References

Abraham DJ, Krieg T, Distler J, Distler O. Overview of pathogenesis of systemic sclerosis. Rheumatology (Oxford). 2009; 48:3-7
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE. Classification Criteria for Systemic Sclerosis. An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Ann Rheum Dis. 2013; 72:1747-1755
Chifflot H, Fautrel B, Sordet C, Chatelus E, Sibilia J. Incidence and prevalence of systemic sclerosis: a systematic literature review. Semin Arthritis Rheum. 2008; 37:223-235
Ioannidis JP, Vlachoyiannopoulos PG, Haidich AB, Medsger TA, Lucas M, Michet CJ Mortality in systemic sclerosis: an international meta-analysis of individual patient data. Am J Med. 2005; 118:2-10
Strickland G, Pauling J, Cavill C, Shaddick G, McHugh N. Mortality in systemic sclerosis – a single centre study from the UK. Clin Rheumatol. 2013; 32:1533-1539
Denton P, Khanna D. Systemic sclerosis – Seminar. Lancet. 2017; https://doi.org/10.1016/S0140-6736(17)30933-9
Mortazavi H, Baharvand M. Review of common conditions associated with periodontal ligament widening. Imaging Sci Dent. 2016; 46:229-237
Alexandridis C, White SC. Periodontal ligament changes in patients with progressive systemic sclerosis. Oral Surg Oral Med Oral Pathol. 1984; 58:113-118
Mehra A. Periodontal space widening in patients with systemic sclerosis: a probable explanation. Dentomaxillofac Radiol. 2008; 37
Nihtyanova S, Ong V, Denton C. Current management strategies for systemic sclerosis. Clin Exp Rheumatol. 2014; 32:S156-S164
Baron M, Hudson M, Tatibouet S. The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population. Rheumatology. 2014; 53:1386-1394
Scardina G, Pizzigatti M, Messina P. Periodontal microcirculatory abnormalities in patients with systemic sclerosis. J Periodont. 2005; 76:1991-1995
Ferreira E, Christmann R, Borba E, Borges C, Siqueira J, Bonfa E. Mandibular function is severely impaired in systemic sclerosis patients. J Oro Pain. 2010; 24:197-202
Pizzo G, Scardina G, Messina P. Effects of a non-surgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Invest. 2003; 7:175-178
Doucet J-C, Morrison AD. Bilateral mandibular condylysis from systemic sclerosis: case report of surgical correction with bilateral total temporomandibular joint replacement. Craniomaxillofac Trauma Reconstr. 2011; 4:11-18
MacIntosh R, Shivapuja P, Naqui R. Scleroderma and the temporomandibular joint: reconstruction in 2 variants. J Oral Maxillofac Surg. 2015; 73:1199-1210
Auluck A, Pai KM, Shetty C, Shenoi SD. Mandibular resorption in progressive systemic sclerosis: a report of three cases. Dentomaxillofac Radiol. 2005; 34:384-386
Mugino H, Ikemura K. Progressive systemic sclerosis with spontaneous fracture due to resorption of the mandible: a case report. J Oral Maxillofac Surg. 2006; 64:1137-1139
Yenisey M, Kulunk T, Kurt S, Ural C. A prosthodontic management alternative for scleroderma patients. J Oral Rehab. 2005; 32:696-700
Hajimahmoudi M, Mostafavi A. A simple and effective method for prosthetic rehabilitation in scleroderma patients: a clinical report. Int J Prosthodont. 2014; 27:169-173
McKenna G, Hayes M, Burke F. Provision of resin bonded bridgework for a patient with microstomia secondary to scleroderma. Eur J Prosthodont Rest Dent. 2012; 20:56-60
Zigdon H, Gutmacher Z, Teich S, Levin L. Full-mouth rehabilitation using dental implants in a patient with scleroderma. Quintessence Int. 2011; 42:781-785

Systemic sclerosis: a case report and considerations for general dental practitioners

From Volume 45, Issue 8, September 2018 | Pages 742-748

Authors

Fiona Wright

BDS, MFDS (RCSEd), PGDip

DCT in Oral Surgery, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK

Articles by Fiona Wright

Eleni Besi

DDS, MFDS (RCSEd) MSc, PGCert, MOralSurg, MDTFEd

StR in Oral Surgery, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK

Articles by Eleni Besi

Nicholas J Malden

BDS, LDS, FDS (RCPSG), DDS

Consultant in Oral Surgery, Edinburgh Dental Institute

Articles by Nicholas J Malden

Abstract

Abstract: Systemic sclerosis is a rare condition but has a high morbidity and mortality rate due to complications associated with the increased deposition of collagen in multi-organ systems. This can result in tightening of the skin, vascular issues and various autoimmune responses. This paper describes a case which was referred into secondary care, where confirmation of systemic sclerosis from the medical history aided the diagnosis of the oral symptoms and allowed appropriate patient management.

CPD/Clinical Relevance: General Dental Practitioners (GDPs) may encounter these patients in primary care and should be aware of the condition and its effects on the mouth.

Article

Systemic sclerosis (SSc) is a rheumatic autoimmune, connective tissue disorder of excess collagen production, which can affect multiple organs, including the vascular, gastrointestinal, renal and musculoskeletal systems. The most prominent features include vasculopathy (fibrosis and disregulation of repair of blood vessels1), fibrosis of the skin and/or internal organs and specific autoantibodies production.2 The true pathogenesis is still unknown, however it has been attributed to genetic, environmental and immune-related factors. The immunological presence in SSc is usually found to involve auto-antibodies and activated lymphocytes, with increased levels of cytokines and growth factors detected.1

SSc tends to present in the 4th and 5th decade of life, with initial presenting symptoms including Raynaud's phenomenon and tightening of the skin. It is a rare condition, with prevalence 140.2 per million3, but it is of importance as this group of patients has a higher mortality and morbidity rate than healthy individuals, namely due to cardiac, renal and pulmonary complications.4,5

Register now to continue reading

Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Up to 2 free articles per month
  • New content available