Surgical orodental implications in ankylosing spondylitis

Abstract

Temporomandibular joint and the pelvic complex are bidirectionally related. Ankylosing spondylitis (AS) is a seronegative arthropathy with the key feature of bony fusion of lumbar vertebrae. A 39 year old known case of AS was presented to private office for left lower impacted third molar surgical removal. Previously, he was rejected to receive oral care for pulpectomy and extraction due to limited mouth opening. Prior to the surgery, lateral neck radiography was obtained to exclude any subluxation of fracture of cervical vertebrae. Neck was supported to insure neck stability during surgical forces. In addition, considering consumption of immunosuppressive medications including corticosteroids, procedure was performed with a great care, with attention to higher possibility of infection and fracture. Access to the surgical site was not desirable, though surgery accomplished without any significant event and the patient discharged with routine analgesic and antibiotics recommendation. Sometimes, impaired access to the oral cavity in patients with AS leads to receive suboptimal or minimal orodental care. Long list of dental implications in these patients may be simplified by considering of careful neck and jaw support, applying at least possible forces and great attention to the infection control rules. It is wised to be performed under patient and skilled hands.

Keywords: Ankylosing spondylitis; immunosuppressant; oral surgery; temporomandibular joint.

Figure 1

Lateral neck radiography revealed no fracture and subluxation of cervical vertebra

Figure 2

Impacted mandibular mesio-angular third molar

Figure 3

Right temporomandibular joint. Note reduced space and sclerotic border of glenoid fossa and condylar head