Dentistry and the myasthenia gravis patient: a review of the current state of the art

An update on myasthenia gravis, challenging disease for the dental profession

“…As a result of masseter weakness, chewing can become progressively difficult with increasing discomfort ("jaw claudication") so that patients are forced to stop and rest during meals (34). In severe cases, they may need to support their lower jaw while eating in order to allow mastication and between meals to prevent spontaneous dropping of the jaw and opening of the mouth (37,38). Chewing difficulty, fatigable reduction in biting force, inability to close the jaw and weak jaw closure are thus typical of MG patients (34,39), occurring in at least 4% of cases (40).…”

“…Chewing difficulty, fatigable reduction in biting force, inability to close the jaw and weak jaw closure are thus typical of MG patients (34,39), occurring in at least 4% of cases (40). Therefore, dentists should be particularly aware of these clinical presentations, as they may be able to pick (38). When using a mouth prop, ensuring efficient suction is mandatory to avoid aspiration of oral debris (38).…”

“…Therefore, dentists should be particularly aware of these clinical presentations, as they may be able to pick (38). When using a mouth prop, ensuring efficient suction is mandatory to avoid aspiration of oral debris (38). The mouth prop can also be removed periodically to allow the patient a rest break, and overstretching should be avoided.…”

“…Additional concerns should also be addressed in elderly patients. It is well known that severe limitations of masticatory performance, together with chewing and swallowing difficulties, may lead to malnutrition and weight loss in MG patients (37,38). However, feeding and swallowing difficulties as well as malnutrition can be common findings in the geriatric population, mostly due by poor appetite (41), stroke (42), neurological disorders (43) or dentition status (44,45).…”

“…However, feeding and swallowing difficulties as well as malnutrition can be common findings in the geriatric population, mostly due by poor appetite (41), stroke (42), neurological disorders (43) or dentition status (44,45). Despite its increased incidence in older adults (18), it is important not to overestimate MG. Lastly, in myasthenic patients, dentists may notice a typical, furrowed and flaccid clinical appearance of the tongue, resulting from lipomatous atrophy, triple longitudinal furrowing (myasthenic tongue) being observed only in severe cases (37,38).…”