When planning surgical extractions, especially if multiple extractions are needed, it is advisable to consult the patient’s physician as profound anaemia could complicate the dental surgery30. For multiple extractions, it has been suggested to extract first the anterior teeth (i.e., from premolar to premolar) and then the molars to allow optimal access30. An atraumatic technique should be used, making firm and safe mucosal incisions to prevent bullae formation10,23. Haemostasis Daporinad research buy can be achieved with gentle pressure using gauze packs9,41. These should be wet to avoid tissue adherence. Some authors have reported the extraction

of healthy third or even second permanent molars in patients with severe generalized RDEB to improve or facilitate oral hygiene2,48. There is controversy among different authors about this intervention. Severe tooth crowding12,22,49, reduced alveolar arches secondary to growth retardation8,50, and severe microstomia1,7,22,23,31,45,51,52 are described Hydroxychloroquine price in patients with severe generalized RDEB, which would justify preventive extractions. However, nowadays most patients receive dietetic advice that optimizes nutrition and growth. They receive orthodontic treatment (serial extractions) and are advised on exercises to improve microstomia. Therefore,

preventive extractions of permanent molars need to be assessed very carefully on an individual basis. Perioperative complications: Despite attempts to

use as gentle manipulation as possible and all the special precautions, mucosal sloughing and blister formation have been reported after almost every surgical extraction in patients with severe RDEB1,9,22,30,41. Blisters can arise at the angles of the mouth, lips, vestibule, tongue, and any sites of manipulation (Image 12); some measuring up to 4 by 3 cm1,30. In some instances, they might only be noticed by the patient or carer only on the second post-operative day9. Post-operative complications: Despite the potential for extensive mucosal damage during surgery, post-operative complications are rare9,30,53. Healing of the oral tissues occurs gradually after one to 2 weeks16,21,41. Healing of the alveolar sockets seems to be uneventful6,9. Nevertheless, there new is a suggestion that scarring of the oral commissure can be accentuated after surgery1,9. The use of post-operative antibiotics will depend on each individual case. 3.8.6 Osseointegrated implants. To avoid destruction of the atrophic residual alveolar ridges of the maxilla, an osteotome technique is advised23,31. Surgical management can be complicated by bleeding and bullae23,31,54. When needed, bone grafts can be placed simultaneously with implants to reduce the number of surgical interventions and, therefore, mucosal/skin damage54. Successful rehabilitation using dental implants has been reported in patients with generalized RDEB, non-Herlitz JEB, and RDEB-I5,23,31,55.