Current Perspectives on Periodontitis in Systemic Sclerosis: Associative Relationships, Pathogenic Links, and Best Practices

Abstract

Systemic sclerosis is a chronic, autoimmune, multisystemic disease characterized by aberrant extracellular matrix protein deposition and extreme progressive microvasculopathy. These processes lead to damage within the skin, lungs, or gastrointestinal tract, but also to facial changes with physiognomic and functional alterations, and dental and periodontal lesions. Orofacial manifestations are common in SSc but are frequently overshadowed by systemic complications. In clinical practice, oral manifestations of SSc are suboptimally addressed, while their management is not included in the general treatment recommendations. Periodontitis is associated with autoimmune-mediated systemic diseases, including systemic sclerosis. In periodontitis, the microbial subgingival biofilm induces host-mediated inflammation with subsequent tissue damage, periodontal attachment, and bone loss. When these diseases coexist, patients experience additive damage, increasing malnutrition, and morbidity. The present review discusses the links between SSc and periodontitis, and provides a clinical guide for preventive and therapeutical approaches in the management of these patients.

Keywords: dental biofilm; pathogenesis; periodontitis; systemic sclerosis.

Figure 1

Schematic view of periodontitis pathogenesis (IL-1 = interleukin-1, TNF-α = tumor necrosis factor α, RANKL = receptor activator of nuclear factor kappa-Β ligand, OPG = osteoprotegerin, MMPs = metalloproteinases) [pictures belong to one of authors (AR) periodontitis database].

Figure 2

More frequent oral problems in SSc patients and the treatment algorithms.