Increased Periodontal Attachment Loss in Patients With Systemic Sclerosis

Abstract

Background: Patients with inflammatory rheumatic diseases and periodontitis share common pathogenetic characteristics, such as proinflammatory traits causative for tissue degradation and loss of function. The aim of the present case control study is to investigate the association between systemic sclerosis (SSc) and periodontitis.Methods: The association between SSc and periodontitis was examined in 58 SSc patients and 52 control patients, matched for age and sex. The periodontal examination included periodontal attachment loss (AL}, probing depth, bleeding on probing, plaque index (PI), and gingival index (GI). Potential risk factors of periodontitis were assessed through patients' questionnaires.Results: In unadjusted analyses, patients with SSc had a significant 0.61 mm higher AL (95% confidence interval [CI] 0.24 to 0.97; P == 0.002) when compared with controls. In a stepwise logistic regression, including SSc status, age, sex, education, smoking, alcohol consumption, and body mass index, only SSc status, age, and sex remained significantly associated with periodontitis. Adjusted for age and sex, patients with SSc had a 0.52 mm higher AL compared with controls (95% Cl 0.16 to 0.88; P== 0.005). The strength of the association of SSc with AL remained statistically significant after additional adjustment for PI (0.44 mm; 95% Cl 0.02 to 0.86; P == 0.04) or GI (0.61 mm; 95% CI 0.24 to 0.97; P== 0.001).Conclusions: This study demonstrates higher AL in patients with SSc, which remained significant after adjustment. The study indicates a possible relationship between SSc and periodontitis.

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

“…Bilateral condylysis can be found in 7–13.7% of the cases (Haers and Sailer, ; Rout et al , ; Vincent et al , ; Doucet and Morrison, ). Temporomandibular joint (TMJ) disorders are also frequently associated with the disease (Vincent et al , ; Matarese et al , ; Pischon et al , ) and can be the consequence of mandibular resorption. The prevalence of clinical signs of TMJ dysfunction (pain, TMJ sounds, impairment of mandibular movements…) and characteristic magnetic resonance imaging (MRI) findings (disk, articular surface and bone changes) is higher in SSc patients compared to healthy controls (Matarese et al , ; Pischon et al , ).…”

“…Regarding tooth loss, no study highlighted a statistical difference between SSc patients and healthy controls (Chu et al , ; Baron et al , ; Pischon et al , ). However, a trend toward an increased number of missing teeth has been observed in recent studies (Baron et al , ; Pischon et al , ). Interestingly, Baron et al found a relationship between reduced manual dexterity (sclerodactyly) and the number of missing teeth (Baron et al , ,b).…”

“…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). Pischon et al demonstrated very recently a higher periodontal clinical attachment loss that remained statistically significant after adjustment for age, gender, education, smoking status, and alcohol consumption but also after adjustment for plaque accumulation (PI) (Pischon et al , ). This observation suggests that the impaired oral hygiene may only partially account for the higher prevalence of periodontal disease in SSc patients.…”

Letter to the Editor: Re: Increased Periodontal Attachment Loss in Patients With Systemic Sclerosis

“…In conclusion, we believe that the study by Pischon et al 1 contributed valuable information on the association between periodontal disease and SSc subtypes. However, a further analysis regarding also the association of periodontal disease and other disease characteristics of SSc, such as MRSS or mean duration of disease, should provide further and interesting information to better understand the role and the main cause of the association between periodontal disease and SSc.…”

“…We read with great interest the recently published article by Pischon et al, 1 and, being ourselves currently involved in research on the mechanism of periodontal and temporomandibular (TMJ) diseases during systemic sclerosis (SSc), we wish to make the following observations and additions to the results obtained by these authors.…”