Abstract
Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p < 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p < 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p < 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile.
Highlights
IntroductionSystemic sclerosis (scleroderma) is a chronic multisystem disease characterized by a dynamic and exclusively complex pathobiology directed by three essential processes: autoimmunity, widespread obliterative vasculopathy of small arteries causing ischemia-reperfusion injury, and varying degrees of inflammation and tissue fibrosis [1,2].The hallmark of this rare connective tissue disorder is its highly variable expression, with clinical phenotypes defined by different stages of disease expression, multiple organ involvement (lung, heart, kidney, gastrointestinal tract, and musculoskeletal system), and specific serologic biomarkers (anti-topoisomerase 1, anti-centromere, and anti-RNA polymerase III antibodies), resulting in significantly altered quality of life and survival [1,2]. recent guidelines tried to redesign therapeutic strategies to prevent progression and to minimize damage of specific organ involvement, the management of scleroderma remains a challenge in routine practice [1,2].Oral health issues are commonly reported in patients with systemic sclerosis (SSc) (up to 80%) and comprise a broad spectrum of manifestations, from reduced mouth opening (microstomia) with abnormal interincisal distance and decreased salivary flow (xerostomia) to increased number of missing teeth and caries, periodontal diseases with gingival recession or other types of oral infections, and even temporomandibular joint involvement [1,2,3,4,5,6,7].A number of explanations concerning the interfaces between SSc and oral health have been proposed; it seems that orofacial manifestations are generally related to excessive and extensive fibrosis of skin and oral mucosa, as well as to local vasculopathy [1,3,4,5,6,7]
A number of explanations concerning the interfaces between systemic sclerosis (SSc) and oral health have been proposed; it seems that orofacial manifestations are generally related to excessive and extensive fibrosis of skin and oral mucosa, as well as to local vasculopathy [1,3,4,5,6,7]
A systematic review of the literature addressing the impact of scleroderma on oral health has identified only a few studies having as endpoint the radiographic findings; the majority considered bi-dimensional panoramic radiographic assessment, and none of them focused on interrelations between imaging parameters and disease characteristics [9,14,15,16,17,20,32,33,34]
Summary
Systemic sclerosis (scleroderma) is a chronic multisystem disease characterized by a dynamic and exclusively complex pathobiology directed by three essential processes: autoimmunity, widespread obliterative vasculopathy of small arteries causing ischemia-reperfusion injury, and varying degrees of inflammation and tissue fibrosis [1,2].The hallmark of this rare connective tissue disorder is its highly variable expression, with clinical phenotypes defined by different stages of disease expression, multiple organ involvement (lung, heart, kidney, gastrointestinal tract, and musculoskeletal system), and specific serologic biomarkers (anti-topoisomerase 1, anti-centromere, and anti-RNA polymerase III antibodies), resulting in significantly altered quality of life and survival [1,2]. recent guidelines tried to redesign therapeutic strategies to prevent progression and to minimize damage of specific organ involvement, the management of scleroderma remains a challenge in routine practice [1,2].Oral health issues are commonly reported in patients with SSc (up to 80%) and comprise a broad spectrum of manifestations, from reduced mouth opening (microstomia) with abnormal interincisal distance and decreased salivary flow (xerostomia) to increased number of missing teeth and caries, periodontal diseases with gingival recession or other types of oral infections, and even temporomandibular joint involvement [1,2,3,4,5,6,7].A number of explanations concerning the interfaces between SSc and oral health have been proposed; it seems that orofacial manifestations are generally related to excessive and extensive fibrosis of skin and oral mucosa, as well as to local vasculopathy [1,3,4,5,6,7]. Systemic sclerosis (scleroderma) is a chronic multisystem disease characterized by a dynamic and exclusively complex pathobiology directed by three essential processes: autoimmunity, widespread obliterative vasculopathy of small arteries causing ischemia-reperfusion injury, and varying degrees of inflammation and tissue fibrosis [1,2]. The hallmark of this rare connective tissue disorder is its highly variable expression, with clinical phenotypes defined by different stages of disease expression, multiple organ involvement (lung, heart, kidney, gastrointestinal tract, and musculoskeletal system), and specific serologic biomarkers (anti-topoisomerase 1, anti-centromere, and anti-RNA polymerase III antibodies), resulting in significantly altered quality of life and survival [1,2]. Widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile
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