Microstomia (Small Mouth) and Systemic Sclerosis (SSc)

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Digital Dentistry
Microstomia Personal Stories


Microstomia (Small Mouth) in a Scleroderma Patient, ISN Photo RepositorySystemic scleroderma can cause the mouth area to shrink and harden, which can impair chewing, brushing, flossing, and dental work. Facial exercises can help; ask your dentist or physical therapist for mouth exercises. Use child-size toothbrushes. Try to find a dentist familiar with scleroderma dental problems. (Also see What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)

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.)

Microstomia is probably the most significant oral consequence of scleroderma, giving rise to limited mouth opening, and as a result difficulty with eating and perhaps speech. The limited mouth opening can also make it difficult for affected individuals to insert and remove dentures and undergo routine dental care. Raynaud's and Scleroderma Association.

The Italian version of the Mouth Handicap in Systemic Sclerosis scale (MHISS) is valid, reliable and useful in assessing oral health-related quality of life (OHRQoL) in systemic sclerosis (SSc) patients. Rheumatology International, September 2012, Volume 32, Issue 9, pp 2785-2790.

Digital Dentistry

Digital dentistry can be of value for sufferers of Microstomia. It can be used to carry out dental procedures rather than using conventional dentistry equipment. ISN.

Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques. This article discusses the various types of digital impression systems and their accuracy compared to traditional impression techniques. PubMed, Compend Contin Educ Dent. 2015 Jul;36(7):529-33.

Intraoral Digital Impression Technique: A Review. This new digital impression technique is expected to bring about absolute digitization to the mode of prosthodontics. PubMed, J Prosthodont. 2015 Jun;24(4):313-21.

Accuracy of digital and conventional impression techniques and workflow. Digital impression techniques can be regarded as a clinical alternative to conventional impressions for fixed dental restorations. PubMed, Clin Oral Investig. 2013 Sep;17(7):1759-64.


Microstomia Treatment & Management. Patients with perioral burns or fibrosis of the skin may benefit from early intervention with a preventive appliance to reduce contracture as scarring and stiffness advance. Medscape.


For UVA1 treatment, first contact your scleroderma expert to see if it they will recommend it for you. If they recommend and prescribe it for you, try to find UVA1 facilities near you. Some dermatology offices (usually large offices or with major health centers) have UVA1 equipment (not UVB). It may also be possible to buy UVA1 phototherapy equipment for home use. It is manufactured by Daavlin and distributed worldwide. Home users must be monitored by a physician, who will prescribe the necessary dosage and monitor for possible side-effects, such as skin cancer.

Limited Mouth Opening Secondary to Diffuse Systemic Sclerosis. Dentists should be aware of the challenges associated with performing routine intraoral examination, periapical radiographs, and dental treatment for SSc patients with limited mouth opening. Passive jaw stretch exercises using tongue blades are modestly effective in improving the limited mouth opening in SSc patients. Hindawi, Case Reports in Dentistry, Volume 2013, Article ID 937487.

Effect of orofacial exercises on oral aperture in adults with systemic sclerosis. A simple mouth stretching exercise may be more feasible and effective in the long run when minimal or no monitoring can be implemented. In order to achieve an improvement in mouth opening of average of 4–5 mm, the stretched mouth positions would need be done 30 seconds at a time, 50 to 60 times per day (30 minutes of orofacial exercise). Disabil Rehabil, 2012; 34(1): 84–89.

A novel prosthodontic alternative for patients who are edentulous and have microstomia: a case report. This flexible denture base material can be manipulated on insertion into a smaller shape that is half the original size and is completely flexible for insertion into a mouth that has limited opening. PubMed, Spec Care Dentist, 2012 Jul-Aug;32(4):160-4.

(PDF) UVA1 Phototherapy: A concise and practical review. UVA1 phototherapy had a significant effect on collagen metabolism by reducing sclerotic plaque and lesional skin thickness, and improving skin elasticity. Skin Therapy Letter. January 2012.

Improvement of microstomia in scleroderma after intense pulsed light (IPL): A case series of four patients. IPL can be a new adjunctive alternative in the non-surgical treatment of microstomia in patients with systemic sclerosis. J Cosmet Laser Ther, 2012 Apr;14(2):102-6.

A simple "fishtail flap" for surgical correction of microstomia. this relatively conservative technique, if judiciously used, can be performed with ease and safety with good results. PubMed, J Craniofac Surg, 2011 Nov;22(6):2292-4.

The rehabilitation of facial involvement in systemic sclerosis (SSc): efficacy of the combination of connective tissue massage, Kabat's technique and kinesitherapy: a randomized controlled trial. The combination of connective tissue massage, Kabat's technique, kinesitherapy and home-based exercises is more effective than a home exercise program alone in the rehabilitative treatment of SSc facial involvement. S Maddali-Bongi. (PubMed) Rheumatol Int, 2010 Mar 18.

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