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Sharma M, Fadl A, Leask A. Orofacial Complications of the Connective Tissue Disease Systemic Sclerosis. J Dent Res 2024; 103:689-696. [PMID: 38779873 PMCID: PMC11191658 DOI: 10.1177/00220345241249408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Scleroderma (systemic sclerosis, SSc) is an autoimmune fibrosing connective tissue disease of unknown etiology. SSc patients show increased levels of autoantibodies, profibrotic cytokines, and extracellular matrix remodeling enzymes that collectively cause activated (myo)fibroblasts, the effector cell type of fibrosis. Despite these impacts, no disease-modifying therapy exists; individual symptoms are treated on a patient-to-patient basis. SSc research has been principally focused on symptoms observed in the lung and skin. However, SSc patients display significant oral complications that arise due to fibrosis of the not only skin, causing microstomia, but also the gastrointestinal tract, causing acid reflux, and the oral cavity itself, causing xerostomia and gingival recession. Due to these complications, SSc patients have impaired quality of life, including periodontitis, tooth loss, reduced tongue mobility, and malnutrition. Indeed, due to their characteristic oral presentation, SSc patients are often initially diagnosed by dentists. Despite their clinical importance, the oral complications of SSc are severely understudied; high-quality publications on this topic are scant. However, SSc patients with periodontal complications possess increased levels of matrix metalloproteinase-9 and chemokines, such as interleukin-6 and chemokine (C-X-C motif) ligand-4. Although many unsuccessful clinical trials, mainly exploring the antifibrotic effects of anti-inflammatory agents, have been conducted in SSc, none have used oral symptoms, which may be more amenable to anti-inflammatory drugs, as clinical end points. This review summarizes the current state of knowledge regarding oral complications in SSc with the goal of inspiring future research in this extremely important and underinvestigated area.
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Affiliation(s)
- M. Sharma
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - A. Fadl
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - A. Leask
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
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Farhat MM, Guerreschi P, Morell-Dubois S, Deken V, Labreuche J, Sanges S, Sobanski V, Hachulla E, Cottencin O, Launay D. Perception of aesthetic impairment in patients with systemic sclerosis determined using a semi-quantitative scale and its association with disease characteristics. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:124-133. [PMID: 38910601 PMCID: PMC11188849 DOI: 10.1177/23971983241231620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 06/25/2024]
Abstract
Background Systemic sclerosis is a fibrotic disease. Body image assessments could be key in optimizing care; however, data are scarce. The main objective was to assess the perception of aesthetic impairment using a visual aesthetic evaluation scale in patients with systemic sclerosis compared with healthy subjects. The secondary objectives were to assess associations between the perception of aesthetic impairment and scores on standardized questionnaires for aesthetic impairment as well as clinical, psychological/quality of life, and functional parameters of patients with systemic sclerosis. Methods This study evaluated and compared the perception of aesthetic impairment in two populations: patients with systemic sclerosis from a referral center at Lille Hospital, France, and healthy controls. Results This study included 88 patients (69 (78.4%) women) with a median age of 52 years and 88 controls (49 (55.7%) women) with a median age of 45 years. The perception of aesthetic impairment assessed using the aesthetic evaluation scale was poorer in systemic sclerosis patients than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p = 0.028) and was statistically correlated with assessments using the adapted satisfaction with appearance, a specific aesthetic impact assessment questionnaire for patients with systemic sclerosis. Patients with anxiety or depressive symptoms had significantly higher aesthetic evaluation scale scores. Systemic sclerosis patients with facial involvement and pitting scars had a worse perception of aesthetic impairment. Compared with healthy controls, systemic sclerosis patients had a worse perception of aesthetic impairment, especially systemic sclerosis patients with anxiety or depression and those with facial and hand involvement. Conclusion The aesthetic evaluation scale appears to be an easy-to-use tool to evaluate body image. Correlations of the aesthetic evaluation scale score with psychological and quality of life parameters reflect the importance of these parameters for body image evaluation and its complex assessment. Trial registration Clinical Trial NCT03271320 (Registered 9 January 2017, https://www.clinicaltrials.gov/ct2/show/NCT03271320?term=NCT03271320&cntry=FR&draw=2&rank=1).
