On the diagnosis and management of neurocutaneous syndrome (NCS), a toxicity disorder from dental sealants.(care and treatment)(Disease/Disorder overview)

Abstract

Neurocutaneous syndrome (NCS), a newly discovered toxicity disorder, is characterized by neurological sensations, pain, depleted energy, and memory loss as well as itchy, cutaneous lesions which may invite various opportunistic infections. Components in the calcium hydroxide dental sealants Dycal, Life, and Sealapex have been identified as sources of the observed symptoms. Sulfonamide and neurological toxicity issues are discussed, and three case histories are presented. Additional notes on zinc oxide, Fynal, IRM, and Sultan U/P sealers are also included. Diagnostic and management protocols at the Parasitology Center, Inc. (PCI) are proposed.

Introduction

The original description of the neurocutaneous syndrome (NCS) (1) was "introductory in nature." (1) Examination of many NCS patients and a careful study of their symptoms, exposures, clinical conditions, and histories made it possible to identify the underlying cause of the syndrome and proceed with its management.

Materials and Methods

Patients were personally evaluated and their clinical history, records, symptomology, and exposures carefully examined. Specimens provided or collected at the Parasitology Center, Inc. (PCI) were studied. An NCS status was only determined based on symptoms and determination that one or more of the suspect sealers had been used on prior dates. Sensitivity to sulfa and elevated levels of sulfa in the blood were used as a confirmation of sulfonamide toxicity. Continuing patients follow our recommendations for dental rehabilitation, extraction of suspect liner(s), and replacement with ethyltoluene sulfonamide (ETS)-free and zinc oxide-free sealants. A list of vitamin/mineral supplements for patient use during the transitional period and another list of substitute sealants are provided. Patients are followed up to monitor and insure the resolution of symptoms.

Results and Discussion

The Neurocutaneous Syndrome

The disorder is double-faceted, with dermatological and neurological symptoms compatible with classical sulfa toxicity. The latter is characterized by changes in blood values, photosensitive reactions, allergic vasculitis sores, bacterial flora changes, and redness of the skin, which may lead to liver and kidney failure. (2) The neurological aspects are characterized by pin-prick and/or creeping, painful, and irritating movement sensations, often interpreted as parasite movements in various body tissues and/or cavities. Movement sensations are either unipolar or bipolar and may proceed horizontally or vertically. They may manifest as variably shaped bruises or waves of elevated ripples or channels. In no case was the movement sensation related to parasites. (1) Neurological symptoms may also include loss of memory, brain fog, lack of concentration, and control of voluntary movements.

The cutaneous aspects include small itchy sores (Figure 1), inflamed often-elevated pimples (Figures 2 and 3), and fully inflamed and painful open/amorphous mucoid lesions that often enlarge and coalesce (Figure 4). Histopathological sections of lesions (Figure 5) show superficial and deep perivascular infiltrate of lymphocytes, accompanied by interstitial deposits of granular mucin material. Eosonophils are usually present within the inflammatory infiltrate, and foci of epidermolytic hyporkeratosis are often identified within the epidermis (Figure 5). Lesions may also be on the scalp where they may be associated with infestation of springtails (Collembola) (1) In many cases, lesions are associated with edematous reaction usually in the arms and legs (Figure 6). Blood vessels may also become enlarged and elevated, and the head…