| Dental Involvement |
| These symptoms may occur by themselves or along with systemic scleroderma but not in localized scleroderma, such as linear and morphea. This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it. See Disclaimer. |
| |
| Overview of Dental Involvement |
| Systemic sclerosis (SSc), commonly known as scleroderma, can cause numerous dental problems when it affects the face and mouth. Skin tightening can cause the mouth to become smaller (microstomia), as well as TMJ and trigeminal neuralgia. |
| Scleroderma is often accompanied by dryness of the eyes, skin and mucous membranes (Sjogren's syndrome) and the resulting dry mouth (xerostomia) may result in increased cavities, gum disease, and difficulty chewing and swallowing. |
| Manifestations of Scleroderma includes good photos of scleroderma oral and dental involvement. It also has a good overview of scleroderma. Université de Genève. |
| Oral complaints in progressive systemic sclerosis: two cases report. Aesthetic and facial dysfunction are followed by important oral and facial manifestation of disturbances such as xerostomia, the lack of saliva in the mouth, and its associated complications. (PubMed) Med Oral Patol Oral Cir Bucal. 2008 Feb 1;13(2):E114-8. (Also see: Diffuse Scleroderma ) |
| Factors related to oral hygiene in persons with scleroderma. Subjects with poor oral hygiene required more time to complete manual dexterity tasks and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. PubMed. Int J Dent Hyg. 2005 Feb;3(1):13-7. |
| Bone Reabsorption of the Mandible (Lower Jaw) |
| Scleroderma can loosen teeth by causing the ligament around the teeth to expand due to collagen deposition. When the ligament expands, the teeth are less supported by bone structure. Dental implants work well in these instances. |
| Mandibular resorption, an underdiagnosed manifestation of systemic scleroderma. Mandibular resorption is a rare but probably underdiagnosed manifestation of SSc. In addition to its esthetic effects, it can cause severe disability. PubMed. Presse Med. 2006 Apr;35(4 Pt 1):611-4. |
| Mandibular resorption in progressive systemic sclerosis: a report of three cases. Mandibular resorption in systemic sclerosis is relatively uncommon and is reported only in 10% of cases. Panoramic radiographs are essential for early detection of resorption in the mandible to prevent possible consequences like pathological fractures, osteomyelitis and neuropathies. PubMed. Dentomaxillofac Radiol. 2005 Nov;34(6):384-6. |
| Candida (Fungal Infection) |
| Due to dry mouth, Scleroderma patients are very prone to Candida infections. |
| Dental Amalgam and Autoimmune Disease |
| Dental amalgam as one of the risk factors in autoimmune diseases. Results imply that, in some patients with thyroiditis, mercury from dental amalgam can stimulate the production of antinuclear antibodies. Dental amalgam may be a risk factor in some patients with autoimmune disease. PubMed. Neuroendocrinol Lett 2003 Feb-Apr;24(1/2):65-67. (Also see: Causes of Scleroderma, Thyroiditis, and Antibodies) |
| ToxFAQs for Mercury Exposure to mercury occurs from breathing contaminated air, ingesting contaminated water and food, and having dental and medical treatments. Mercury, at high levels, may damage the brain, kidneys, and developing fetus. Agency for Toxic Substances and Disease Registry, Centers for Disease Control (CDC). |
| Is there a medical test to show whether I have been exposed to mercury? Tests are available to measure mercury levels in the body. Blood or urine samples are used to test for exposure to metallic mercury and to inorganic forms of mercury. Mercury in whole blood or in scalp hair is measured to determine exposure to methylmercury. Your doctor can take samples and send them to a testing laboratory. Agency for Toxic Substances and Disease Registry, Centers for Disease Control (CDC) |
| Increased Prevalence of Scleroderma in Southwestern Ontario: A Cluster Analysis The cluster in Woodstock seems statistically validated. Associations with alcohol and dental fillings require further study. The Journal of Rheumatology VOLUME 29: NO. 9 SEPTEMBER 2002. |
| Dental Caries (Cavities) |
| Reflux (heartburn) can rot your teeth. Make sure your reflux is adequately treated. Use SonicCare toothbrush, floss regularly. Have molds made for your teeth, and use them to apply fluoride gel daily. |
| Dental Fears, Difficulties and Phobias |
