The prevalence of myasthenia gravis (about 1 in 10 000 people) is such that every dentist will probably treat more than one patient with the condition during their career. Changes in tongue and facial muscle strength can often be the first sign of myasthenia gravis. These changes may impact on oral hygiene and the ability to wear dentures. Postural changes and the potential for the patient's medication to interact with drugs given by the dentist means that patients with myasthenia gravis have specific needs during dental treatment.

A review of the dental literature recommended that, depending on the severity of disease, patients should have multiple, short, early morning appointments, perhaps preceded by oral anticholinesterase drugs, to take advantage of their early morning muscle strength.1 Factors related to dental treatment that are likely to worsen myasthenia gravis should be avoided, such as stressful protracted procedures, the use of ester-linked local anaesthetics (not available in Australia) and the use of antibiotics that have some muscle relaxing properties (erythromycin, gentamicin, neomycin and clindamycin).1 The use of these drugs, as well as the use of benzodiazepines, sedation and general anaesthesia, has been reported to worsen muscle weakness and should only be undertaken after consultation with the patient's physician. To avoid complications, dentists should therefore have good communication not only with the patient, but also with the treating physician.


Stephen W Reddel

Sydney Neurology, Brain and Mind Research Institute, The University of Sydney

Departments of Neurology and Molecular Medicine, Concord Repatriation General Hospital, Sydney