Oral manifestations in systemic sclerosis

Abstract

Background & Aim:  Systemic sclerosis (SS) is an autoimmune disease with multiple organ involvement. The orofacial manifestations include: a mask-like appearance of the face,microstomia ,melanoleukoderma,  telangiectasia, varying degrees of xerostomia which increases liability to caries ,gingivitis , possibly fungal infections, periodontitis;missing and filled teeth .A number of skeletal changes about the face can also arise

The aim of the present study was to  mention the  clinical and radiological manifestations, and  to correlate the clinical variablesof  the disease, mouth opening measurements, presence/absence of teeth and presence/absence of mandibular osteolysis among patients with SS. 

Materials and methods: For this cross sectional prospective study, which was developed in Al-Mouassat University Hospital  , 35 patients were selected. 20 of these individuals had diffuse SS(mean age 38.89 ± 6.91 years)and the other 15 (mean age 33.32 ± 11.85 years) were normal.  All of the 20 subjects underwent oral clinical evaluation ,laboratory tests, and panoramic radiography. The patients with SS(20) were interviewed individually, to gather information such as gender, age, time when the first symptoms appeared and difficulties in opening their mouths, loss of teeth, disease duration, treatments . The patients were classified as possessing a full or a partial set of teeth.  All patients had done :CBC,ALT,AST,Urea, Creatinine,Anti-Centromere antobodies, panoramic radiography .

Results:Twenty individuals had diffuse SS(mean age 38.89 ± 6.91 years)(6M,14F) with a time duration of the disease (5-10)median(7,4±1,6), and the other 15 (mean age 33.32 ± 11.85 years)(4M, 11F) were normal.  The mouth opening distance among SS patients in millimeter was(22-38)median(28±5,8) leading to speech difficulty in 3 patients.  The skin and mucosa pigmentation (melanoleukoderma) was seen in 7 patients, and telangiectasia in 8 patients, hardening of the tongue in 3 patients, varying degrees of xerostomia  in 12 patients without investigations of other criteria of Sjogren syndrome was observed in anticentromere antibodies positive localized cutaneous  forms of systemic sclerosis; total missing teeth was found in6 patients and partial in 9 patients. Gingival enlargement  was seen in a patients treated with nifidepine, for a long time(7 years).  Evolution of radiographic abnormalities like periodontal ligament space widening (n=11  ), or osteolytic lesions (n=3) ,bone resorptions (n=0). A mean measurement ofmouth opening was smaller than in the control group (p = 0.003). Comparing between patients  with osteolysis presented the same mean opening as did the patients  without osteolysis (p = 0.310).The mouth opening in patients group  was correlated to the disease duration  (p = 0.095) and oesophageal involvement (p=0.025). The patients with osteolysis had a moderate tendency towards increased mouth opening over the course of the years (p = 0.095), while among the patients without osteolysis this trend was not observed (p = 0.321).Xerostomia was significantly associated to localised cutaneous form (p=0.045) and to anticentromeres antibodies expression (p=0.002). Dental caries were not more relevant withXerostomia(p=  0,213). That is, osteolysis may develop both in patients with a full set of teeth and in those with only a partial set (p > 0.683). There was a relationship between presence/absence of teeth and duration of the disease (p > 0.039).

keywords: Systenic Sclerosis, oral manifestation; Panoramic radiography.