Factors associated with gingival inflammation among adults with systemic sclerosis

Abstract

OBJECTIVE To identify factors associated with increased gingival inflammation in adults with systemic sclerosis (SSc, scleroderma). METHODS In this cross-sectional study, forty-eight adults with SSc received assessment of gingival inflammation using Löe and Silness gingival index (LSGI), measurement of oral aperture, and evaluation of manual dexterity to perform oral hygiene using the Toothbrushing Ability Test, as well as completion of an oral health-related questionnaire. RESULTS Three explanatory variables in the final multiple predictor models for the LSGI outcome were statistically significant -- manual dexterity to perform oral hygiene, flossing in the evening, and SSc subtype, with higher LSGI score among those with impaired manual dexterity, not flossing in the evening and diffuse form of SSc. In addition, posterior teeth had higher LSGI scores compared to that of the anterior teeth after adjusting for other variables CONCLUSIONS Results suggest that dental health professionals take manual dexterity into consideration when educating patients with SSc to improve their oral hygiene, and educate them on paying more attention on cleaning their posterior teeth and the importance of flossing in the evening -- especially those who only floss once a day or less often.

Factors associated with oral hygiene practices among adults with systemic sclerosis

“…The dexterity to perform sufficient oral hygiene has been previously suggested as affecting oral health in people with SSc (7, 9). In this study, an objective measure of manual dexterity impairment as indicated by the TAT score, and size of oral aperture were not significantly associated with frequency of oral hygiene practices.…”

“…In the present study, only 40% of the study participants flossed at least once daily, which is at the same rate as that of a clinical population (45). Since patients with SSc are at a greater risk of dental disease (46, 47), and dental flossing, especially in the evening, was shown to be significantly related to less gingival inflammation in this patient population (9), it is important for dental health professionals to educate patients with SSc on the importance of daily flossing. The strategies that may aid those who floss less than daily include the use of adapted flossing or interdental cleaning device to decrease the difficulty in flossing and increase daily flossing adherence.…”

“…SSc affects the skin and musculoskeletal tissue of the hands as well as the oral and perioral tissues (3–6). Manual dexterity impairments and orofacial dysfunction (e.g., microstomia and xerostomia) are two major clinical manifestations that may complicate oral hygiene and lead to oral health problems among people with SSc (7–9). Hand deformity and limited oral aperture may affect oral hygiene performance as well as willingness to perform oral hygiene (7, 10).…”

The spectrum of orofacial manifestations in systemic sclerosis: a challenging management

“…The etiology of periodontal disease in SSc is most likely multifactorial but remains elusive (Baron et al , b). Indeed, various disease‐related factors, such as xerostomia that promotes the development of dental plaque, impaired oral hygiene due to reduced manual dexterity and mouth opening or microvascular alterations that can lead to tissue ischemia could account for the higher prevalence of periodontal disease in SSc patients (Yuen et al , ). According to Yuen et al , a correlation between gingivitis and the diffuse form of SSc and/or an impaired manual dexterity has been observed (Yuen et al , ).…”

“…Indeed, various disease‐related factors, such as xerostomia that promotes the development of dental plaque, impaired oral hygiene due to reduced manual dexterity and mouth opening or microvascular alterations that can lead to tissue ischemia could account for the higher prevalence of periodontal disease in SSc patients (Yuen et al , ). According to Yuen et al , a correlation between gingivitis and the diffuse form of SSc and/or an impaired manual dexterity has been observed (Yuen et al , ). In contrast, the large case–control study of Baron et al did not found any relationship between periodontal disease and global disease severity, reduced saliva secretion or decreased mouth opening, and sclerodactyly that could impede oral hygiene (Baron et al , b).…”