risk of bacterial infections, including dental procedures, precautions must be taken.
How are the most common dental problems treated in people with Marfan syndrome?
There is little research on the specific approach to orthodontic problems that are often seen in people with Marfan syndrome, but the search for orthodontic care is an important part of Marfan syndrome management, especially in children.
According to the American Association of Orthodontists, children should see an orthodontist when they are about 7 years old. This is especially true for children with the Marfan syndrome. Many treatment methods are possible for a child in growth. However, if the patient becomes older, a teenager or an adult, the treatment options become more limited.
When a child is about 7 to 8 years old, it is possible to see a narrow upper jaw, a common feature in Marfan syndrome. Through a narrow upper jaw, the choice of the upper jaw can be placed within the lower teeth; this creates a cross bite.
With a young child, it is usually possible to treat a cross bite by widening the arch of the upper jaw by an orthodontic broadened. The seam where the bones of the palate meet is not yet attached. As the child grows older, these parts attach together and become less flexible. If the widening is done on time, so if the palate is still flexible, it is often beneficial to continue the treatment with a fixed bracket.
If a crossbite cannot be corrected with a broader (usually because the person has passed the growth period) surgery can help to widen the arch of the upper jaw. With every surgical procedure, there are risks involved in people with the Marfan syndrome who already have heart-related problems. Consultation with the treating cardiologist is necessary to consider the benefits and risks of this optional surgery.
If the cardiologist and the patient decide that the operation is not worth the possible risks, the crossbite cannot be treated. The orthodontist will tackle the other orthodontic issues separately – and without surgery – such as lack of space, an overbite or an underbite. It is important to consult the orthodontist to determine the timing that is best for your situation. And – if there is any doubt – you can ask for the opinion of another orthodontist who has already treated people with the Marfan syndrome.
Endocarditis (infection of the inside of the heart and/or heart valves) is a serious complication for everyone. Especially for someone who has had surgery on the aorta with the placement of an artificial valve, which many people have had with Marfan. It is only very difficult to cure with medication. An operation is almost always required to remove the artificial valve and the aortic graft. The operation is not only riskier than the original procedure, but there is a substantial chance that not all inflamed tissue will be removed and the endocarditis will come back.
To prevent endocarditis, precautions should be taken in an operation where bacteria can enter the bloodstream. This also applies to dental treatments. Tell your dentist that you have the Marfan syndrome and also any heart problems. Your dentist should consult your cardiologist for the need for antibiotics before starting the dental treatment. (endocarditis prophylaxis)
What can you do yourself?
There are several things you can do yourself daily for good dental care if you have Marfan.
First and foremost, daily dental care – brushing and flossing – and regular check-ups at the dentist!
Because of the risk of endocarditis, you should strive to keep your teeth as clean and healthy as possible before problems arise, to avoid as many dental treatments as possible. Inflamed gums are a source of harmful bacteria. Keep your gums healthy through good hygiene.
What to think about:
Ask your cardiologist if antibiotics are needed before an operation on the teeth.
Consider whether an intervention on the teeth is really necessary for improving functions (eating, speaking) or for cosmetic reasons (to look more beautiful). It is important to find a good balance between the treatment of dental problems and the risks for the heart and blood vessels.
Children with Marfan syndrome should consult an orthodontist if they are about 7 years old.