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

Abstract

Objective-The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population.Study Design-Patients with SSc and healthy controls were enrolled in a multi-site crosssectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph. Radiographs were evaluated by two oral and maxillofacial radiologists tested for interobserver and intraobserver reliability. Chisquared tests, Fisher exact tests, and Mann Whitney U tests were used to summarize the radiologic manifestations of patients and controls.Results-We assessed 163 SSc patients and 231 controls. Widening of the periodontal ligament space (PLS) (P < .001), with higher percentage of teeth with PLS widening (P < .001), was significantly more frequent in patients with SSc than in controls. The most significant differences between the two groups were found in the molars and premolars (P < .001). Moreover, 26% of the patients with SSc had a periapical PLS greater than 0.19 mm compared with 13% of the controls (P = .003). Patients with SSc had significantly more erosions compared with controls (14.5% vs. 3.6%; P < .001), mostly in the condyles (P = .022), coronoid processes (P = .005) and other locations (P = .012). CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusion-Patients with SSc had more teeth with PLS widening and erosions of the mandible compared with controls.Systemic sclerosis (SSc) is a multi-system disorder of connective tissue characterized clinically by thickening and fibrosis of the skin and involvement of internal organs. Prevalence estimates for SSc are between 240 per million 1 and 276 per million 2 in an American population. The incidence rate of SSc is about 20 new cases per million per year. 3 It affects mainly women in their third or fourth decade of life and is associated with significant morbidity and increased mortality. No treatment has been shown to alter the natural history of SSc. 4 SSc is characterized by fibroblast dysfunction, which leads to fibrosis of the skin, internal organs, or both; 5 autoantibodies (anticentromere, antitopoisomerase I, anti-RNA polymerase III); and vasculopathy. 5,6 SSc is usually categorized into limited cutaneous SSc (lcSSc), diffuse cutaneous SSc (dcSSc), and SSc without skin involvement. 6 Although several candidate genes and regions of the genome have been identified as potentially being involved in SSc, these are also associated with other autoimmune conditions. SSc is a complex disease, where no single polymorphism is known to cause the complete manifestation of the condition; it has been suggested that it may be the combined action of several single nucleotide polymorphisms in different genes that may result in the complex traits of the disease. 7 We compared patients with SSc with a control population and demonstrated that oral problems in patients with SSc include decreased oral opening, decreased s...

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

“…In the recent Canadian study that assessed 159 SSc patients and 222 controls, PLS widening affected at least one tooth in 38% of SSc patients compared with 11.1% of controls. The difference remains significant after adjustment for age, gender, ethnicity, education, and smoking status, in particular in premolars and molars (Dagenais et al , ). PLS thickening can be observed in every group of teeth but posterior areas are more frequently involved (Stafne and Austin, ; White et al , ; Marmary et al , ; Alexandridis and White, ; Anbiaee and Tafakhori, ; Dagenais et al , ).…”

Reparative bone‐like tissue formation in the tooth of a systemic sclerosis patient

“…, Dagenais et al . ). External cervical resorption in a systemic sclerosis patient was recently reported as a new manifestation of systemic sclerosis (Arroyo‐Bote et al .…”

Patients' self‐reported measures of oral health—A validation study on basis of oral health questions used in a large multi‐country survey for populations aged 50+

“…Dental diseases are among the most common diseases worldwide and have been shown to be associated with various chronic‐systemic diseases . There is a growing body of evidence which suggests links between dental diseases and cardiovascular diseases, type II diabetes, chronic obstructive pulmonary disease, systemic sclerosis or chronic nephropathies . The effect on individuals' quality of life has also been studied, emphasising the impacts of dental impairments not only on functional but also on psychological and social dimensions .…”