Reduced salivary flow and caries status are correlated with disease activity and severity in patients with diffuse cutaneous systemic sclerosis

Abstract

Objective: To analyze the correlations of saliva production and pH value with disease activity, disease severity, and oral health-related quality of life in patients with diffuse cutaneous systemic sclerosis (dcSSc) without concomitant Sjögren's syndrome (SS) or SS-related antibodies.

Methods: This cross-sectional study included 28 patients with dcSSc and matching healthy controls. Sialometric assessment and caries status were compared between the two groups. Clinical and laboratory parameters were used to evaluate disease severity, in accordance with the Medsger Severity Scale.

Results: In patients with dsSSc, reduced saliva production and higher pH value were associated with disease activity and severity; moreover, caries status was correlated with SSc disease characteristics, including disease duration and disease severity. Oral health-related quality of life was negatively correlated with mean salivary flow rate.

Conclusions: These findings contradict the existing notion that reduced saliva production in patients with SSc is linked to SS-related antibodies or caused by underlying SS. In addition, patients with dcSSc exhibit elevated risk of cardiovascular disease and invasive dental treatment has been shown to enhance the rates of stroke and heart attack in the general population; therefore, oral health is particularly important in patients with SSc.

Keywords: Diffuse cutaneous systemic sclerosis; activity; caries; salivary flow; severity; tooth status.

Figure 1.

Correlations in patients with dsSSc between (a) USF rate and disease activity (ρ = −0.375, P = 0.025), (b) USF rate and mRSS (ρ = −0.416, P = 0.045), (c) resting salivary pH value and disease activity (ρ = 0.389, P = 0.020), (d) resting salivary pH value and mRSS (ρ = 0.550, P = 0.003), (e) DMFT index and disease activity (ρ = 0.477, P = 0.005), and (f) DMFT index and mRSS (ρ = 0.384, P = 0.022). Abbreviations: dcSSc, diffuse cutaneous systemic sclerosis; DMFT, decayed, missing, filled teeth; mRSS, modified Rodnan skin score; USF, unstimulated salivary flow.