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.

Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review

“…Poole (13) reviewed the evidence for the efficacy of rehabilitation techniques for musculoskeletal impairments in persons with SSc; Casale et al (14) summarized the current management of skin, joints, tendons, muscles, pain, ergonomics, and working interventions in SSc; and Alantar et al (15) reviewed preventive and curative treatments for oral and dental involvement in patients with SSc. However, these reviews did not use a systematic approach to identify and synthesize evidence, did not assess the quality of included studies, and had a narrow scope of nonpharmacologic interventions and outcome measures to be included in the review.…”

Chirurgie implantaire et sclérodermie systémique (ScS) : à propos d’un cas suivi sur 5 ans

“…Cette décision a pu être prise en raison de la bonne coopération du patient et d'une bonne hygiène bucco-dentaire. Dans les atteintes sévères, la diminution des capacités physiques et de la dextérité manuelle dues à la fibrose cutanée [7] peuvent compliquer la maîtrise rigoureuse du contrôle de plaque et contre-indiquer ces traitements. Les parodontopathies ont une incidence plus élevée chez ces patients [6], non seulement pour les raisons d'hygiène dues au handicap fonctionnel, mais aussi en raison de changements sclérotiques (microvascularisation et ischémie tissulaire) au sein du complexe muco-gingival [7,8].…”

“…L'hyposialie est pré-sente chez 70 % des patients atteints de ScS [7], en rapport avec une fibrose des glandes salivaires, ou plus rarement avec un syndrome de Gougerot-Sjögren associé [11]. La sécheresse buccale engendrée peut être aggravée par les reflux gastrooesophagiens et expliquer les ulcérations buccales.…”

Implant-Supported Prosthetic Treatment in a Patient with Systemic Sclerosis: Case Report

“…[2][3][4][5] Turkiye Klinikleri J Dental Sci Cases 2015;1 (3) 183 Sistemik Skleroz Olgusunda İmplant Destekli Protetik Tedavi Uygulaması Ö ÖZ ZE ET T Sistemik skleroz, kan damarlarını, deriyi ve organları etkileyen sistemik bağ dokusu hastalığıdır. Oral bulgular arasında; trigeminal nöropati, kserestomi, kalınlaşmış periodontal ligaman, dilde sklerotik değişiklikler, mikrostomi, diş ve çene kemiklerinde idiyopatik rezorpsiyonlar ve yetersiz oral hijyen varlığı bulunmaktadır.…”

“…2,6 Edirne bölgesinde yapılan bir çalış-mada ise ülkemiz için SSk prevalansı milyonda 110 olarak belirlenmiştir. 7 SSk, kadınlarda erkeklere oranla dört-sekiz kat fazla görülmekte olup sıklıkla 45-64 yaş aralığında ortaya çıkmaktadır.…”