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Why do some patients struggle with anesthesia, requiring multiple cartridges just to get numb?
Could your TMD patients have an underlying systemic condition that’s been missed?
Are you overlooking the signs of a connective tissue disorder?
https://youtu.be/gaoJKPTV_Z0
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”When you can’t connect the issue, think connective tissue!”
Dr. Audrey Kershaw joins Jaz for a fascinating deep dive into the world of connective tissue disorders and their hidden impact on dentistry. Together, they explore how hypermobility, unexplained joint issues, and even a history of spontaneous injuries could be key indicators of an underlying disorder.
They also break down why dentists play a crucial role in screening and identifying these conditions, ensuring better patient outcomes and a more holistic approach to care. Because sometimes, when things don’t seem connected… they actually are.
Protrusive Dental Pearl: Don't just take a "relevant" medical history—take a comprehensive one! Encourage patients to share all health issues, even those they don’t think relate to dentistry. You might uncover important clues about conditions like connective tissue disorders or sleep-disordered breathing, leading to better care and stronger patient trust.
Need to Read it? Check out the Full Episode Transcript below!
Key Take-aways
Ehlers-Danlos Syndrome is often misunderstood and underdiagnosed.
Patients with connective tissue disorders often face skepticism from healthcare providers.
POTS is a common condition associated with EDS that affects blood pressure regulation.
Many TMD patients may have undiagnosed connective tissue disorders.
Awareness and education about EDS are crucial for better patient outcomes.
The healthcare system can be challenging for patients seeking diagnoses.
Research on local anesthetic effectiveness in EDS patients is lacking.
Personal experiences can help in understanding and diagnosing connective tissue disorders.
Collaboration between healthcare professionals is essential for patient care. Genetic testing is crucial for diagnosing rare types of Ehlers-Danlos.
Dental professionals should be aware of the signs of connective tissue disorders.
Diagnosis can empower patients to understand their health better.
Holistic care is vital in managing symptoms associated with EDS and TMD.
Medical histories should be seen as relevant in dental practice.
Highlights of this episode:
02:17 Protrusive Dental Pearl
04:21 Dr. Audrey Kershaw's Journey and Insights
09:45 Personal Experiences and Professional Observations
11:55 Diagnosis and Management of Connective Tissue Disorders
13:31 POTS (Postural Orthostatic Tachycardia Syndrome)
15:30 Understanding Ehlers-Danlos Syndrome (EDS)
24:55 Hypermobile EDS and the Need for Awareness
27:53 International Consortium of EDS GP Checklist
28:34 Genetic Testing and Red Flags
31:44 The Role of Dentists in Identifying EDS
40:32 Journey to Diagnosis
43:47 The Value of a Diagnosis
48:43 Dental Implications of EDS
55:00 Final Thoughts and Resources
"If you know one case of EDS, you only know one. Every case is different. Many are severely debilitated, unable to work or carry out daily tasks, often denying their struggles after years of being dismissed." - Dr. Audrey Kershaw
Promised Resources
Podcast Recommendation:
Linda Blustein’s Podcast (about POTS and connective tissue disorders)
Specialists & Research:
Dr. Alan Hakim – A specialist in Ehlers-Danlos Syndrome (EDS) research based in London.
Norris Lab (U.S.) – Researching genetic markers for hEDS
Local Anesthesia Information
Resources for Screening & Diagnosis:
Diagnostic Criteria for Hypermobile Ehlers-Danlos SyndromeDownload
5-part-questionnaire-for-hypermobilityDownload
Symptomatic Joint-Hypermobility GuideDownload
Red Flag PatientsDownload
Educational Conferences & Talks:
Scottish Dental Show – Audrey is involved in raising awareness at this event.
Podcast with Periodontist Reena – Discussing HbA1c meters for diabetes screening in dental practice.
"If you can't connect the issues, think connective tissues". An EDS talk for professionals.
Advocacy & Support:
Learn more about EDS and Dr. Audrey Kershaw
Ehlers-Danlos Support UK Scotland – Audrey collaborates with them for better patient care pathways.