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Affiliation(s)
- Méryem-Maud Farhat
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Pierre Guerreschi
- Plastic Surgery Department, University Hospital of Lille, Lille, France
- Competence Center for Clefts and CranioFacial Malformations, Lille, France
| | - Sandrine Morell-Dubois
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Sebastien Sanges
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Eric Hachulla
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Olivier Cottencin
- INSERM U-1172. Univ Lille. LiNC. PSY team, CHU Lille Department of Psychiatry and Addiction Medicine, Lille, France
| | - David Launay
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
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De Múgica AD, Bailey E, Loughlin A. Scleroderma: oral, maxillofacial and radiographic manifestations for dental practitioners. Br Dent J 2024; 236:881-886. [PMID: 38877249 DOI: 10.1038/s41415-024-7453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 06/16/2024]
Abstract
Scleroderma is an autoimmune condition of unknown aetiology with a range of manifestations, which can be limited to the skin or can extend to be multisystemic. It is characterised by fibrosis, microangiopathy and dysregulation of the immune system and commonly affects the oral cavity. Frequent oral and maxillofacial features include fibrosis of the face, circumoral furrows and reduced oral aperture. Radiographic findings are often incidental, including uniform, asymptomatic periodontal ligament space widening of teeth and osteolysis of bone at muscular attachments. The oral and maxillofacial manifestations significantly contribute to its disease burden and are often overlooked and undertreated as their treatment can be limited due to their challenging rheumatological care. Given the complexity of the condition and its multisystemic impacts, better co-operation between dentists and rheumatologists may help improve this patient cohort's quality of life. This clinical article aims to better equip dentists to identify features of scleroderma and manage the day-to-day oro-facial manifestations.
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Affiliation(s)
- Alexander Davies De Múgica
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK; Department of Dental and Maxillofacial Radiology, Eastman Dental Hospital, 47-49 Huntley St, London, WC1E 6DG, UK.
| | - Edmund Bailey
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 1FR, UK
| | - Amanda Loughlin
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK
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Chen IC, Lin CT, Hsu PY, Pai LW, Yu CH, Liu HL. The effect of oral massage intervention on oral hygiene at home care. Int J Dent Hyg 2024. [PMID: 38773918 DOI: 10.1111/idh.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/24/2024]
Abstract
INTRODUCTION Oral hygiene for individuals with disabilities living at home heavily relies on caregiver assistance. This study investigates differences in mouth opening, dental plaque index and halitosis grade among home-dwelling individuals with and without oral massage intervention. It is important to consider that extended bedridden periods, the presence of nasogastric tubes and difficulties in mouth opening can affect caregivers' oral cleaning effectiveness. METHOD This single-blind controlled experiment spanned 12 weeks. Primary caregivers underwent a 15- to 20-min demonstration. The experimental group received guidance on the Bass brushing method, instructions for using oral cleaning tools and training in oral massage. The control group received guidance on the Bass brushing method and instructions for oral cleaning tools. Measurement tools included basic participant information, oral examination records, mouth opening assessments, dental plaque index evaluations and halitosis ratings. RESULTS The study included 38 subjects, all over 80 years old with disabilities. Dental plaque index significantly improved after massage (p = 0.001). Compared to their pre-massage conditions, the experimental group showed significant improvements in maximum mouth opening (11.65-20.71 mm, p = 0.001), dental plaque index (98.04%-59.74%, p < 0.0001) and halitosis rating (4.12-3.76, p = 0.034). CONCLUSIONS Oral massage effectively improved mouth opening, reduced the dental plaque index and lowered halitosis ratings in the experimental group, underscoring its positive impact on oral hygiene. The study's insights can significantly benefit oral care for individuals with disabilities living at home.
