Dental Sealant Toxicity: Neurocutaneous Syndrome (NCS), a dermatological and neurological disorder

Neurocutaneous syndrome (NCS), a newly discovered toxicity disorder, is described in light of our new understanding of its relationships with the causative agents included in the dental liners used in afflicted patients. NCS is characterized by neurological sensations, pain, depleted energy and memory loss as well as itchy cutaneous lesions that 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 considered compatible with classical sulfa toxicity. Sulfonamide and neurological toxicity issues are discussed, three case histories are presented and an outline of management protocol is proposed. Additional notes on zinc oxide, Fynal, IRM and Sultan U/P sealants are also included. Introduction The original description of the neurocutaneous syndrome(NCS)1 was “introductory in nature... intended only to bring attention to a new disease entity that has not been previously reported.”1 Examination of many NCS patients and a careful study of their symptoms, exposures, clinical conditions and histories have made it possible to identify the underlying cause of the syndrome and proceed with its management. It is now also possible to help NCS clinical cases and to make dentists aware of the adverse impact of some routine dental procedures commonly regarded as harmless or safe. Materials and Methods NCS patients from the United States sought our help after having exhausted all other means to resolve their symptoms. Upon signing an informed consent, patients were personally evaluated and their clinical history, records, symptomology and exposures carefully examined. Fecal and blood specimens provided or collected at the Parasitology Center, Inc. (PCI) were studied and identified. An NCS status was only determined upon confirming that neurological and dermatological symptoms are compatible with those of NCS and that one or more of the suspect sealants (based on the dental records of hundreds of patients) have been used on prior dates. Sensitivity to sulfa and the level of sulfa in the blood were used as a confirmation of sulfonamide toxicity. Continuing patients followed our recommendations of rehabilitation of their compromised teeth, removed suspect liner(s), and replaced with ethyltoluene sulfonomide (ETS)and zinc oxide-free sealers. We provided the dentists with a list of vitamin/ mineral supplements for the patient to take during the transitional period and another list of substitute sealants. Patients were followed up for weeks/months to monitor the resolution