| How to Deal with a Bad Gag Reflex. Quite a few people have a sensitive gag reflex. This can be very upsetting when you want to have dental treatment. Gagging can be due to psychological factors, or physiological factors, or both. Psychological factors can include fear of loss of control and past traumatic experiences. Dozens of tips for dealing with a gag reflex. Dental Fear Central. |
| What is Dental Phobia? Dental phobia causes a lot of distress, and impacts on other aspects of the individual's life, not just their oral health. We'll help you realize you are not alone with your fears; identify your fears; and provide concrete, hands-on tips and suggestions for overcoming them. Dental Fear Central. |
| 5 advances that make a trip to the dentist easier. While pointy objects and numb lips are still part of the dentistry equation, the antiseptic atmosphere has given way to technological wonders and warm fuzzies. The days of pliers and a shot of whiskey are worlds away. dallasnews. 06/14/08. |
| Scleroderma: considerations for dental hygienists. Appropriate dental hygiene management of patients with this autoimmune disorder requires an understanding of clinical characteristics, the recognition of oral facial involvement, treatment considerations and pharmacological interventions. SL Tolle.(Blackwell Synergy) Int J Dent Hygiene 6, 2008; 77–83. |
| Dental Implants |
| Scleroderma and Dental Implants. I have treated a scleroderma patient with implants, and one with conventional dentistry, and everything went fine. OsseoNews. 05/24/06. |
| Implants in Patients with Sjogren’s Syndrome? I have a 62 year old female patient with Sjogren’s syndrome. Has anyone had the experience placing implants into people with Sjogren’s syndrome. OsseoNews. 05/05/08. (Also see: Sjogren's Syndrome ) |
| Denture Problems |
 Dry mouth, infections, and mouth ulcers may make denture wearing difficult for Scleroderma patients. Schedule frequent exams and use artificial saliva. Clean and soak dentures every night, and never wear them while sleeping. | | The Eastflex Bridge is a new type of bridge which is minimally invasive, and suitable for those with special medical conditions. | |
| Fabricating sectional-collapsible complete dentures for an edentulous patient with microstomia induced by scleroderma. Sectional-collapsible maxillary and sectional mandibular complete dentures were fabricated by means of sectional trays. With the use of palatal midline hinge and stud attachments, the sectional dentures were successfully and easily inserted and removed. PubMed. Quintessence Int. 2007 Jan;38(1):15-22. |
| The short-term efficacy of osseointegrated implants in patients with non-malignant oral mucosal disease: a case series. This report details the implant placement outcomes in three patients with pre-existing oral mucosal disease. PubMed. Oral Dis. 2006 Sep;12(s1):11. |
| A prosthodontic management alternative for scleroderma patients. Sectional mandibular and maxillary trays and a collapsed mandibular denture were fabricated for the total edentulous patient. With the use of lingual midline hinge, the collapsed denture was successfully and easily inserted and provided adequate function in the patient's mouth. PubMed. J Oral Rehabil. 2005 Sep;32(9):696-700. |
| Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren's syndrome. Palatal mucous saliva may help stabilize the maxillary complete denture in patients with hyposalivation. The results suggest that neither UWS (unstimulated whole saliva) or PS (palatal saliva) flow rate are influenced by the placement of new dentures in complete denture wearers. PubMed. J Prosthet Dent. 2004 Jun;91(6):577-81. (Also see: Sjogren's Syndrome) |
| Microstomia (Small Mouth) |
| Scleroderma can cause the mouth area to shrink and harden, which can impair chewing, brushing, flossing, and dental work. Facial exercises can help; ask you dentist or physical therapist for mouth exercises. Use child-size toothbrushes. Try to find a dentist familiar with Scleroderma dental problems. |
| Dentists should use pediatric-size molds for impressions, provide tooth rests to ease the stress of keeping your mouth open, and arrange hand-signals for the patient to signal any discomfort during dental procedures. |
| For tooth extractions, see an oral surgeon so that the jaw can be relaxed manually while you are under anesthesia. |
| Scleroderma Lips: Deep lines around the lips worry many scleroderma sufferers but unfortunately collagen injections and laser treatment are not advisable as they may cause scarring. Tightening of the skin of the face may lead to microstomia - a small mouth. Facial and mouth exercises may help. "Disappearing lips" can be a very upsetting cosmetic problem and a reputable plastic surgeon may be able to perform an operation called a mucosal advancement. (Expired article from Royal Free Hospital web site.) |
