Disease manifestations of progressive systemic sclerosis: sensitivity and specificity

Janssens, Xavier; Herman, L.; Mielants, Herman; Verbruggen, G.; Veys, Eric

doi:10.1007/bf02330590

Cited by 13 publications

(10 citation statements)

References 17 publications

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“…In rare cases, mandibular resorption may cause neuropathy (34). Finally, wide periodontal ligament spaces, particularly in molar and premolar teeth, as well as dental root resorption, may also occur, although they are rarely reported (23,28,32,(35)(36)(37).…”

Section: Resultsmentioning

confidence: 99%

Recommendations for the care of oral involvement in patients with systemic sclerosis

Alantar¹,

Cabané²,

Hachulla³

et al. 2011

Arthritis Care & Research

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Objective. To review the literature and collect expert advice for proposing preventive and curative treatments of mouth and dental involvement in patients with systemic sclerosis (SSc; scleroderma). Methods. The literature pertaining to mouth and/or dental involvement related to SSc was reviewed, and recommendations were developed according to the suggestions of a French multidisciplinary working group of experts and validated by a lecture committee. Results. Dentists face 3 main issues in caring for SSc patients: oral mucosa involvement, manducatory apparatus and mouth involvement responsible for limitations in mouth opening, and treatment-related adverse events. An increased risk of tongue carcinoma has been noted. In patients with severe limitation in mouth opening (<30 mm), recommended treatments are a specific mouth-opening rehabilitation program, flexible sectional dentures, and splint therapy. Indications for dental implants depend on the severity of SSc, comorbidities, and/or ongoing bisphosphonate treatment. Prevention of mouth infections and caries implies patient education and teaching about mouth and dental hygiene, periodontal maintenance, and treatment of sicca syndrome. Cessation of tobacco use is mandatory. Patient-tailored rehabilitation may improve limitations in mouth opening. Systematic dental panoramic radiography allows for the early detection of dental caries. Conclusion. Prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and ongoing treatments.

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Section: Resultsmentioning

confidence: 99%

Recommendations for the care of oral involvement in patients with systemic sclerosis

Alantar¹,

Cabané²,

Hachulla³

et al. 2011

Arthritis Care & Research

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“…Previous studies have used either measurements of magnified periapical radiographs 15,28 or subjective assessments. 14,17,18,26,27 The two studies that used more than one observer 12,15 did not report a method for resolving conflicts. We found PLS widening in at least one tooth in 38% of the patients with SSc but in only 11% of controls (see Table II), in the range of the reports of similar findings of 33% to 100% in previous studies (see Table III This study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings add substantially to the knowledge in the literature, as none of the previous studies of the estimates of the prevalence of radiographic abnormalities in the jaws in SSc systematically studied all suspected SSc radiographic manifestations (Table III). In addition, the number of patients examined in these studies was generally small, between 15 and 47, [12][13][14]17,18,[26][27][28][29] and controls were used in only seven studies. [12][13][14][15][16][17][18] Another limitation of the previous studies is that the controls were either selected from patients attending the dental clinic, 14 hospital staff, 14 or patients with inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18] Another limitation of the previous studies is that the controls were either selected from patients attending the dental clinic, 14 hospital staff, 14 or patients with inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus. 18 Prevalence estimates had been documented by using a convenience sample in some studies; consequently, selection and information bias may have affected the internal validity of these results. This may have biased these studies against finding abnormalities in the patients with SSc, potentially underestimating the true increased prevalence of oral disease compared with the general population (see Table III).…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only six previous studies have compared patients with SSc to normal controls, [12][13][14][15][16][17] whereas a seventh study used controls with rheumatoid arthritis and systemic lupus erythematosus. 18 The purpose of this carefully performed study in a large sample of patients with SSc was to assess all the previously described individual radiographic manifestations of SSc and to compare the prevalence of these radiographic manifestations with those in the general population. The aim was to present the radiologic results of a heterogeneous population of patients with scleroderma, involving miscellaneous cohorts throughout Canada against a matched general population.…”

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confidence: 99%

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The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population

