Guidebook Home

Table of Contents

Preface

Introductory Comments

General Questions About FOP

Genetics of FOP

How FOP Affects the Body

Care and Treatment

Activities

Feelings About FOP

Helpful Addresses

Family Resources

Ideas for Independence

Medical Articles

Acknowledgments and Contributions

A Dental Guide for People with FOP

Brief Definition of FOP: Fibrodysplasia Ossificans Progressiva (FOP) is a rare disease in which bone forms in abnormal locations, leading to stiffness, locking, and permanent immobility. Extra bone growth can occur without any warning or as a result of trauma, which can be as minimal as a bump or a fall. Malformations of the great toe are commonly noted at birth. Ectopic bone formation usually begins in the first decade of life and progresses episodically in characteristic anatomic patterns.

Special Concerns for Dental Care:
The temporomandibular joints in the jaw are characteristically among the last joints to be affected by FOP. However, involvement of the TMJ area has been reported following dental procedures or oral trauma at any age. This, combined with the age-increasing risk that the jaw will become affected by FOP (71% of patients have jaw restriction by age 18), points to the need to take certain precautions to minimize the need for invasive procedures which could result in jaw restriction, or the need for procedures which may be more difficult to deal with as a result of existing jaw restriction. Even in routine circumstances, stretching of the jaws and neck to open or turn can have dire consequences in people with FOP.

People with FOP can have preventative oral health care including prophys, fluoride, and sealants. Restorative care must be accomplished but using great caution. Similarly, dental extractions should be avoided unless absolutely necessary. Orthodontic care can be accomplished using short visits and caution; All bonded appliances are recommended to avoid extra pressure on the jaws. The condition prevents use of intramuscular injections of any type including block anesthesia. Local anethesia can be applied as infiltrations, periodontal (PDL), and intraligamentary. Electronic anesthesia is also recommended. But remember: no intramuscular injections! If general anethesia is needed, the person must be intubated using a fiberoptic laryngoscope through the nose to avoid TMJ fusion.

To help us evaluate dental care for people with FOP and to participate in an on-going study, please send copies of your dental records on a yearly basis to Dr. Nussbaum.

For additional questions about dental care and people with FOP:

Burton L. Nussbaum, D.D.S.
Dentistry for Special People, P.A
1910 Marlton Pike E Ste 9
Cherry Hill, NJ 08003-2123
Phone: (856) 667-2123
Fax: (856) 482-7825
Email: bikr2th@aol.com
www.dentistryforspecialpeople.com

Frederick S. Kaplan, M.D.
University of Pennsylvania Medical Center
Department of Orthopaedics
Silverstein Pavilion-2nd Floor
34th & Spruce Streets
Philadelphia, PA 19104
Phone: (215) 349-8727
Fax: (215) 349-5928

Luchetti W, Cohen RB, Hahn GV, Rocke DM, Helpin M, Zasloff MA, Kaplan, FS. "Temporomandibular joint ankylosis following routine injection of local anesthetic in patients who have fibrodysplasia ossificans progressiva. Oral Surgery. 81: 1996. 21-25.

Nussbaum, B, O'Hara I, Kaplan FS. "Fibrodysplasia Ossificans Progressiva, Report of a Case with Guidelines for Pediatric Dental and Anesthetic Management." J Dent Child, Nov-Dec 1996. 338-450.