Recommendations for the care of oral involvement in patients with systemic sclerosis

Abstract

Objective. To review the literature and collect expert advice for proposing preventive and curative treatments of mouth and dental involvement in patients with systemic sclerosis (SSc; scleroderma). Methods. The literature pertaining to mouth and/or dental involvement related to SSc was reviewed, and recommendations were developed according to the suggestions of a French multidisciplinary working group of experts and validated by a lecture committee. Results. Dentists face 3 main issues in caring for SSc patients: oral mucosa involvement, manducatory apparatus and mouth involvement responsible for limitations in mouth opening, and treatment-related adverse events. An increased risk of tongue carcinoma has been noted. In patients with severe limitation in mouth opening (<30 mm), recommended treatments are a specific mouth-opening rehabilitation program, flexible sectional dentures, and splint therapy. Indications for dental implants depend on the severity of SSc, comorbidities, and/or ongoing bisphosphonate treatment. Prevention of mouth infections and caries implies patient education and teaching about mouth and dental hygiene, periodontal maintenance, and treatment of sicca syndrome. Cessation of tobacco use is mandatory. Patient-tailored rehabilitation may improve limitations in mouth opening. Systematic dental panoramic radiography allows for the early detection of dental caries. Conclusion. Prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and ongoing treatments.

Orofacial consequences of systemic sclerosis: A systematic review

“…Our findings are consistent with other studies such as the recommendations for the care of oral involvement in patients with SSc published in 2011 (35)…”

“…Our findings are consistent with other studies such as the recommendations for the care of oral involvement in patients with SSc published in 2011 (35) Prevention of mouth infections and tooth decay implies mouth hygiene education, periodontal maintenance and treatment of hyposialia (35)(36)(37). Since SSc is a multi-system Results with * were statistically significant compared to healthy controls according to authors (p < 0.05).…”

Perception of Aesthetic Impairment in Patients With Systemic Sclerosis: A Case Control Study Using a Semi-Quantitative Scale for Body Image Assessment.

“…In 2014, Nguyen et al (23) evaluated the aesthetic impact in patients with SSc using the same scale, but without a control group. The median score in their study was 5 (3)(4)(5)(6)(7), a value close to that of our study, namely 3.9 (1.55-6). Their study focused on the evaluation of anxiety/depressive symptoms in patients with SSc; aesthetic evaluation was therefore secondary but still allowed them to reveal a previously unknown aspect of management of the disease.…”

Fixed Implant Supported Rehabilitation of Partially Edentulous Posterior Maxilla in a Patient With Systemic Scleroderma

“…This is contrary to some removable denture prostheses which may have inhibited home care and increased complications due to lack of removal and insertion associated from a combination of reduced manual dexterity, progressive microstomia, gingival fibrosis, and continued ridge atrophy. 18 The psychological benefits cannot be ignored or minimized. The patient associated the premature loss of her dentition with succumbing to the eventuality of her own disease.…”

“…11-15 Furthermore, patient specific conditions must be considered, including complications from both the disease (microvascular impairment, tissue fibrosis, and reduced rate of osseous turn-over) and medications (frequently, including blood thinners, bisphosphonates, and corticosteroids), which are all risk factors that are contrary to the placement of dental implants. 18 Furthermore, consideration of accessibility and bone quality in the selected region adds an additional degree of potential complication that is not to be underestimated.…”