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Krämer S, Lucas J, Gamboa F, Peñarrocha Diago M, Peñarrocha Oltra D, Guzmán‐Letelier M, Paul S, Molina G, Sepúlveda L, Araya I, Soto R, Arriagada C, Lucky AW, Mellerio JE, Cornwall R, Alsayer F, Schilke R, Antal MA, Castrillón F, Paredes C, Serrano MC, Clark V. Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa. SPECIAL CARE IN DENTISTRY 2020; 40 Suppl 1:3-81. [PMID: 33202040 PMCID: PMC7756753 DOI: 10.1111/scd.12511] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. AIMS To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. METHODS Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting. RESULTS This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided. CONCLUSIONS Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.
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Affiliation(s)
- Susanne Krämer
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | - James Lucas
- Dental DepartmentRoyal Children's HospitalMelbourneAustralia
| | | | | | | | - Marcelo Guzmán‐Letelier
- Hospital Base ValdiviaValdiviaChile
- Facultad de OdontologiaUniversidad San SebastiánValdiviaChile
| | | | - Gustavo Molina
- Universidad Nacional de CórdobaArgentina
- Universidad Católica de CórdobaArgentina
| | | | - Ignacio Araya
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
- Hospital Santiago OrienteMaxillofacial Surgery UnitChile
| | - Rubén Soto
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | | | - Anne W Lucky
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
- The University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jemima E Mellerio
- St John's Institute of DermatologyGuy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Roger Cornwall
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
| | - Fatimah Alsayer
- Royal National ENT and Eastman Dental HospitalsUniversity College London HospitalsLondonUK
| | - Reinhard Schilke
- Hannover Medical SchoolDepartment of Conservative DentistryPeriodontology and Preventive DentistryHannoverGermany
| | | | | | - Camila Paredes
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
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Oral and perioral soft tissue lesions and oral functions in patients with dystrophic epidermolysis bullosa. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp201010128c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Numerous oral manifestations may occur within dystrophic
epidermolysis bullosa (DEB). Aim of the study was to examine oral and
perioral soft tissues and oral functions in DEB patients over a period of
one year. Methods. Twenty-four patients (1 month to 36 years old), were
clinically examined initially (T0), after 6 months (T6) and after 12 months
(T12). Appearance and localization of perioral and oral bullae and scars,
maximum mouth opening, reduced vestibule depth, absence of lingual papillae
and palatal rugae and restricted tongue movement due to scarring were
monitored. The values of maximum mouth opening at the initial examination
were compared to those measured in healthy control group of the same age.
The age of patients and differences between dominant and recessive subtype
of DEB were analyzed. Results. Average maximum mouth opening was
significantly lower in DEB patients compared to healthy individuals. Oral
and perioral bullae and scars, microstomia, and reduced vestibule depth were
very common, with no statistically significant difference among T0, T6, and
T12. The prevalence of restricted tongue movement due to scarring and the
absence of lingual papillae and palatal rugae increased significantly over
one year. Patients with microstomia, vestibule depth, and restricted tongue
movement due to scarring were significantly older than patients without
these characteristics. Lingual papillae and palatal rugae were more
frequently absent in recessive than in dominant DEB. Conclusion. DEB causes
significant changes in oral and perioral soft tissues and oral functions
impairment.
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Khan MT, O'Sullivan M, Faitli B, Mellerio JE, Fawkes R, Wood M, Hubbard LD, Harris AG, Iacobaccio L, Vlahovic T, James L, Brains L, Fitzpatrick M, Mayre-Chilton K. Foot care in epidermolysis bullosa: evidence-based guideline. Br J Dermatol 2019; 182:593-604. [PMID: 31397882 PMCID: PMC7065089 DOI: 10.1111/bjd.18381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
This guideline was designed to provide service providers and users with an evidence-based set of current best practice guidelines for people and their families and carers, living with epidermolysis bullosa (EB). A systematic literature review relating to the podiatric care of patients with EB was undertaken. Search terms were used, for which the most recent articles relating to podiatric treatment were identified from as early as 1979 to the present day, across seven electronic search engines: MEDLINE, Wiley Online Library, Google Scholar, Athens, ResearchGate, Net and PubFacts.com. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used. The first guideline draft was analysed and discussed by clinical experts, methodologists and patients and their representatives at four panel meetings. The resulting document went through an external review process by a panel of experts, other healthcare professionals, patient representatives and lay reviewers. The final document will be piloted in three different centres in the U.K. and Australia. Following an EB community international survey the outcomes indicated six main areas that the community indicated as a priority to foot management. These include blistering and wound management, exploring the most suitable footwear and hosiery for EB, management of dystrophic nails, hyperkeratosis (callus), maintaining mobility and fusion of toes (pseudosyndactyly). The evidence here is limited but several interventions currently practised by podiatrists show positive outcomes.
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Affiliation(s)
- M T Khan
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,Royal London Hospital for Integrated Medicine, UCLH, London, U.K.,St George Hospital, Sydney, NSW, Australia.,Barts and The London NHS Foundation Trust, London, U.K
| | - M O'Sullivan
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - B Faitli
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - J E Mellerio
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - R Fawkes
- St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - M Wood
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - L D Hubbard
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A G Harris
- St George Hospital, Sydney, NSW, Australia.,Department of Dermatology, Concord Hospital, Sydney, NSW, Australia
| | - L Iacobaccio
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - T Vlahovic
- Temple University, Philadelphia, PA, U.S.A
| | - L James
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - L Brains
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia
| | - M Fitzpatrick
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia.,DEBRA International, Vienna, Austria
| | - K Mayre-Chilton
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,DEBRA International, Vienna, Austria
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