EDS PATIENT EMAIL Template April 2025
GMP EDS EMAIL TEMPLATE April 2025
Connect with specialists like Dr. Audrey Kershaw
Pack to aid identification of possible HCTD/EDS cases in the dental setting
1. Watch YouTube video made for Prof Tara Renton, by Drs Kershaw and Bluestein
2. Read this - https://gptoolkit.ehlers-danlos.org/
3. Fill out Oral Surgery Scotland Advanced Medical History Form
4. Fill out this - International Consortium of EDS GP Checklist
OR use this link - https://apps.apple.com/app/id6642710534
5. If appropriate, give patient EDS information email EDS PATIENT EMAIL Template April 2025
6. Send email to GMP GMP EDS EMAIL TEMPLATE April 2025
7. For any issues, or feedback, please contact Dr. Audrey Kershaw
If you loved this episode, make sure to watch Periodontal and Systemic Link - Correlation or Causation?
This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes B and C.
AGD Subject Code: 150 Health medicine and nutrition
Aim: To enhance dentists’ awareness and understanding of connective tissue disorders (CTDs), particularly Ehlers-Danlos Syndrome (EDS), and their impact on dental treatment, local anesthesia effectiveness, TMD, and overall patient care.
Dentists will be able to -
1. Identify key dental manifestations of EDS, including local anesthesia failure, TMD, and periodontal considerations.
2. Apply a multidisciplinary approach to managing complex TMD cases with suspected connective tissue involvement.
3. Appreciate the dentist’s role in identifying and supporting patients with suspected connective tissue disorders.
#PDPMainEpisodes #BestofProtrusive #BreadandButterDentistry
Click below for full episode transcript:
Jaz's Introduction: When you can't connect the issue, think of connective tissue. This message has really hit me like a bus. As you know from a few episodes ago, I had my own health issues with a spontaneous lung collapse. Don't worry, I'm okay now. That was scary and strange, but it made me look into my own health.
Jaz's Introduction:Like I've had a dislocated shoulder and I've got stretchy skin and numerous other things, which you'll see from this podcast with our amazing guest, Dr. Audrey Kershaw. She's an oral surgeon and she's so passionate about screening for and helping patients connect these seemingly unconnected issues to discover that they may have a connective tissue disorder.
And so why is it important for dentists to know about this? Well, me personally, and for Audrey, our TMD patients are highly likely to have some sort of connective tissue disorder, or at least have this label of hypermobility. And you'll see why in the podcast where this label perhaps does it in justice also, we would've all had a patient at some point that was just difficult to numb up.
Like, you've given like five cartridges and this tooth is not going numb. Did you know that this could be a sign of a connective tissue disorder? And nowadays, we're not tooth mechanics, right? We are really integrated in the health of the patient. The clinics that I see thriving are talking about the patient's health.
Think about sleep disorder breathing, and how dentists are playing a key role in managing and screening for patients, obstructive sleep apnea, how we are giving this message of reducing sugar that's so important for a patient's overall health. Periodontists are getting very good at screening for and helping patients get diagnosed with diabetes.
And now we get to screen for connective tissue disorders. So for those of you who want to play a role in the patient's overall health, which I think makes our career more fulfilling, this episode will really be right up your street. This episode is of course, eligible for CPD or CE credits. We are a PACE approved provider.
The way to get that is through the Protrusive Guidance app. The website for that is protrusive app. We have over 3000 dentists on there. It's the nicest and geest community of dentists in the world. And we don't use the Facebook group anymore. The Facebook group is now defunct, so please do join us on the app. So I would suggest going on Protrusive app, the website, making your account, and then downloading the Android or iOS app and then using those credentials to log in.
Dental Pearl:Now, every PDP episode I give you a Protrusive Dental Pearl, and one of the messages from this podcast is about the medical history. Now, I know we all take a medical history and we update it, but the problem is the word relevant.
We often take a relevant medical history, and if you only take a relevant medical history, you miss out on the patient's overall health. For example, if I was going to the dentist where it says relevant medical history, I would never have thought to write about my several dislocations I've had on my right shoulder or various other health issues, which I just don't think are relevant for my dentist.
So for example, your patients might have IBS or other things, and they aren't telling you 'cause you're the dentist. Why do you need to know? How is it gonna affect dental care? But actually all these things are important in the medical history 'cause part of screening for a connective tissue disorder, they are incredibly powerful and incredibly relevant.
So let your patients talk about their medical health and really encourage 'em to open up about everything.
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