MTHFR Gene Polymorphism Dental Care

Over the last several years, many patients have received dental care with the MTHFR gene mutation presentation. What is MTHFR and how can your child receive dental care in a safe and effective manner? Many children present with moderate to advanced dental needs, some of whom have been delaying treatment because of the mutation present. This mounting tension can often show up with patients needing the use of anxiolytics, most common of which is nitrous oxide, and more advanced with oral sedatives like general anesthesia).

So how can we manage the emotional needs of our patients while receiving dental care in a safe manner?

 

Let us provide background on this gene mutation. MTHFR stands for Methylenetetrahydrofolate Reductase — the rate-limiting enzyme in the methylation cycle converting inactive folate to active folate, used in DNA production and homocysteine regulation. This gene mutation essentially affects all the DNA processes in the body. It is correlated with an increased risk of vascular inflammation, neural tube defects, midline defects, and autism. A person may have single or double gene mutations. Mild variations in the MTHFR mutation are fairly common, but to be homozygous is exceptionally rare and can lead to hyperhomocysteinemia. Severe MTHFR mutation symptoms may include hypotonicity, motor dysfunction, and motor delay.  

 

Nitrous oxide causes an elevation in plasma homocysteine through irreversible inactivation of vitamin B-12, particularly of concern in patients with severe forms of MTHFR mutations. This is why supplementation of vitamin B-12, magnesium, and folate (active) vitamin, not folic acid (inactive) is important in children with mild mutations who are also struggling with anxiety surrounding dental treatment needs.

 

Important steps to follow should your child requires nitrous oxide or sedation/general anesthesia (safe alternatives still remaining for MILD mutations):
 

  • Vitamin B-12 supplementation a few days BEFORE/AFTER procedure
     

  • Increase consumption of methylfolate in green leafy vegetables (green smoothie is a good intake option) a few days BEFORE/AFTER procedure
     

  • Epsom salt baths using magnesium sulfate can aid in quickening the metabolism process of nitrous and sedative medications
     

  • Avoid nitrous oxide in patients with existing B-12 deficiency or with homozygous/severe MTHFR mutations

 

A consultation with your child’s medical provider is always important and we are familiar with working cohesively with your medical team.