Therefore, prescriptions should be in liquid form, that Selleckchem BIBW2992 is, soluble painkillers (analgesics), ideally a sugar-free form. Frequency of dental review should be scheduled according to the risk of caries every 3 to 6 months5,15,22,27. As the predisposition to develop intraoral carcinoma (SSC) increases with age, cancer screening must be considered a very important aspect of the review appointment in patients with RDEB from the second decade on19,28. Routine dental treatment can be provided5,22,29.

Dental management does not require many modifications4; however, a careful approach is advised as tissue manipulation can produce oral ulceration. This group of patients requires an aggressive preventive programme and frequent visits to the dentist as they present enamel hypoplasia/defects, leading to an increased risk for cavities and severe attrition. Patients with DDEB are able to receive routine dental treatment with little or no modifications28. Patients with the severe generalized RDEB subtype of EB require several treatment modifications and a careful approach to avoid as much tissue damage as possible. Management of Tanespimycin these patients ideally requires a well-organized multidisciplinary team approach27,30 with good communication involving case discussion. 1 Lubrication Lips should always be lubricated with Vaseline®/petrolatum or other appropriate lubricant before any procedure is performed to reduce

adherence and lesions formation1,5,18,27,31. Bullae formation or epithelium sloughing can occur upon contact with the suction tip1. It is suggested to lean the

suction tip or saliva ejector upon hard tissue, that is, on the tooth surface. High vacuum suction should be avoided. Blood- or fluid-filled bullae that occur during treatment have to be drained with a sterile needle or by a cut with scissors to avoid lesion expansion because of fluid pressure13,22,23,33. Extreme care of fragile tissues is important. To handle tissues, a little pressure (compressive forces) can be applied, but no sliding movements (lateral traction or other shear forces) should MG-132 mw be used, as these can cause tissue sloughing5,11,23. At the end of every clinical session, it is important to check for fluid-filled blisters and drain them. It is also important to check whether there are remnants of dental materials. A careful approach is advised, as mucosal sloughing can form following dental treatment34. In patients with severe generalized RDEB, periapical technique is difficult in the posterior area because of microstomia, ankyloglossia, and scarring of the sublingual area. Orthopantomography (panoramic) is the investigation of choice. Other alternatives are as follows: small films bitewings, extraoral bitewings capabilities in panoramic radiographs (if equipment is available), and occlusal or lateral oblique techniques. There are no contraindications to the use of conventional dental materials5,38.