| Small Mouths…Big Problems? A Review of Scleroderma and its Oral Health Implications. Common oro-facial findings include xerostomia, gastroesophageal reflux disease and limited mouth opening. This review article describes scleroderma, or PSS, and its various manifesta- tions. Concerns relevant to the prevention of dental disease and the safe delivery of dental care in this group of challenging patients are emphasized. University of Toronto, 2007. |
| Application of cast iron-platinum magnetic attachment to sectional collapsed complete dentures for an edentulous patient with microstomia: A clinical report. This clinical report describes the prosthodontic treatment of an edentulous patient with microstomia induced by scleroderma using cast Fe-Pt magnetic attachments. Texas A&M University System, Baylor College of Dentistry. |
| Oral rehabilitation of a patient with scleroderma associated with systematic lupus erythematosus (SLE): a case report. A new approach was required for this patient with SLE who had a very limited mouth opening. The retention for the removable partial denture (RPD) used the undercut in the abutment teeth and a magnet-retained sectional RPD. P ubMed. Spec Care Dentist. 2006 May-Jun;26(3):121-3. (Also see: Lupus ) |
| Deep phenol peeling and fat injection: treatment option for perioral wrinkles in a scleroderma patient. Based on our experience, this intervention may be suggested for patients suffering from scleroderma after a detailed explanation of the possible wound healing difficulties is provided to the patients. PubMed. Dermatol Surg. 2005 Jul;31(7 Pt 1):777-9. |
| Prosthetic rehabilitation for a patient with microstomia: a clinical report. This clinical report describes the fabrication of a collapsible maxillary removable complete overdenture using a sectional impression tray technique and a custom-made palatal hinge mechanism for a partially edentulous woman with microstomia resulting from scleroderma. PubMed. J Prosthet Dent. 2004 Oct;92(4):322-7. |
| Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma. At the end of the 18-week period, all patients commented that eating, speaking and oral hygiene measures were easier. These findings suggest that regular application of the proposed exercise program may be useful in the management of microstomia in SSD patients. PubMed. Clin Oral Investig. 2003 Sep;7(3):175-8. |
| Scleroderma is a rare connective tissue disease of unknown origin. The main oral manifestation of scleroderma is microstoma, which is a limiting factor in oral selfcare and professional oral health care. PubMed. Ned Tijdschr Tandheelkd. 2003 Nov;110(11):457-9. |
| Marthie D: CREST Scleroderma I live in a small town, which developed around a chemical and petrochemical industry in this area in South Africa... |
| Neelam: Systemic Sclerosis (India) In December 1998 my right pointer finger started becoming blue and was hurting a lot... |
| Periodontal Disease |
| Due to dry mouth and hygiene difficulties, Scleroderma patients are at increased risk for periodontal disease. |
| Sensitive Teeth |
| Gel-Kam by Colgate is a fluoride preventive treatment gel which is available over the counter. It comes in two forms-a gel you apply with your toothbrush or an individual treatment which has it's own applicator. It is available in several flavors. |
| Sjogren's Syndrome |
| About twenty percent of patients with systemic scleroderma also have Secondary Sjögren's Syndrome. Hallmark symptoms of Sjögren's include dry eyes and dry mouth, however in some cases Sjögren's can also affect the skin, lungs, heart, kidneys, muscles, central nervous system, etc. (Also see Sjogren's Syndrome) |
| Related Topic: Sjogren's Syndrome ISN. |
| TMJ (Temporo-Mandibular (Jaw) Joint |
| Scleroderma can cause TMJ (Temporo-Mandibular Joint) involvement. |
| Temporomandibular Joint Disorder and Other Medically Unexplained Symptoms in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia. It would be helpful if clinicians would resume using and teaching tender point assessments in patients whose unexplained symptoms may be due to referred pain. J. Rheumatol. 2005 Dec;32:2288. Editorial: Hugh A Smythe, MD, FRCPC. (Also see: Fibromyalgia ) |
| Tinnitus is ringing or noise in the ear, which is often caused by TMJ problems. |
