No abstract

In systemic sclerosis (SSc), mouth and face involvement leads to problems in oral health-related quality of life (OHRQoL). Mouth Handicap in Systemic Sclerosis scale (MHISS) is a 12-item questionnaire specifically quantifying mouth disability in SSc, organized in 3 subscales. Our aim was to validate Italian version of MHISS, by assessing its test-retest reliability and internal and external consistency in Italian SSc patients. Forty SSc patients (7 dSSc, 33 lSSc; age and disease duration: 57.27 ± 11.41, 9.4 ± 4.4 years; 22 with sicca syndrome) were evaluated with MHISS. MHISS was translated following a forward-backward translation procedure, with independent translations and counter-translation. Test-retest reliability was evaluated, comparing the results of two administrations, with intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's α and external consistency by comparison with mouth opening. MHISS has a good test-retest reliability (ICC: 0.93) and internal consistency (Cronbach's α:0.99). A good external consistency was confirmed by correlation with mouth opening (rho: -0,3869, p: 0.0137). Total MHISS score was 17.65 ± 5.20, with scores of subscale 1 (reduced mouth opening) of 6.60 ± 2.85 and scores of subscales 2 (sicca syndrome) and 3 (aesthetic concerns) of 7.82 ± 2.59 and 3.22 ± 1.14. Total and subscale 2 scores are higher in dSSc than in lSSc. This result may be due to the higher presence of sicca syndrome in dSSc than in lSSc (p = 0.0109). Our results support validity and reliability in Italian SSc patients of MHISS, specifically measuring SSc OHRQoL.

Background: Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening. Methods: A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2). Results: Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total ( p = 0.00178] and for MHISS Mouth opening ( p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed. Conclusion: The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects.

No abstract

Background In SSc patients, microstomia is frequent and impairs mouth function. It may be due to fibrosis of skin face and to changes in TMJ, scarcely evaluated and treated with rehabilitation in SSc. Objectives To evaluate, in SSc patients (pts) with microstomia due to TMJ dysfunction, the efficacy of 2 rehabilitation protocol. Methods We enrolled 26 SSc pts (22 women, 4 men; age and disease duration: 59.08±10.31 and 13.65±5.71 years) with microstomia and TMJ dysfunction. Group 1 (13 pts) was treated by Protocol 1 (P1) (home exercises for mimic, masticatory and neck muscles; 20 minutes/day, 3 days/week) and group 2 (13 pts) was treated by Protocol 2 (exercises plus face and neck,connective tissue massage, Kabat technique for mimic muscles, manual techniques -intra- and extra-oral manipulation of TMJ, stretching and mobilization of cranio-cervical muscles-; 1 hour/week). Pts were evaluated at T0, at T1 (end of treatment; week 12) and at T2 (at 8 weeks of follow-up) by: Helkimo Index (Anamnestic -A-dysfunction -D- and occlusal-O- index), for TMJ dysfunction; mobility of cervical rachis (cm) and mouth (ROM) (mm); SSc face involvement (facial skin score; Mouth Handicap in SSc scale–MHISS-). Results At T1, both protocols improved Helkimo A index and Helkimo O Score, while only protocol 2 improved Helkimo D (p<0.05).Mouth left lateralization and protrusion were improved by both protocols while mouth opening and right lateralization were increased only by P2 (p<0.05). At T1, P1 improved cervical anterior flexion and left rotation (p<0.05), with the latter result confirmed at T2 versus (vs) T0 (p<0.01), P2 ameliorated cervical right lateralization, while both protocols improved cervical left lateralization, right rotation and extension (p<0.05), with the latter result confirmed at T2 vs T0 for P1 and P2 (p<0.05). Both protocols reduced facial skin score at T1 (p<0.01), with the results confirmed at T2 vs T0 for both treatments (p=NS). P2 also improves at T1 vs T0 values of MHISS (p<0.05). T0 T1 T2 PT0/T1 P T0/T2 PT1/T2 Helkimo A P1 1.42±0.51 1.08±0.67 1.25±0.62 <0.05 NS NS P2 10.57±4,58 5.64±2,17 9.28±5,73 <0.05 NS NS Helkimo D P1 11.17±4.63 9.08±5.64 10.42±5.35 NS NS NS P2 10.57±4,58 5.64±2,17 9.28±5,73 <0.05 NS NS Helkimo score O P1 2.68±0.49 2.33±0.78 2.50±0.67 <0.05 NS NS P2 2.50±0.65 1.78±0.42 2.36±0.63 <0.01 NS <0.05 Mouth opening P1 42.83±9.51 44.42±13.83 45.08±9.18 NS NS NS P2 44.79±9.17 51.57±8.8 50.57±9.06 <0.001 <0.01 NS Mouth protrusion P1 7.5±2.47 10.63±2.42 9.08±2.61 <0.001 <0.05 <0.05 P2 7.21±2.63 8.71±2.16 8.5±1.74 <0.05 NS NS Cervical anterior flexion P1 3.92±1.16 3.00±0.47 3.54±0.78 <0.05 NS NS P2 3.03±1.47 2.18±1.25 2.5±1.27 NS NS NS Cervical extension P1 18.50±2.81 21.58±2.94 22.46±1.96 <0.001 <0.001 NS P2 17.64±2.5 19.79±1.80 19.86±2.98 <0.05 <0.05 NS Facial Skin Score P1 6.33±2.74 3.83±1,90 4.33±2.01 <0.001 <0.01 NS P2 6.43±2.44 2.93±1.94 3.0±2.07 <0.001 <0.001 NS MHISS P1 22.92±10.73 21.58±9.24 18.42±9.43 NS NS NS P2 22.43±10.43 13.64±7.81...