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CC BY 4.0 · Eur J Dent 2022; 16(03): 710-714
DOI: 10.1055/s-0042-1745773
Case Report

The Dental Management of Pediatric Patient Diagnosed with Myasthenia Gravis: A Case Report

Saad M. AlManea
1   Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
,
Mashael A. AlHadlaq
1   Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
,
Noura M. AlBuqmi
1   Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
,
Sultan S. AlGomaiz
2   Department of Dental Services, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Abstract

Myasthenia gravis (MG) is a rare autoimmune neurological disorder characterized by muscle weakness and can vary in severity from the mild form that affects the ocular muscles only to the generalized form that affects the other muscle groups. The prevalence of MG is 150 to 200 per million population over the past 50 years, and approximately 10% of these cases are pediatric patients where the disease onset starts before the age of 18 years. The etiology of MG is due to the blockage of neuromuscular transmission by circulating autoantibodies targeting mainly the nicotinic acetylcholine receptor (AChR) and associated proteins in the postsynaptic membrane of skeletal muscles. In MG patients, dental treatment is challenging due to the nature of the condition and its complexity. Moreover, dentists treating MG patients should acquire knowledge about the disease background and the special considerations that need to be taken. In this case report, our aim was to raise awareness about MG among dentists and discuss the dental management of the patients who have this disease and the precautions that should be taken. This case report presents a pediatric MG patient with poor oral hygiene, multiple decayed teeth, dental fluorosis, tongue thrust oral habit that led to anterior open-bite and uncomplicated crown fracture of the upper permanent central incisors. The decision was made to treat the patient under general anesthesia because of the medical condition and the extent of the dental treatment. In the process of preparing the patient for surgery, the patient was cleared from the treating physicians and was admitted under neurology care as per the primary physician. On the day of surgery, the patient received full-mouth dental rehabilitation under general anesthesia, including pulp therapy, crowns, restorations, and extractions. Furthermore, she was seen regularly in recall visits every 3 months.

Keywords

myasthenia gravis - pediatric - dental management - dentistry - dental rehabilitation


Publication History

Article published online:
21 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 2015; 14 (10) 1023-1036
    CrossrefPubMedGoogle Scholar
  • 2 Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. J Clin Med 2021; 10 (11) 2235
    CrossrefPubMedGoogle Scholar
  • 3 Al-Moallem MA, Alkali NH, Hakami MA, Zaidan RM. Myasthenia gravis: presentation and outcome in 104 patients managed in a single institution. Ann Saudi Med 2008; 28 (05) 341-345
    CrossrefPubMedGoogle Scholar
  • 4 Alanazy MH. Clinical features and outcomes of patients with myasthenia gravis. Neurosciences (Riyadh) 2019; 24 (03) 176-184
    CrossrefPubMedGoogle Scholar
  • 5 Peragallo JH. Pediatric myasthenia gravis. Semin Pediatr Neurol 2017; 24 (02) 116-121
    CrossrefPubMedGoogle Scholar
  • 6 Tamburrini A, Tacconi F, Barlattani A, Mineo TC. An update on myasthenia gravis, challenging disease for the dental profession. J Oral Sci 2015; 57 (03) 161-168
    CrossrefPubMedGoogle Scholar
  • 7 Rousseff RT. Diagnosis of myasthenia gravis. J Clin Med 2021; 10 (08) 1736
    CrossrefPubMedGoogle Scholar
  • 8 Patton LL, Howard Jr JF. Myasthenia gravis: dental treatment considerations. Spec Care Dentist 1997; 17 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 9 Berrih-Aknin S, Frenkian-Cuvelier M, Eymard B. Diagnostic and clinical classification of autoimmune myasthenia gravis. J Autoimmun 2014; 48-49: 143-148
    CrossrefPubMedGoogle Scholar
  • 10 Berrih-Aknin S, Le Panse R. Myasthenia gravis: a comprehensive review of immune dysregulation and etiological mechanisms. J Autoimmun 2014; 52: 90-100
    CrossrefPubMedGoogle Scholar
  • 11 Thomas CE, Mayer SA, Gungor Y. et al. Myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation. Neurology 1997; 48 (05) 1253-1260
    CrossrefPubMedGoogle Scholar
  • 12 Jamal BT, Herb K. Perioperative management of patients with myasthenia gravis: prevention, recognition, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107 (05) 612-615
    CrossrefPubMedGoogle Scholar
  • 13 Murthy JM, Meena AK, Chowdary GV, Naryanan JT. Myasthenic crisis: clinical features, complications and mortality. Neurol India 2005; 53 (01) 37-40 , discussion 40
    CrossrefPubMedGoogle Scholar
  • 14 Patil PM, Singh G, Patil SP. Dentistry and the myasthenia gravis patient: a review of the current state of the art. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114 (01) e1-e8
    CrossrefPubMedGoogle Scholar
  • 15 Yarom N, Barnea E, Nissan J, Gorsky M. Dental management of patients with myasthenia gravis: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100 (02) 158-163
    CrossrefPubMedGoogle Scholar
  • 16 Prabhu SS, Khan SA, Doudnikoff AL, Reebye UN. Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting. J Dent Anesth Pain Med 2019; 19 (01) 67-72
    CrossrefPubMedGoogle Scholar
  • 17 Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med 2002; 69 (1-2): 31-37
    PubMedGoogle Scholar