The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population

Abstract

Objective: The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population.

Methods: SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL.

Results: We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores.

Conclusion: Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

Keywords: Sjögren’s syndrome; dental caries; oral health; periodontal disease; quality of life; systemic sclerosis; tooth loss.

Fig. 1

Anatomy of a tooth Pocket depth (PD) is the distance from the top of the gingival margin to the bottom of the gingival sulcus. In a normal tooth the periodontal ligament is attached to the root at the cemento-enamel junction. Cementum is the bony covering of the root. PD is increased because inflammation of the gingiva elevates the gingival margin and/or the attachment of the periodontal ligament to the cemento-enamel junction is destroyed as the alveolar process is resorbed. CAL is the distance from the cemento-enamel junction to the bottom of the gingival sulcus. CAL cannot be assessed if the cemento-enamel junction is not exposed. It reflects bone resorption, an effect of periodontal disease. Either an abnormal PD or an abnormal CAL reflect periodontal disease, although different stages in the disease process.