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The MastAttack 107: The Layperson’s Guide to Understanding Mast Cell Diseases, Part 58

72. How does mast cell disease affect your dental health?

Mast cells are found naturally throughout your body. One of their most important functions is to fight off parasites and infections in your GI tract, starting in the mouth. Everyone has mast cells in their mouth, although most people don’t have a lot of them. They release mediators there like they do everywhere else. For mast cell patients, releasing too many mediators can be a source of symptoms. It causes the oral symptoms many of us experience, including swelling of the lips, mouth and tongue. It can also cause excessive salivation or dryness depending upon the patient.

Your teeth and mouth can be damaged by things that are very acidic. Frequent vomiting as a result of mast cell disease (or anything) can really damage your teeth. It erodes the protective coating over your teeth. It is very hard to effectively wash all the acid out of your mouth after vomiting as it can collect at or below the gumline. This is the reason I personally have had some dental issues in the last few years. Even though I was very diligent about brushing after vomiting, I couldn’t brush beneath the gums to prevent formation of cavities.

My dentist recently recommended that I neutralize the acid in my mouth before brushing instead of brushing immediately after vomiting. Brushing your teeth with acid in your mouth spreads it around your teeth and causes little craters to form on your teeth. My dentist recommended I rinse my mouth out with water and baking soda to neutralize the acid before brushing after I vomit. I also use a prescription toothpaste to help keep my teeth strong. (Always consult your own care team about specific steps you can take before changing your care plan.)

Redness and burning in the mouth can be the result of mast cell activation. For mast cell patients, this can be worsened by exposure to triggers, especially triggers you ingest.

Gum health can be tricky for mast cell patients. For those of us with connective tissue diseases like Ehlers Danlos, we are always at a disadvantage. My old dentist used to constantly give me crap about not flossing even I flossed regularly. This was years before I knew I had EDS and that patients with EDS often have bleeding gums regardless of flossing. Bleeding of any kind activates mast cells, so if you bleed when you brush your teeth, that can be a trigger.

Having swollen or bleeding gums makes it easier for you to get infections in your mouth. Even more seriously, it makes it much easier for infectious organisms to be transferred from your mouth into your bloodstream, where they can cause an infection. This is exactly what happened to me in March 2016 when I had the Danger Tooth pulled. This is a concern for anyone but especially people who have central lines. When you have a central line, bugs that end up in your bloodstream can stick onto your central line and grow more quickly. As this line ends just above your heart, line infections can be very serious, even if they started in the mouth and not the line itself. Sometime dentists treat patients with antibiotics before dental care to avoid this, but it is very patient specific.

Dental cleanings use lots of materials or meds that can trigger mast cell degranulation. A lot of them have extra junk in them, like dyes or flavors. Vibration and scraping during the cleaning can be triggering. Many mouth washes are off limits for us, especially those with dyes and alcohols. And of course, dental work can be painful or cause bleeding which is problematic for us. Anxiety is also common.

I personally do okay with the plain grey pomice scrub for cleanings. Mast cell patients should premedicate before any procedures, including detail appointments. See the link below for the premedication recommendations for mast cell patients.

Dental procedures or surgeries have the same problems as cleanings but to a stronger degree. Installing permanent or semipermanent hardware into the mouth carries the risk of later reacting to it. Braces, retainers and splints can be super tricky for us. The decision to put in a crown or something similar should involve the mast cell specialist on your care team. I personally have opted to have a tooth pulled rather than run the risk of later reactions to the crown.

Numbing medications can be mast cell triggers, like some of the –caine anesthetics. Sometimes dentists will use a preparation of anesthetic that also has a little epinephrine in it to help control the bleeding. While I personally do not have problems with this preparation, a lot of mast cell patients do because it contains a preservative.

For more detailed reading, please visit the following posts:

The Provider Primer Series: Medications that impact mast cell degranulation and anaphylaxis

Premedication and surgical concerns in mast cell patients