Dental Issues (Not Opening Wide ... ) a Severity Indicator in SSc

June 5, 2015

Hardening of the skin in systemic sclerosis impairs patients' ability to care for their own teeth properly. As a result, this study suggests, dental issues may be prognostic indicators.

Baron M, Hudson M, Tatibouet S, et al., Relationship Between Disease Characteristics and Orofacial Manifestations in Systemic Sclerosis: Canadian Systemic Sclerosis Oral Health Study III. Arthritis Care & Research. 2015;67:681–690,First published online: 24 April.  doi: 10.1002/acr.22490.

Many systemic sclerosis (SSc, scleroderma) patients have a reduced capacity to open their mouths widely (decreased interincisal distance), possibly related to skin fibrosis. A new study says diminished interincisal distance and other dental abnormalities in SSc, such as gum disease and missing teeth, may be an indicator of disease severity.

The study of 163 patients from the Canadian Scleroderma Research Group cohort, finds that limited mouth opening ability is significantly associated with a higher physician global assessments of disease and higher Rodnan skin thickness scores, as well as the presence of diffuse cutaneous disease.

Tooth loss and periodontal disease are associated with poor hand and upper extremity function that impairs proper tooth-brushing, the researchers add.

At the same time, other dental abnormalities seen in SSc, such as decreased saliva production, may not be directly related to the disease itself but to the presence of Sjögren's syndrome antibodies.

More than half of the patients, 90% of whom were women in their mid-50s, reported having gastroesophageal reflux disease (GERD), which the study also links to tooth loss and decreased saliva.

The etiology of periodontal disease in SSc is likely multifactorial and remains unclear, the study authors note.

This first study to conduct oral exams on a well-defined SSc cohort was limited by a small number of patients with limited skin disease and lack of biopsies to diagnose Sjögren’s or tests to confirm self-reported GERD.

In surveys sent online or by mail at 3- to 6-month intervals for almost two years, with responses linked to electronic medical records, most patients said they had "constant and unremitting" symptoms for around 30 years, markedly limiting their physical and functional status. The subjects were recruited from a population-based AS cohort in Wales.

Given the limited prognostic factors in AS, "a history of severe flare and a constant, unremitting disease pattern offer accessible indicator" to identify patients at high risk, the authors wrote.