Dental complications in homocystinurias

Abstract

Background: Cystathionine beta synthase deficiency (causing classical homocystinuria) has been associated with high-arched palates and crowded teeth, but little has been said about other oral health complications. Other homocystinurias (e.g., the remethylation defects) also have had little reported in terms of oral health. Individuals with the homocystinurias have been described as having bone density issues which can correlate with oral health. Moreover, elevations in homocysteine have a theoretical impact on tooth health and the paucity of clinical reports of oral health issues in homocystinuria may be the consequence of lack of attention by the medical community.

Significance: Oral health is essential to overall health. If inadequate attention is paid to the oral health complications which can be seen in homocystinurias, then appropriate referrals and attention in therapeutic guidelines will not reflect the importance of oral health.

Specific aims/research question: What oral health complications are reported by individuals with homocystinurias? Do these differ according to diagnosis?

Methods: Data were collected from patients with homocystinurias by a series of questionnaires using the RARE-X platform. All subjects were consented prior to the collection of their data. All research was performed in accordance with the Declaration of Helsinki. Demographic data were collected as the initial questionnaire and other data were collected via the oral health questionnaire.

Analysis: Questionnaires were opened to the community in mid-2022 and collection of data for this study ended with data submitted up to November 2022. Descriptive statistics were done. Due to the small size of the cohort, additional statistical analyses were not attempted.

Results: Patients with homocystinuria, not related to cystathionine beta synthase deficiency, are reporting some tooth structure differences. The cohort taken as a whole does not have increased risk for gingivitis, but there appears to be a risk for long-term gum disease possibly due to the rate of osteoporosis/osteopenia in this population. A large number of individuals have malalignment and malocclusion of the teeth. These data highlight oral health as an important component of care in individuals with the homocystinurias as is true of the general population at large.

Keywords: Cobalamin processing defects; Cystathionine beta synthase deficiency; Dental; Homocystinuria; Methylene tetrahydrofolate reductase deficiency; Oral health.

Fig. 1

Cartoon illustrating the Homocystinurias including MTR/MTRR (also known as Cobalamin G and E), Methylene tetrahydrofolate reductase (MTHFR), and Cystathionine beta synthase (CBS) deficiencies as designated by the red lines. Cobalamin C, D, J and F deficiencies are also marked by red lines. Tetrahydrofolate is a folate derivative which is active in this pathway.