Clinical and radiographic study of orofacial alterations in patients with systemic sclerosis

Abstract

Systemic sclerosis (SS) is an autoimmune disease with great repercussions on the hard and soft tissues of the orofacial region. The aim of this study was to investigate the relationship between mandibular osteolysis and mouth opening measurements, duration of disease and presence/absence of teeth. Twenty-fi ve subjects were selected: 15 diagnosed with systemic sclerosis and 10 healthy controls. The SS patients were grouped according to the presence (group I) or absence (group II) of mandibular osteolysis. The healthy subjects served as the control group (III). All of them underwent panoramic radiography on Ortophos ® equipment (Siemens) and were clinically examined, with mouth opening measurement. We observed that group I had a longer duration of the disease than group II (p = 0.003). Groups I and II presented the same mean mouth opening. There was an increasing correlation between mouth opening and duration of the disease in group I (p = 0.095), but this was not observed in group II (p = 0.596). There was no correlation between presence/absence of teeth and osteolysis (p > 0.999), or between presence/absence of teeth and side of osteolysis (p = 0.143). We could conclude that osteolysis seemed to develop in patients with a longer duration of the disease, but did not modify the degree of mouth opening in relation to patients without osteolysis, and the presence/absence of teeth was not signifi cant. On the other hand, in the osteolysis cases, the longer the duration of the disease, the greater the opening of the mouth.

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population

“…Our findings add substantially to the knowledge in the literature, as none of the previous studies of the estimates of the prevalence of radiographic abnormalities in the jaws in SSc systematically studied all suspected SSc radiographic manifestations (Table III). In addition, the number of patients examined in these studies was generally small, between 15 and 47, [12][13][14]17,18,[26][27][28][29] and controls were used in only seven studies. [12][13][14][15][16][17][18] Another limitation of the previous studies is that the controls were either selected from patients attending the dental clinic, 14 hospital staff, 14 or patients with inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus.…”

“…12,13,17,[26][27][28][29] Bone resorption has been noted in patients with more advanced disease 27 and can occur in areas of muscle attachment in the mandible. Muscles involved in such areas are the masseter at the angle of the mandible, the lateral pterygoids at the condylar head, and the temporalis the coronoid process.…”

“…11 Only a few studies, however, have estimated the prevalence of these radiographic abnormalities, and none has included more than 47 patients with SSc. To our knowledge, only six previous studies have compared patients with SSc to normal controls, [12][13][14][15][16][17] whereas a seventh study used controls with rheumatoid arthritis and systemic lupus erythematosus. 18 The purpose of this carefully performed study in a large sample of patients with SSc was to assess all the previously described individual radiographic manifestations of SSc and to compare the prevalence of these radiographic manifestations with those in the general population.…”

A Dentist Inquires About His Patient with Systemic Sclerosis

“…44 They found no relationship between the absence or presence of teeth and osteolysis, or that and the side of osteolysis. 44 Other imaging modalities have been evaluated in assessing the oral health in patients with SSc. A recent study analyzed the masseter musculature in patients with SSc with the use of MRI.…”

“…44 They studied 25 subjects - 15 with SSc and 10 healthy controls, and they found that mandibular osteolysis appeared to develop in SSc patients with longer disease duration, and its presence appeared to have a tendency toward having an increased mouth opening, whereas this did not occur in patients without osteolysis. 44 They found no relationship between the absence or presence of teeth and osteolysis, or that and the side of osteolysis. 44 Other imaging modalities have been evaluated in assessing the oral health in patients with SSc.…”