Dagenais

MacDonald

Baron

et al. 2015

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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Objective-The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population.Study Design-Patients with SSc and healthy controls were enrolled in a multi-site crosssectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph. Radiographs were evaluated by two oral and maxillofacial radiologists tested for interobserver and intraobserver reliability. Chisquared tests, Fisher exact tests, and Mann Whitney U tests were used to summarize the radiologic manifestations of patients and controls.Results-We assessed 163 SSc patients and 231 controls. Widening of the periodontal ligament space (PLS) (P < .001), with higher percentage of teeth with PLS widening (P < .001), was significantly more frequent in patients with SSc than in controls. The most significant differences between the two groups were found in the molars and premolars (P < .001). Moreover, 26% of the patients with SSc had a periapical PLS greater than 0.19 mm compared with 13% of the controls (P = .003). Patients with SSc had significantly more erosions compared with controls (14.5% vs. 3.6%; P < .001), mostly in the condyles (P = .022), coronoid processes (P = .005) and other locations (P = .012). CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusion-Patients with SSc had more teeth with PLS widening and erosions of the mandible compared with controls.Systemic sclerosis (SSc) is a multi-system disorder of connective tissue characterized clinically by thickening and fibrosis of the skin and involvement of internal organs. Prevalence estimates for SSc are between 240 per million 1 and 276 per million 2 in an American population. The incidence rate of SSc is about 20 new cases per million per year. 3 It affects mainly women in their third or fourth decade of life and is associated with significant morbidity and increased mortality. No treatment has been shown to alter the natural history of SSc. 4 SSc is characterized by fibroblast dysfunction, which leads to fibrosis of the skin, internal organs, or both; 5 autoantibodies (anticentromere, antitopoisomerase I, anti-RNA polymerase III); and vasculopathy. 5,6 SSc is usually categorized into limited cutaneous SSc (lcSSc), diffuse cutaneous SSc (dcSSc), and SSc without skin involvement. 6 Although several candidate genes and regions of the genome have been identified as potentially being involved in SSc, these are also associated with other autoimmune conditions. SSc is a complex disease, where no single polymorphism is known to cause the complete manifestation of the condition; it has been suggested that it may be the combined action of several single nucleotide polymorphisms in different genes that may result in the complex traits of the disease. 7 We compared patients with SSc with a control population and demonstrated that oral problems in patients with SSc include decreased oral opening, decreased s...

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Relationship Between Disease Characteristics and Oral Radiologic Findings in Systemic Sclerosis: Results From a Canadian Oral Health Study

Baron

Hudson

Dagenais

et al. 2016

Arthritis Care & Research

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Objective Systemic sclerosis (SSc; scleroderma) is associated with a wide periodontal ligament (PDL) and mandibular erosions. We investigated the clinical correlates of SSc with these radiologic abnormalities. Methods Subjects from the Canadian Scleroderma Research Group cohort underwent detailed radiologic examinations. Associations between radiologic abnormalities and clinical manifestations of SSc were examined with univariate and multivariate analyses. Results The study included 159 subjects; 90.6% were women, the mean ± SD age was 56 ± 10 years, diffuse disease was present in 28.3%, and mean ± SD disease duration was 13.7 ± 8.4 years. Widening of the PDL involving at least 1 tooth was present in 38% of subjects, and 14.5% had at least 1 site in the mandible with an erosion. In analyses adjusting for age, disease duration, sex, smoking, and education, we found significant associations between the number of teeth with widening of the PDL and disease severity assessed by the physician global assessment (PGA) (relative risk [RR] 1.19, 95% confidence interval [95% CI] 1.02–1.39, P = 0.028). Analyses replacing the PGA with the skin score, disease subset, or anti–topoisomerase I antibodies confirmed the relationship with indices of disease severity. There was no relationship between either the number of teeth with periodontal disease or the number of missing teeth, and the number of teeth with wide PDL. A smaller interdental distance (RR 0.89, 95% CI 0.82–0.97, P = 0.006), but not disease severity, facial skin score, or ischemia was associated with a larger number of erosions. Conclusion In SSc, a wide PDL may reflect generalized overproduction of collagen, and mandibular erosions are related to local factors in the oral cavity.

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Disease manifestations of progressive systemic sclerosis: sensitivity and specificity

Cited by 13 publications

References 17 publications

Recommendations for the care of oral involvement in patients with systemic sclerosis

Recommendations for the care of oral involvement in patients with systemic sclerosis

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population

Relationship Between Disease Characteristics and Oral Radiologic Findings in Systemic Sclerosis: Results From a Canadian Oral Health Study

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