Early diagnosis of progressive systemic sclerosis (scleroderma) from a panoramic view: report of three cases

Abstract

Systemic sclerosis (scleroderma) is a multisystem disease involving the skin, lungs, heart, kidneys and gastrointestinal tract. It is probably owing to a disorder of the immune system. It may also have some oral manifestations, including limited ability to open the mouth, widening of the periodontal ligament (PDL) space and mandibular bone resorption. We report here on three asymptomatic cases that were referred to our oral and maxillofacial radiology centre for another reason, and in which we suspected scleroderma based on the widening of the PDL in the panoramic view. The early diagnosis was finally confirmed by pathological findings.

Review of common conditions associated with periodontal ligament widening

“…It is a disease of middle age (30 to 50 years), and is 3 times more frequent in women than men 4. Oral manifestations of progressive systemic sclerosis include limitation in mouth opening, xerostomia, periodontal disease, increase in the width of the PDL, and mandibular bone resorption 35. The most common oral radiographic finding of progressive systemic sclerosis is an increase in the width of the PDL occurring in about two-thirds of patients.…”

“…The affected PDL space usually is at least twice as thick as normal, and both anterior and posterior teeth are involved 4. The incidence of PDL widening in patients with progressive systemic sclerosis varied from 7% by Stafne to 100% by Marmary et al3637 In a recent study, Anbiaee and Tafakhori35 argued that progressive systemic sclerosis should be considered in the differential diagnosis in patients with PDL widening and intact lamina dura, especially in posterior immobile teeth when widened PDL is found in more than 1 quadrant (Fig. 7).…”

Scleroderma and dentistry: Two case reports

“…Our patient also exhibited Raynaud’s phenomenon, along with other cardinal features, which are the most common and earliest manifestations of the disease in 95 % of cases, as suggested by Lester et al . [14] and other authors [6]. Localized scleroderma/morphea is more common in white women with a female to male ratio of 2 to 4:1 and an incidence rate of 0.3 to 3 cases per 100,000 individuals/year.…”

“…However, some articles have mentioned acrosclerosis (scleroderma of the peripheries associated with Raynaud’s phenomenon) as a third form [5, 6]. Morphea (localized scleroderma) is again subdivided into five types, namely: plaque, generalized, bullous, linear, and deep [7, 8].…”

“…Oral and facial tissues are the most affected, manifesting as the characteristic mask-like face (Mona Lisa face), constricted lips (fish mouth), a narrowing and stiffening of the tongue (chicken tongue), microstomia, pseudoankylosis, resorption of the mandibular angle, xerostomia, dental caries, and a widening, radiographically, of periodontal ligaments [2, 13]. Oral ulceration, secondary to gastroesophageal reflux disease (GERD), is also reported in some cases [6]. Most of the time, as a result of these manifestations, patients visit dentists for these aesthetical and facial dysfunctions.…”