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Good Morning!

Welcome to this week’s edition of More Than Teeth, where we dive deeper into cases that remind us how dentistry is often the first step in whole-body healing.

Today’s story is about Jessie, a patient with Ehlers-Danlos Syndrome (EDS), chronic pain, and sleep-disordered breathing. Her journey reminds us that what we see in the chair is rarely just dental. It’s airway, neurology, connective tissue, and even reproductive health.

In Today’s Edition

- Jessie’s subjective experience of pain, fatigue, and dysfunction
- Clinical exam findings and diagnostic work-up
- Phase 1 & 2 treatment plan and outcomes, Dental implications of EDS for practice
- Evidence-based protocol for dry mouth management (with Xylitol/Spry)
- Cathy’s Corner reflection
- Business & Professional Insights

5-minute read👇

Clinical Corner

Use the clinical corner as your secret weapon to impress your colleagues and patients!

Key Takeaways

• Recognize airway & EDS clues early: Narrow arches, scalloped tongues, gum recession, and cold sensitivity can indicate airway compromise and connective tissue fragility.

• Protect fragile tissues: A structured dry mouth protocol, including Xylitol gum/mints (Spry by Xlear), fluoride, and saliva substitutes, helps prevent caries and soft tissue breakdown in EDS patients.

• Treat comprehensively, not symptomatically: Instead of managing pain and sensitivity in isolation, prioritize airway function, hydration, and sympathetic regulation.

• Make collaboration a standard of care: Work with PCPs, rheumatologists, ENTs, and nutritionists to optimize collagen strength and systemic health.

• Integrate sleep screening into dentistry: Position yourself as a whole-health provider—airway and sleep evaluation should be routine, not optional.

• Document & educate: Detailed notes, SOAP-style thinking, and accessible patient handouts strengthen clinical care and patient trust, while boosting case acceptance.

• Differentiate your practice: Sharing these advanced approaches in your marketing and education elevates your practice as a leader in airway-centered, whole-body dentistry. Check out this article below from Wyns et al, 2023.

Jessie’s Story

Jessie lived with unexplained pain and fatigue for most of her life. As a child, she thought it was “normal” to wake at night in blinding pain, scavenging Tylenol from the medicine cabinet while the rest of the house slept. She endured daily migraines, gut problems, nausea, and joint pain that left her struggling to even walk home from school.

By adulthood, mornings began with dizziness, nausea, and brain fog so severe that she often couldn’t drive safely to work. At night, she collapsed into bed in tears from pain. Every day felt like survival.

For years, doctors told her she was “fine.” She began to believe her suffering was normal, even imagining others must feel the same.

Finally, at age 30, she was diagnosed with Ehlers-Danlos Syndrome (EDS), a connective tissue disorder marked by hypermobility, fragile collagen, poor wound healing, gut dysmotility, and airway challenges. Her dentist (me) was one of the first providers to suspect the diagnosis, noting her narrow bite and limited tongue space, which are airway red flags.

She also described:

• Inability to tolerate cold foods like ice cream or apples due to extreme tooth sensitivity

• Gum recession and dry mouth worsened in her 30s

• Migraines were linked to poor sleep and musculoskeletal pain

• Fatigue so profound that she doubted whether motherhood would ever be possible

Objective Findings

• Radiographs: Posteriorization of the mandibular condyles, maxillary hypoplasia, mandibular retrognathia

• Airway: Inferior turbinate hypertrophy, nasal valve compromise

• TMJ: Capsule tenderness, deviation upon opening, positive to palpation of elevator muscles

• Dental: Generalized cold sensitivity, early gum recession, scalloped tongue, narrow arches

• Systemic: Neuromas in both feet; hypermobility; chronic pain; dry mouth

• Sleep Study: Mild OSA with significant fragmentation (board-certified sleep physician evaluation)

Assessment

1. Sleep-disordered breathing (mild OSA + fragmentation)

2. TM joint capsulitis with condylar displacement and myofascial pain

3. Airway compromise (nasal obstruction, tongue space limitation)

4. Connective tissue fragility (EDS) with systemic manifestations

5. Xerostomia contributes to caries risk, hypersensitivity, and gingival recession

6. Suspected chronic sympathetic overactivation (fight-or-flight state) is linked to pain and reproductive suppression

Plan

Airway & TMD Therapy (Phase 1)

• Mandibular decompression via day and night orthotics (EMA sleep device with anterior deprogrammer on a 3 to 1 alternating schedule for muscle pain relief; day orthotic lower arch deprogrammer)

• Six months of orthotic wear with monthly in-office therapies (LLLT, ultrasound, alpha-stim, spray & stretch)

• Home care: tongue suction holds (2 min, BID), reciprocal inhibition of elevator muscles (TID or prn)

• Nasal regimen: Xlear nasal spray/moisturizer, Flonase, nasal valve supports

Dry Mouth & Dental Prevention Protocol

• Prescribe Xylitol gum/mints (e.g., Spry by Xlear), 5–6g/day in divided doses

• High-fluoride toothpaste or varnish for enamel protection

• Saliva substitutes or rinses as needed (non-acidic, alcohol-free)

• Dietary guidance to minimize fermentable carbs

• Monitor closely for caries and cervical recession progression

Interdisciplinary Collaboration

• PCP: Sleep fragmentation, overall coordination

• Rheumatologist: EDS and connective tissue management

• Nutritionist: Anti-inflammatory, collagen-supportive diet (vitamin C, glycine, proline, omega-3s)

• ENT: Address nasal obstruction, turbinate hypertrophy, and allergy therapy

Phase 1 Outcome:
After six months, Jessie experienced 90–100% resolution of jaw pain and headaches. Migraines became rare, fatigue improved, and she regained function.

Phase 2: Orthodontic Stabilization

• Airway-centric protocol using CandidPro

• Retention for occlusal stability

Quality of Life Outcome:
During Phase 2, Jessie became pregnant and later delivered her daughter. She reflected that she could never have managed motherhood in her prior state of pain and fatigue. Sleep restoration and pain relief gave her back not only her health but her ability to build a family.

Dental Implications of EDS

• Increased risk of gum recession due to fragile collagen

• Hypersensitivity from thin dentin and exposed root surfaces

• Dry mouth exacerbates caries risk. Xylitol protocols are essential

• Airway considerations: Narrow arches and tongue restriction are common; dentists should screen aggressively

• Joint instability: TMD, condylar displacement, and muscle pain are frequent and require decompression strategies

Cathy’s Corner

Jessie’s story reminds us that patients often live decades believing their suffering is “normal.” Dentists can be the ones to break that cycle. Sometimes the most important thing we do is see what others have missed, like a scalloped tongue, dry mouth, or narrow arch, and connect it to the bigger picture.

And while airway and dental interventions are vital, healing also depends on nutrition. Our bodies need real, whole foods, especially vegetables, for the vitamins, minerals, and antioxidants that strengthen connective tissue, calm inflammation, and support long-term recovery.

Here’s my reminder for the week: don’t just buy vegetables—wash, cut, and prepare them ahead of time. Keep them ready in your fridge so they’re as convenient to grab as chips or crackers. When healthy food is easy to access, it’s much easier to make it a daily habit.

That’s this week’s More Than Teeth. Jessie’s journey is proof that when we help patients breathe, sleep, and heal—we don’t just treat teeth. We restore lives.