Many children who have been diagnosed with Ehlers-Danlos syndrome have crooked teeth and can benefit from careful treatment of orthodontic devices. However, children with Ehlers-Danlos (EDS) also often require head and neck MRIs, which can be difficult to obtain correct images when orthodontic devices are in place.

Fortunately, braces and other orthodontic devices can be temporarily removed if necessary. Here's what you need to know if your child has been diagnosed with EDS—or may have the condition—and wears metal braces. 

What is Ehlers-Danlos syndrome? 

Ehlers-Danlos syndrome is a group of genetic connective tissue disorders that are the result of the defective collagen. Essentially, collagen is the glue that holds cells together. With defective collagen, cells are weak and unable to bounce back. This results in many various symptoms depending on the type of EDS, such as easily dislocated joints, joint hypermobility, an inability for wounds to heal, easy bruising, stretchy skin, weak veins and vessels, headaches, and dental malocclusion. The fragility of cells and nerves can cause comorbid neurological conditions and spinal manifestations that can require routine head and neck MRIs. A geneticist is a medical professional who can diagnose EDS. 

What comorbid conditions would require head and neck MRIs? 

Due to the cells and joints being weakened, several things can happen in the head and neck region: in particular, Chiari malformation, atlantoaxial instability, craniocervical instability, idiopathic intracranial hypertension, segmental kyphosis, and tethered cord syndrome. These comorbid conditions often result in pressure on the brain stem due to changes in the structure at the base of the brain and the neck as well as a change in the flow of cerebral spinal fluid. Most of these comorbid conditions can progress rapidly and require routine and urgent MRI imaging, including cine MRI imaging. A neurosurgeon is a medical professional who can diagnose these disorders. 

Why would orthodontic devices need to be removed for MRIs? 

MRIs use magnets to produce a magnetic field. The protons that are produced are forced into the body and resonate and create radio waves, which produce images on a computer monitor. Since most orthodontic devices contain metal, the images can produce artifacts or, in other words, white areas that have nothing to do with the pathology of the body. Typically, orthodontic devices are not required to be removed when getting an MRI, but they should be when it comes to the potentially serious comorbid conditions of EDS, particularly when brain stem compression is suspected due to risks of morbidity. Also, for patients who require surgery, clear MRI imaging is crucial for the neurosurgeon to view in order to plan for surgical techniques. The treating neurosurgeon can determine whether or not orthodontic devices should be removed prior to having head and neck MRIs. 

What if the neurosurgeon recommends routine MRIs? 

Many patients who have EDS have MRIs of the head and neck on a routine basis as well as whenever new symptoms arise that are concerning. Instead of going through the removal and replacement process of orthodontic devices each and every time an MRI is necessary, it's better to consider having non-metallic orthodontic devices instead. An additional benefit of this is that non-metallic orthodontic devices typically do not cause irritation in the oral cavity that often results when someone with fragile oral mucosa from EDS. Oral mucosa is the soft membrane that lines the inside of your mouth. 

In conclusion, if your child has been diagnosed with EDS or you strongly feel that your child may have EDS, ask their pediatrician to refer them to a geneticist for testing. If comorbid conditions are possible, a referral to a neurosurgeon will be necessary. With proper diagnoses and EDS and any related condition, speak with the orthodontist for advice on how to move forward with continuing orthodontic treatment but with a non-metallic device.