Use of anti-inflammatory medications in managing atypical gingivitis associated with hypermobile Ehlers-Danlos syndrome: A case report

Background: Ehlers-Danlos syndrome (EDS) is a group of collagen disorders primarily affecting the skin and joints. This case report describes the periodontal management of a case of hypermobile EDS (type III) associated with atypical gingivitis. Methods: A 17-year-old Caucasian female with a history of EDS type III presented with erythematous mucogingival lesions. An incisional biopsy was taken. The treatment objective was to control the mucogingival inflammatory lesions. Plaque control measures were followed with anti-inflammatory medications. Prednisone was administered systemically for 3 weeks (first week: 30 mg/day, second week. 15 mg/day, and third week: 5 mg/day), and was followed with topical applications of clobelasol (0.05%) twice daily for 2 weeks. Persistent marginal gingival inflammation was managed with a 3-month course of doxycycline (20 mg) twice/day. The patient was placed on a 3-month maintenance program and monitored for over a year. Results: Histopathology showed multiple granulomas enclosing fragments of crystalline foreign material. Steriodal anti-inflammatory medications partially reduced the size and intensity of the mucogingival lesions. Doxycycline controlled the residual marginal inflammation. A 3-month maintenance interval helped in maintaining the results obtained. Conclusions. The collagen disorder may have facilitated the introduction and lodging of foreign material within the gingival tissues, initiating a foreign body reaction. Poor healing associated with EDS excluded surgical excision and necessitated the use of anti-inflammatory medications. A combined approach of plaque control measures along with anti-inflammatory medications was helpful in controlling the mucogingival inflammatory lesions associated with this condition.