| Tinnitus: Treatment and Relief by Jack A. Vernon. A good book for both patients and practitioners. It covers nearly everything known about tinnitus (extraneous noise in the ears; which is often referred to as "ringing in the ears" and is sometimes related to dental or TMJ problems.) |
| The TMJ Association features support and resources for TMJ patients. |
| Related Topic: Autoimmune Ear Disease ISN. |
| Tongue Cancer |
| Sixty Fold Increase in the Incidence of Squamous Cell Carcinoma of the Tongue in Patients with Systemic Sclerosis. Potential causative agents may be chemical substances ingested through the oral route, possibly triggering both cancer and systemic sclerosis (SSc), or an oral based viral infection due to the immunocompromised state of SSc. C. T. Derk. FRI0098 EULAR 2003 (Also see: Associated Conditions: Cancer) |
| Trigeminal Neuralgia |
| Trigeminal neuralgia (TN—tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. Trigeminal Neuralgia Association. |
| Xerostomia (Dry Mouth) |
| People with dry mouth are more likely to get periodontal disease, cavities, and dental infections. Dry mouth can also make it difficult to eat, speak, or swallow. Drink at least eight glasses of water a day, and drink water during meals to ease painful chewing and swallowing. |
| Increase saliva by using saliva substitutes, gargling or sipping club soda, or using sugar-free lozenges or gum. Brush and floss diligently. Avoid dry, spicy or acidic foods and tobacco and alcohol as these have a drying effect. Instead, eat foods such as gelatins, yogurt, potatoes and melons. |
| Use Biotene toothpaste, mouthwash, ointment, and chewing gum or similar products, which you can buy over-the-counter or on the Internet. |
| Related Topic: Sjogren's Syndrome ISN. |
| See Also |
| En Coup de Sabre. When the face or scalp is affected with linear morphea, the involvement is often compared to a stroke from a sword (sabre), usually on the paramedian forehead. En coup de sabre is almost always unilateral, but rare bilateral cases have been reported. Loss of the eyebrow or eyelashes, ptosis, pseudo-oculomotor palsy, uveitis, asymmetry of the tongue, altered dentition, and dental caries may also occur. Mayo Clinic. (Also see: Localized Scleroderma: En Coup de Sabre ) |
| Academy of General Dentistry. Ask a dentist a question on Smileline, find a dentist and get the latest consumer information. |
| Dental Involvement in Systemic Scleroderma, includes excellent photos of scleroderma oral and dental involvement, and includes an overview of scleroderma. UNIVERSITé DE GENÈVE FACULTé DE MéDECINE. |
| Mouth Problems Use this chart to determine possible causes of pain, swelling, discolored patches, and much more. familydoctor.org. |
| Polysystemic autoimmune diseases often cause orofacial and stomatognathic symptoms. Inflammation of the temporomandibular joint only rarely and slightly reduces the range of mouth opening (rheumatoid arthritis), which is much more restricted in systemic sclerosis due to fibrosis of perioral soft tissues. Weakness of masticatory and pharyngeal muscles in idiopathic inflammatory myopathies results in dysphagia and dystonia. PubMed. Fogorv Sz 2003 Feb;96(1):9-15. |
| Tooth Development. For human teeth to have a healthy oral environment, enamel, dentin, cementum, and the periodontium must all develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth weeks in utero, and permanent teeth begin to form in the twentieth week in utero.[1] If teeth do not start to develop at or near these times, they will not develop at all. Wikepedia. |
| Tooth Problems A tooth that causes ongoing pain can be due to a serious problem. Use this chart to determine if an immediate exam is needed. familydoctor.org. |
| Scleroderma/Lupus Oral Care fact sheet by Dr Chris Daly (Periodontist) HAPS, NSW. |
| Personal Stories About Dental Involvement |
| Craig R: CREST Scleroderma I had my first scleroderma symptoms at age twenty-two, which included severe Raynaud's with some ulceration and tissue loss... |
| Related Books |
| Dental First Aid for Families by Richard Diamond. What to do for toothaches, lost caps, broken dentures, cut lips, canker soes, cold sores, bad breath, etc. With this book and the recommended first aid supplies, you'll be prepared for your next dental emergency. |
| Tinnitus: Treatment and Relief by Jack A. Vernon. A good book for both patients and practitioners. It covers nearly everything known about tinnitus (extraneous noise in the ears; which is often referred to as "ringing in the ears" and is sometimes related to dental or TMJ problems.) |
