Research Underscores Need to Assess Oral Health in Patients with Systemic Sclerosis

Rheumatologists see patients with SSc much more often than a dentist, and patients will complain about their oral opening, dry mouth, and more.
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Oral health is not frequently considered within the sphere of a rheumatologist’s practice. However, recent results published by the Canadian Scleroderma Research Group (CSRG) point out the importance of assessing oral health in patients with systemic sclerosis (SSc).

Result of 3-Year Grant

Between 2008 and 2011, 163 patients with SSc and 231 controls were entered into a multisite, cross-sectional study. “[This study is] the result of a three-year grant from the Canadian Institute of Health Research for ‘The impact of oral–facial manifestations of SSc on health-related quality of life (QoL),’” says Mervyn Gornitsky, FRCD(C), professor emeritus in the faculty of dentistry at McGill University in Montreal, Canada. “Recruitment for both controls and patients was greater in number than had ever been done.”

Seven CCRG sites throughout Canada were involved with recruitment. Dentists from various sites performed detailed, standardized examinations of the oral and dental tissues. X-rays were taken as needed and read by two (blinded) oral radiologists.

Control subjects were drawn from a cohort who were being seen for mechanical joint problems. They were matched by gender and age and were recruited from the same study sites. Over 90% of the cohort was female, with a mean age of 56 years.

Diffuse disease was present in over 28% of the group and the mean duration of disease was 13.7 years. The mean physician global assessment of disease severity was 2.9.

Dr. Gornitsky

Quality of life was measured using the Oral Health Impact Profile. This is a 49-question instrument that looks at seven dimensions of oral health, including functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap.

“Rheumatologists see patients with SSc much more often than a dentist,” says Dr. Gornitsky. “Patients will complain about their oral opening, dry mouth, painful teeth and bleeding gums. Rheumatologists should be asking their patients if they are having trouble chewing and oral health questions with the intent of sending them to their dentist for treatment.” Questions to ask include:

• Do you have problems with your teeth?
• Do you have any problems chewing?
• Are there any sores in your mouth?
• Do you have any symptoms of gastroesophageal reflux disease (GERD)?
• Do you have problems with saliva production or dry mouth?

The research turned up some interesting results for rheumatologists in this sphere.