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Affiliation(s)
- I-Chen Chen
- Taipei Veterans General Hospital-Hsinchu Branch, Hsinchu City, Taiwan
| | - Chi-Te Lin
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | | | - Lee-Wen Pai
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | - Chuan-Hang Yu
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Hsin-Li Liu
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
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Bajonaid A, Guntaka PK, Harper M, Cutler C, Duncan C, Villa A, Sroussi HY, Woo SB, Treister NS. Characterization of orofacial features in sclerodermatous chronic graft-versus-host disease. Oral Dis 2024. [PMID: 38514965 DOI: 10.1111/odi.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Chronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). The sclerodermatous form of cGVHD can be particularly debilitating; however, orofacial sclerodermatous involvement remains poorly described. OBJECTIVE To characterize orofacial features of sclerodermatous cGVHD in a single center cohort of patients who underwent alloHCT. STUDY DESIGN Retrospective data were collected from electronic medical records and analyzed descriptively. RESULTS There were 39 patients who received alloHCT between 1993 and 2017 and developed orofacial sclerodermatous cGVHD. Concomitant cutaneous sclerodermatous cGVHD was common (n = 20, 51%). Orofacial sclerodermatous cGVHD features included fibrous bands of the buccal mucosa (n = 23, 59%), limited mouth opening (n = 19, 54%), perioral fibrosis (n = 8, 21%), and focal gingival recession (n = 4, 10%). Oral mucosal fibrosis was observed at the site of active or resolved chronic lichenoid inflammation in 30 patients, with all but two also presenting with a history of ulcerations. Management included jaw stretching exercises (n = 10; 6 stable/improved), surgery (n = 3; 2 improved), and intralesional corticosteroid injections (n = 2; 2 improved). CONCLUSIONS Orofacial involvement with sclerodermatous cGVHD can present with multiple manifestations including fibrous banding, limited mouth opening, perioral fibrosis, and focal gingival recession. Surgical and non-surgical management strategies may improve clinical function and reduce morbidity.
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Affiliation(s)
- Amal Bajonaid
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Matthew Harper
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Dentistry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine Duncan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, California, USA
- Herbert Wertheim College of Medicine and Miami Cancer Institute, Miami, Florida, USA
| | - Hervé Y Sroussi
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathaniel S Treister
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mosaddad SA, Abdollahi Namanloo R, Ghodsi R, Salimi Y, Taghva M, Naeimi Darestani M. Oral rehabilitation with dental implants in patients with systemic sclerosis: A systematic review. Immun Inflamm Dis 2023; 11:e812. [PMID: 36988245 PMCID: PMC10022424 DOI: 10.1002/iid3.812] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Objective To assess the influence of systemic sclerosis (SSc) on the survival rate of dental implants in SSc patients receiving implant‐supported treatments. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) Statement and the Cochrane Collaboration's guiding principles were followed during the study's execution. The data from three databases, PubMed, Google Scholar, and Scopus, available until January 2023, were used to compile the material for our research. Only English‐language publications were submitted for this research and evaluated based on their titles, abstracts, and full texts. For performing a quality assessment, quality scores were calculated. Results The total number of patients and implants studied were 37 and 153, respectively, all having had scleroderma. The patients’ ages ranged from 28 to 77 years old, with a mean (SD) age of 58.16 (12.88). All the patients in the case reports and most in the case series study were female. The range of follow‐up duration was from 1 to 10 years. In case report studies, the survival rate was 100%; in case series, it was 89.2%. Conclusion The SSc status had no discernible impact on the implant survival rate. Implant‐based treatments in SSc patients should not worsen the overall morbidity and should not conflict with systemic treatments. Before starting implant therapy, a thorough risk assessment is essential, though.
