Influence of systemic sclerosis on periodontal health

The EFP recently awarded its Graduate Research Prize 2023 which promotes original graduate research. In the first of a series of articles by the four winners, Marianna Gavriiloglou (Université de Strasbourg, France) outlines a case-control study about how systemic sclerosis may influence periodontal health.

Systemic sclerosis or scleroderma (SSc) derives from the Greek words sclero (hard) and derma (skin) and involves the hardening of the skin. It is a rare chronic autoimmune disease characterised by tissue fibrosis, vasculopathy, and immune dysfunction. Patients with SSc present a progressive fibrosis of the skin and/or other organs.

Specifically, the localised cutaneous form of the disease (lcSSc) is defined when skin fibrosis is restricted to the face, neck, and area distal to elbows and knees, while the diffused cutaneous form (dcSSc) also includes skin fibrosis of the proximal limbs and/or trunk. Furthermore, various oral manifestations – both clinical and radiological – have been associated with the disease, such as microstomia, xerostomia, periodontitis, and the radiographic widening of the periodontal ligament (PDL) surface.

Unfortunately, treatments are not able to reverse the pathological effects of the disease. As a result, when disease is severe, dental treatments are challenging and often it has not been possible to treat patients appropriately. Therefore, the prevention and early management of oral diseases are of tremendous importance for this specific population.

The aim of this study was to compare the PDL surface of SSc patients with healthy controls using cone-beam computed tomography and to assess oral status, oral-health-related quality of life (OHRQoL), and gingival crevicular fluid (GCF) levels of different biomarkers between the two groups.

The study included 39 SSc patients and 39 matched healthy controls. Eighteen of the 39 SSc patients were diagnosed with the diffused form of the disease (dcSSc).

The main findings of this study include an increase of the PDL surface in SSc patients, which may be correlated with fibrosis and increased collagen deposition. It is worth mentioning that PDL thickening involves the whole root, without affecting tooth prognosis. Similar studies suggested that more than 30% of SSc patients present PDL widening at their radiographic examination.

A common clinical feature is the reduction of the mouth opening. In our study, only the dcSSc group had a statistically significant decrease of mouth opening, which highlights the proportional relationship between disease severity and the extent of fibrosis. Worsened oral health was confirmed, as SSc patients had a higher number of missing teeth and a higher decayed, missing, and filled Teeth (DMFT) index, as well as an increased gingival bleeding and attachment loss.