Last Updated on July 5, 2026 by Dr. Nico Kamosi
Part 2: How We Identify, Investigate, and Care for You
One of the most significant challenges with EDS and MCAS is that many patients go years without a diagnosis or are told their symptoms are unrelated to one another. In my specialist practice, I am often the first clinician to recognise the pattern: gum disease that is far more severe than expected, tissues that do not heal, or a history of reactions to materials and medications.
This article explains the signs I look for, how I investigate, and the specialist care pathway we follow at London Specialist Dentists to keep your mouth safe and stable.
Recognising the Signs: When Should EDS or MCAS be Suspected?
Both EDS and MCAS are systemic conditions, but the mouth often shows signs very early sometimes long before a medical diagnosis has been made. Here is what I look for:
Signs Suggestive of EDS
Throughout the body:
- Joints that bend back further than normal, dislocate easily, or click frequently
- Skin that is very soft, velvety, or stretchy; bruises with minimal force; or scars unusually
- Wounds or surgical sites that take weeks to heal, or break down and reopen
- Chronic widespread pain often beginning in childhood or early adulthood
- Severe fatigue without a clear cause
- Digestive problems such as reflux or irritable bowel symptoms
In the mouth (what I specifically look for):
- Gum disease that is severe or has started very young out of proportion to age or oral hygiene
- Gums that look thin, almost transparent, and bleed with the lightest touch
- Gum recession exposing the roots of teeth
- Teeth that feel loose or have shifted without obvious infection
- Very slow or poor healing after any dental treatment
- A high, narrow palate or crowding of the teeth
Signs Suggestive of MCAS
Throughout the body:
- Recurrent flushing, hives, itching, or unexplained swelling
- Digestive symptoms: pain, bloating, nausea, or diarrhoea
- Brain fog, headaches, or episodes of feeling unwell without infection
- Extreme sensitivity to foods, medications, chemicals, or temperature changes
- Symptoms that are unpredictable varying in severity and affecting different parts of the body at different times
In the mouth (what I specifically look for):
- Gum inflammation that appears far greater than the amount of plaque or bacteria would explain
- Burning or pain sensations in the gums that do not match clinical findings
- Rapid bone loss sometimes occurring over just a few months
- Recurrent infections that are difficult to treat with standard approaches
- Reactions to local anaesthetics, mouthwashes, or filling materials
- Unexplained swelling of the lips, tongue, or gums
If you recognise these patterns in yourself whether or not you have a formal diagnosis please tell us.
We take a thorough history at every appointment. The more information you share, the better we can tailor your care.
How We Investigate: Our Systematic Approach
When I suspect EDS, MCAS, or both, I follow a structured assessment process looking far beyond a routine dental check-up.
Step 1: Detailed History
I begin with a focused conversation asking questions that many standard appointments miss:
- Do you bruise easily, or heal slowly after cuts or procedures?
- Do your joints bend back further than normal?
- Do you have frequent allergies, flushing, or gut issues?
- Have you ever reacted to anaesthetic, a medication, or a dental material?
- Does anyone in your family have similar symptoms?
This history is often the most valuable diagnostic tool available particularly for Hypermobile EDS, which has no genetic blood test.
Step 2: Clinical Examination
For EDS, I assess:
- Joint flexibility using the standardised Beighton Score
- Skin quality elasticity, fragility, and texture
- A detailed periodontal examination measuring pocket depths, recession, bleeding, and tissue attachment
- Tissue quality how the gums feel: thin, friable, or unusually soft
For MCAS, I assess:
- Whether the pattern of gum inflammation is consistent with a mast cell-driven process
- Whether reactions to stress, foods, or materials appear to worsen oral symptoms
- Presence of other inflammatory signs such as swelling of the tongue or lips
Step 3: Imaging
High-quality digital X-rays and 3D Cone Beam CT (CBCT) scans allow us to see exactly what is happening beneath the gumline. In EDS and MCAS patients, we typically see:
- Bone loss that is more widespread and more severe than expected for the patient’s age
- Reduced bone density the jawbone appears less dense than normal even in young patients
- Irregular bone patterns around the teeth
This imaging is essential both for diagnosis and for planning treatment precisely and safely.
Step 4: Coordination with Your Medical Team
Dental assessment is only one piece of the picture. Where EDS or MCAS is suspected, we can correspond with your:
- Clinical geneticists for formal EDS diagnosis and genetic advice
- Immunologists and allergists for MCAS management, including antihistamines and mast cell stabilisers
- Rheumatologists and pain specialists particularly where joint and muscle involvement is significant
- Dietitians to identify dietary triggers that may worsen MCAS
Important: If you are already seeing specialists for EDS or MCAS, please share their contact details with us.