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Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of DentistryShiraz University of Medical SciencesShirazIran
| | | | - Raziye Ghodsi
- Department of Periodontics, Dental SchoolShiraz University of Medical SciencesShirazIran
| | - Yasaman Salimi
- Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Masumeh Taghva
- Department of Prosthodontics, School of DentistryShiraz University of Medical SciencesShirazIran
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Frech TM, Poole JL, Murtaugh M, Matucci-Cerinic M. Expanding the Treatment Team. Rheum Dis Clin North Am 2023; 49:377-387. [PMID: 37028841 DOI: 10.1016/j.rdc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The optimal systemic sclerosis (SSc) care plan includes an occupational therapist and physical therapist as well as wound care experts and a registered dietitian if indicated. Screening instruments for functional and work disability, hand and mouth limitations, malnutrition, and dietary intake can identify the need for ancillary support services. Telemedicine can assist in developing effective ancillary treatment plans. Reimbursement for services may limit access for patients with SSc to expand their care team but a focus on prevention rather than management of damage is recognized as an important unmet need in SSc. In this review, the role of a comprehensive care team for SSc is discussed.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Janet L Poole
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Maureen Murtaugh
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence and Department of Experimental and Clinical Medicine, University of Florence, Italy
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Ciurea A, Rednic NV, Soancă A, Micu IC, Stanomir A, Oneț D, Șurlin P, Filipescu I, Roman A, Stratul ȘI, Pamfil C. Current Perspectives on Periodontitis in Systemic Sclerosis: Associative Relationships, Pathogenic Links, and Best Practices. Diagnostics (Basel) 2023; 13:diagnostics13050841. [PMID: 36899985 PMCID: PMC10000920 DOI: 10.3390/diagnostics13050841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Systemic sclerosis is a chronic, autoimmune, multisystemic disease characterized by aberrant extracellular matrix protein deposition and extreme progressive microvasculopathy. These processes lead to damage within the skin, lungs, or gastrointestinal tract, but also to facial changes with physiognomic and functional alterations, and dental and periodontal lesions. Orofacial manifestations are common in SSc but are frequently overshadowed by systemic complications. In clinical practice, oral manifestations of SSc are suboptimally addressed, while their management is not included in the general treatment recommendations. Periodontitis is associated with autoimmune-mediated systemic diseases, including systemic sclerosis. In periodontitis, the microbial subgingival biofilm induces host-mediated inflammation with subsequent tissue damage, periodontal attachment, and bone loss. When these diseases coexist, patients experience additive damage, increasing malnutrition, and morbidity. The present review discusses the links between SSc and periodontitis, and provides a clinical guide for preventive and therapeutical approaches in the management of these patients.
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Affiliation(s)
- Andreea Ciurea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
| | - Nicolae Voicu Rednic
- Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor St., No. 19, 400394 Cluj-Napoca, Romania
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
| | - Alina Stanomir
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
| | - Diana Oneț
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
| | - Petra Șurlin
- Department of Periodontology, University of Medicine and Pharmacy Craiova, Petru Rareș St., No. 2, 200349 Craiova, Romania
| | - Ileana Filipescu
- Department of Rheumatology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor St., No. 2, 400000 Cluj-Napoca, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș St., No. 15, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-722-627-488
| | - Ștefan Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, Victor Babeș University of Medicine and Pharmacy Timișoara, Revoluției from 1989 St., No. 9, 300041 Timișoara, Romania
| | - Cristina Pamfil
- Department of Rheumatology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor St., No. 2, 400000 Cluj-Napoca, Romania
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Zimmermann F, Robin F, Caillault L, Cazalets C, Llamas-Gutierrez F, Garlantézec R, Jousse-Joulin S, Diot E, Mensi SE, Belhomme N, Jégo P, Coiffier G, Lescoat A. Sicca syndrome in systemic sclerosis: a narrative review on a neglected issue. Rheumatology (Oxford) 2023; 62:SI1-SI11. [PMID: 35866609 DOI: 10.1093/rheumatology/keac412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
SSc is an auto-immune disease characterized by life-threatening manifestations such as lung fibrosis or pulmonary arterial hypertension. Symptoms with a detrimental impact on quality of life are also reported and sicca syndrome (xerostomia, xeropthalmia) is present in up to 80% of patients with SSc. Sicca syndrome can occur in the absence of overlap with Sjögren's disease and recent studies highlight that fibrosis of minor and major salivary glands, directly linked to the pathogenesis of SSc, could be a major contributor of xerostomia in SSc. This narrative review provides an overview of the clinical presentation, diagnostic strategies, management and future perspectives on sicca syndrome in patients with SSc.
