“This addresses what are really often mental health issues,” noted Dr. Gornitsky. “The aesthetics are as important to OHRQoL as other concerns. People don’t want to be without teeth and want their teeth to look good.”
Both experts say that it is important for rheumatologists to get their patients to the dentist if they have any suspicion of oral health problems.
Dr. Baron
“We don’t think about this a lot, but to the patient it is obviously very important,” says Dr. Baron. “These results are a wake-up call and physicians need to start thinking about oral health in their patients.”
Although the suggestion is to get your patient to a dentist that may, in many areas, be much easier said than done. There are very few dentists who are knowledgeable about the disease and how it impacts on teeth. There are also some manifestations of the disease itself that make it harder to locate the appropriate practitioner.
“You have to find dentists who are comfortable with these patients,” notes Dr. Baron. “SSc tends to make the mouth opening small, and it is hard to maneuver inside the mouth. It takes quite a bit of skill on the part of the dentist.”
Grow Your Own Dentists
The chances are that in a lot of communities you aren’t going to find dentists with experience in the care of SSc patients. It may mean the rheumatologist has to essentially “grow their own” oral health practitioners by finding someone who is interested in these patients and in developing the expertise and learning as they go.
There are often SSc treatment centers in university settings. These centers are likely to have dentists familiar with the disease. Scleroderma self-help groups would also be aware of dentists willing and able to treat patients. These sources could be used as resources both to send patients to and to direct community dentists who are looking for help, training and mentors.
Help for Patients
Rheumatologists can do some things to help their patients. Stress the importance of oral hygiene. Talk with patients about using topical fluorides in soaking trays for 10 to 15 minutes a day. This alone can help substantially reduce tooth decay. Dry mouth can be addressed by suggesting the patient chew sugar-free gum and hard candies, limiting caffeine intake, stop all tobacco use and sip water regularly. There are also many over-the-counter saliva substitutes and mouthwashes designed specifically for dry mouth concerns. SSc can also have an impact on the hands, which can in turn make it hard to properly brush the teeth. Dr. Gornitsky suggests putting a hole in a tennis ball and putting the toothbrush in the hole so it can be more easily held.
