No abstract

Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p < 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p < 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p < 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile.

Although the relationship between periodontal disease and rheumatoid arthritis (RA) is widely documented, centered by common pathobiologic pathways, the effect of various tumor necrosis factor alpha (TNF) antagonists in modulating not only inflammatory and immune articular damage, but also periodontal microenvironment remain debatable. We aimed to evaluate the periodontal status with and without TNF inhibitors in RA patients and to identify potential relation among these entities. We performed a prospective longitudinal 6-months analysis on 96 RA initiating their first biological therapy. Standard assessments included a dual rheumatologic (RA activity, disability, serological, inflammatory prolife) and dental evaluation such as plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), clinical attachment level (CAL). More than half of RA presented at baseline with chronic periodontitis, as suggested by high prevalence of sites with dental plaque, abnormal BOP, PD and CAL. Advanced inflammatory (CRP, ESR) and immune (anti-cyclic citrullinated peptide antibodies, ACPA) markers were described in RA subsets presenting with aggressive periodontal diseases, while significant correlations between dental pathology, RA activity and ACPA levels were also reported (p[0.05). Furthermore, we revealed significant improvement in both RA-related characteristics and periodontal status after 6 months of anti-TNF therapy (p[0.05). RA, particularly active severe, ACPA positive disease, is essentially accompanied by comorbid periodontal disease. TNF blockade is efficient in patients with active RA and potentially able to modulate the inflammatory process in the periodontal tissue.

The link between immune mediated rheumatic disorders and oral health, particularly periodontal disease, is widely accepted, based on shared immune and inflammatory processes as well as local (articular, gingival) damage mediated by similar pro-inflammatory cytokine and destructive mediators. We aimed to evaluate periodontal status in psoriatic arthritis (PsA) before and after 24-weeks treatment with TNF inhibitors and to identify potential relation between disease activity, inflammatory parameters, therapeutic response and chronic periodontitis. Patients were prospectively assessed according to a standard protocol comprising a complex rheumatologic (PsA activity, inflammatory prolife) and dental evaluation (plaque and gingival index, bleeding on probing, periodontal pocket depth, clinical attachment level). Up to one third PsA presented with moderate to severe periodontitis at baseline, with high prevalence of sites with dental plaque, abnormal bleeding, increased periodontal pocket depth and clinical attachment loss. Higher levels of inflammatory parameters were described in the subset of PsA presenting with aggressive periodontal diseases, while significant correlation between dental pathology and CRP (p[0.05). A significant improvement in both PsA-related parameters and periodontal status was demonstrated after 24 weeks of anti-TNF therapy (p[0.05). Periodontal disease may develop in PsA and should be commonly evaluated, particularly patients with active disease. Benefits of TNF inhibitors, with significant response in articular and periodontal parameters, suggest common inflammatory pathways in both entities.

Background: The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). Methods: We performed a 6-month prospective study in 51 patients with chronic periodontitis and moderate-to-severe RA starting TCZ in accordance with local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and periodontal (visible plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months. Results: We demonstrated significant correlations between periodontal status, disease activity, and serologic biomarkers (p < 0.05). Tocilizumab significantly improved the gingival index scores and decreased the number of sites with bleeding on probing after only 3 months (p < 0.05), while the probing pocket depth significantly decreased after 6 months; overall, clinical attachment loss presented only slight changes without any statistical significance as well as teeth count and plaque levels (p > 0.05). Conclusion: IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, which is essentially related to a dramatic decrease in serum inflammatory mediators.