Evaluation of oral health in 148 patients with systemic sclerosis-data from a prospective interdisciplinary monocentric cohort

Abstract

In daily rheumatology practice, systemic sclerosis is primarily regarded as a potentially life-threatening disease characterized by fibrosis of various organs. Therefore, other manifestations, such as orofacial involvement, are often not of primary concern. Furthermore, due to its rarity, the disease might not be well known by dentists, which contrasts with the increased risk of various problems in the oral cavity. Periodontitis in particular is a known risk factor for morbidity and mortality and is associated with various systemic diseases. The risk of periodontitis appears to be increased in patients with systemic sclerosis, but little is known about the gender-specific differences. This study aims to elucidate the health-conscious behaviour of patients, their dental care and the risk of periodontitis with regard to gender-specific differences. This descriptive study of the Interdisciplinary Centre of Rheumatic Diseases (INDIRA) in collaboration with the Department of Orthodontics at the University Hospital of Tuebingen, Germany, examined the data of 148 patients with systemic sclerosis with regard to their oral health using a questionnaire and evaluating the risk of periodontitis with the DG Paro self-assessment score in this cohort. Among the participating patients, 90% reported regular visits to the dentist and good dental care. Nevertheless, more than half of the patients had missing teeth and problems opening their mouths. Sicca symptoms in the oral cavity were also common (40%). The risk of periodontitis among female participants was high (around 60%), and even higher among male study participants (around 80%). Gingival bleeding as a surrogate parameter for periodontitis was associated with salivary flow and the modified Rodnan skin score (mRSS). Despite a high awareness of dental health, we observed a high risk of periodontitis, especially in male patients with systemic sclerosis. In addition, the association between xerostomia and missing teeth as well as gingival bleeding and mRSS may indicate an increased risk in patients with a more progressive disease. We would therefore recommend regular dental consultations and careful oral hygiene for patients with systemic sclerosis in addition to the-more organ-focused-regular examinations of patients.

Keywords: Dental hygiene; Oral manifestations; Periodontitis; Surveys and questionnaires; Systemic sclerosis.

Fig. 1

Comparison of female (n = 111) and male patients (n = 37) with systemic sclerosis. A Male patients showed a higher risk for periodontal disease (p < 0.001) using the self-reported questionnaire from the German Society of Periodontology and B the number of patients visiting the dentist at least once per year compared to never or only in case of complaints was also significantly lower in the male group (p < 0.05)

Fig. 2

Violin plot, illustrating patient-reported outcome on the severity of xerostomia, reduced salivary flow and impairment of oral hygiene through xerostomia on a visual analogue scale (VAS) [0 = no xerostomia/no saliva/no impairment to 10 = very strong xerostomia/normal amount of salivary flow /severe impairment in daily oral hygiene]. Dashed lines report median and dotted lines quartiles