How do you treat a patient with scleroderma who has periodontal issues – advanced recession, stripping of the attached gingiva from the roots?
This question was submitted by a general dentist: How do you treat a patient with scleroderma who has periodontal issues – advanced recession, stripping of the attached gingiva from the roots?
Dr. George Sandor, DDS MD and Dr. Suham Alexander, Oasis Clinical Editor provided this initial response.
Systemic Scleroderma
Systemic scleroderma is a relatively rare condition that affects ~19/1,000,000 adults annually. Women experience the condition 3 times more than men. A vasoconstrictive event known as Raynaud’s phenomenon is often one of the first signs of the disease which is precipitated by emotional distress or exposure to cold. (It should be noted that Raynaud’s phenomenon is also associated with other immune-mediated conditions and in healthy individuals.)
Other features of the disease include:
- Claw-like fingers (resorption of terminal phalanges and flexion contractures)
- Ulcerations on fingertips (abnormal collagen deposits)
- Smooth and hardened texture of the skin
- Pinched appearance of the nose
- Fibrosis of the heart, lungs, kidneys ultimately leading to organ failure
Oral Manifestations and Radiographic Findings
- Limitations in opening the mouth due to collagen deposition in perioral tissues (microstomia)
- “Purse string” appearance of the mouth
- Loss of attached gingiva
- Several areas of gingival recession
- Dysphagia
- Xerostomia
- Varying degrees of PDL widening throughout dentition
- Varying degrees of bone resorption – chin, coronoid process, posterior ramus
Dental Management
Currently, treatments are aimed at limiting the progression of the disease. D-penicillamine is used to treat skin sclerosis as it affects collagen formation and may be beneficial in managing systemic sclerosis, as well.
Patients with this condition may have difficulty in maintaining their oral hygiene due to sclerotic changes affecting their motor skills. Additionally, patients may find wearing dental prostheses increasingly awkward due to microstomia and decreased elasticity of the mouth.
Physical and occupational therapy to increase the range of motion and minimize the formation of contractures is recommended. Patients may benefit rarely from a bilateral commissurotomy to widen the opening of their mouth.
It is vital for these patients to maintain their oral health. Clinicians should educate and reinforce the importance of oral hygiene and encourage regular and frequent dental examinations and recare appointments.
References
- Albilia JB, Lam DK, Blanas N, Clokie CML, Sándor GK. Small mouths…Big problems? A review of scleroderma and its oral heath implications. Journal of the Canadian Dental Association. November 2007; 73(9): 831-836.
- Neville, BW, Damm, DD, Allen, CM, Bouquot, JE. Oral and Maxillofacial Pathology. 2009. Saunders Elsevier. St. Louis, Missouri.
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