Myasthenia gravis: dental treatment considerations.

Myasthenia gravis is an autoimmune neuromuscular disorder that presents challenges for the dental practitioner. Facial and masticatory muscles may be involved and complicate dental treatment. Exacerbations of the skeletal muscle weakness and fatigability that characterize this disorder can be precipitated by certain medications used in dentistry. A review of 47 dental treatment episodes in 16 patients with myasthenia gravis was undertaken to identify neuromuscular responses to dental treatment and post-dental treatment medical therapy required for control of resultant exacerbations of muscular weakness. Neuromuscular sequelae occurred in 5 treatment episodes for four different patients. Management considerations and drug precautions are discussed.