Coordinated, whole-person care consistently produces better outcomes than treating each area in isolation.
Our Specialist Care Pathway
Once we have identified that EDS, MCAS, or both are present, standard dental protocols are not appropriate. We adapt our entire approach based on the latest clinical evidence and our own extensive experience with these patients.
1. Reducing inflammation first safely
Before any procedure, our priority is to reduce both local and systemic inflammation as much as possible. This means:
- Working with your doctors to optimise any medications for MCAS before we begin
- Using ozone therapy to eliminate bacteria gently and without chemical irritants that may trigger reactions
- Applying Photo-biomodulation (PBM / low-level laser) to calm inflamed tissues and support collagen production
- Gentle, non-traumatic cleaning techniques never aggressive scaling that can damage fragile tissue
2. Avoiding foreign body reactions and hypersensitivity
For patients with MCAS especially, exposure to the wrong dental materials can trigger significant immune reactions including flare-ups that affect the whole body. Our approach:
- We review every material before use for its biocompatibility profile
- We avoid materials known to provoke mast cell activation including certain metals, resins, and chemical agents
- Where amalgam removal is indicated, we use the SMART protocol (Safe Mercury Amalgam Removal Technique) to protect you from mercury vapour exposure
- We discuss planned materials with your immunologist where complex cases require it
3. Laser-Assisted Periodontal Treatment (LAPT)
Conventional deep cleaning and periodontal surgery can be too traumatic for patients with fragile, EDS-affected tissue. Dental lasers allow us to:
- Remove infected and inflamed tissue precisely, without instruments that pull or stretch delicate gums
- Eliminate bacteria deep within the gum pockets
- Seal treated tissue as we work reducing bleeding, bruising, and post-treatment sensitivity
- Actively stimulate collagen formation in the treated area
4. Regenerative Procedures
Where bone or gum tissue has been lost, regeneration is possible but it must be done carefully in patients with connective tissue disorders. We use:
- Biocompatible bone graft materials that act as a scaffold, reducing the burden on the patient’s own compromised collagen
- Resorbable barrier membranes gentle on tissue and free from materials that may trigger reactions
- Growth factors to encourage better tissue organisation and healing
- L-PRF (Leucocyte-Rich Platelet Fibrin) a concentrate made from your own blood to provide natural growth factors with no foreign body risk
5. Frequent, gentle maintenance
Long-term stability in EDS and MCAS patients requires more frequent review than standard care provides. We typically see these patients every 8 to 12 weeks. Each visit is:
- Gentle never aggressive or traumatic to already-fragile tissue
- Focused on early detection of any change, so we can act before problems escalate
- Supported by photo-biomodulation and ozone where beneficial
- Coordinated with updates to your medical team as needed
Our Commitment to You
We understand that living with EDS or MCAS means navigating a healthcare system that often misses the connections between your symptoms.
At London Specialist Dentists, we see the whole picture. Our role is not just to treat your gums it is to recognise patterns, investigate thoroughly, and provide care that respects the unique complexity of your body.
You deserve dental care that is genuinely safe, genuinely gentle, and genuinely effective.
Summary: What to Expect from Your Care
- A thorough history and clinical assessment including specific questions about EDS and MCAS
- High-quality imaging to map bone levels and tissue quality accurately
- A carefully selected, biocompatible treatment plan reviewed with your medical team where needed
- Use of ozone therapy, PBM, and laser techniques to minimise trauma and inflammation
- SMART protocol where amalgam removal is required
- Regenerative procedures using the most biocompatible materials available
- More frequent review appointments tailored to your level of risk
If you have questions about your own situation, or would like to discuss your symptoms before booking an appointment, please do not hesitate to contact us. We are here to help.
Dr. Nico Kamosi
Dr. Nico Kamosi
Specialist Periodontist, Implantologist, Prosthodontist, Holistic and Biological Dentist
TDL. DDS. (Swe.), MSc.Perio.(Eng.),
MClinDent.Perio.(Eng.), MSc.Imp.Dent.(Eng.),
Dip.Aesth.Med. (Eng.), MClinDent.Prosth.(Eng.),
Cert., Dip.DHSLM.(RCS.Eng.), Cert.Orth.(Eng.), Cert.Law (Eng.), AIAOMT
Accredited member of IAOMT, SMART Certified
Member of AACD, EFP, AAP, ESCI, IAOMT