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Affiliation(s)
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1.,Department of Rheumatology, Rennes University Hospital, University Rennes; Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolisms and Cancer), University Rennes
| | | | | | | | - Ronan Garlantézec
- Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | | | | | | | | | - Patrick Jégo
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | - Guillaume Coiffier
- Department of Internal Medicine.,Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
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10
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Khidir SJH, Boonstra M, Bergstra SA, Boerrigter GWM, Voogt-van der Harst EM, Ninaber MK, Ajmone Marsan N, Huizinga TWJ, van der Helm-van Mil AHM, de Vries-Bouwstra JK. Mouth opening in systemic sclerosis: Its course over time, determinants and impact on mouth handicap. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:64-71. [PMID: 36743815 PMCID: PMC9896194 DOI: 10.1177/23971983221138177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022]
Abstract
Objective Decreased maximal mouth opening is a common and disabling manifestation in systemic sclerosis patients. We aimed to study the course of maximal mouth opening, determinants of smaller maximal mouth opening over time and the burden of smaller maximal mouth opening on mouth handicap. Methods Consecutive systemic sclerosis patients participating in the prospective Leiden Combined Care in systemic sclerosis cohort were included. Annual clinical assessment included maximal mouth opening measurement and mouth handicap evaluation (Mouth Handicap in Systemic Sclerosis scale). Presence of microstomia (maximal mouth opening < 30 mm) was studied. Maximal mouth opening over time was assessed on group level and for all patients individually. Baseline characteristics were analysed for their association with smaller maximal mouth opening over time (linear mixed-effects models). Furthermore, cross-sectional association between maximal mouth opening with Mouth Handicap in Systemic Sclerosis scale was assessed (linear regression analysis). Results A total of 382 systemic sclerosis patients were studied with median follow-up time of 2.0 years (interquartile range = 0.0-3.0). At baseline, mean maximal mouth opening was 42.2 ± 8.0 mm and 7% suffered from microstomia. Annual decrease of > 5.0 mm in maximal mouth opening during follow-up occurred in 63 patients and was accompanied by increase in disease severity. Disease characteristics at baseline independently predictive for smaller maximal mouth opening over time were: more extended skin subtype; peripheral vasculopathy; pulmonary, renal and gastrointestinal involvement. Smaller maximal mouth opening was significantly associated with more reported mouth handicap. Conclusion The course of maximal mouth opening is stable in a majority of systemic sclerosis patients. Still, maximal mouth opening over time was smaller in patients with more severe organ involvement. Although microstomia was infrequent, a smaller maximal mouth opening was significantly associated with more mouth handicap, indicating the importance to address maximal mouth opening in routine care of systemic sclerosis patients.
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Affiliation(s)
- Sarah J H Khidir
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike Boonstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerry W M Boerrigter
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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11
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Abstract
The upper gastrointestinal (GI) tract is frequently involved in systemic sclerosis (SSc) and may impact quality of life, physical function and survival. Although we are currently very proactive in terms of screening for heart and lung involvement, patients with SSc are not routinely screened for GI involvement. This review details the available investigations for common upper GI symptoms in SSc, including dysphagia, reflux and bloating and provides advice as to how to integrate these investigations into current clinical care.
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12
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Haque M, Ahmad R. Oral health alterations: Glimpse into its connection to inflammatory rheumatic diseases. ADVANCES IN HUMAN BIOLOGY 2023. [DOI: 10.4103/aihb.aihb_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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13
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Cheah JX, Khanna D, McMahan ZH. Management of scleroderma gastrointestinal disease: Lights and shadows. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:85-97. [PMID: 35585948 PMCID: PMC9109510 DOI: 10.1177/23971983221086343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Gastrointestinal symptoms affect the great majority of patients with systemic sclerosis. Management of these complications is often challenging as any region of the gastrointestinal tract may be involved, and significant heterogeneity exists in clinical presentation, kinetics, and outcomes. Here, we highlight new findings relevant to the management of systemic sclerosis-related gastrointestinal disease (lights) and consider areas that we have yet to elucidate (shadows).
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Affiliation(s)
- Jenice X Cheah
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
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14
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Farina N, Benanti G, De Luca G, Palmisano A, Peretto G, Tomassetti S, Giorgione V, Forma O, Esposito A, Danese S, Dagna L, Matucci-Cerinic M, Campochiaro C. The Role of the Multidisciplinary Health Care Team in the Management of Patients with Systemic Sclerosis. J Multidiscip Healthc 2022; 15:815-824. [PMID: 35480063 PMCID: PMC9035450 DOI: 10.2147/jmdh.s295478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vascular damage and fibrosis affecting the skin and multiple internal organs. The clinical spectrum of SSc is wide and its manifestations may lead to severe morbidity and mortality, in addition to a great impact on patients’ quality of life. Due to the multifaceted clinical manifestations of SSc, its management requires a combined expertise of different medical specialists to guarantee an adequate disease control and prevent organ complications. Multi-disciplinary teams (MDT), which are composed by physicians and other specialized health professionals, represent therefore a key element for the comprehensive management of SSc patients. Moreover, MTD can improve communication and patients’ empowerment while the presence of dedicated nurses can help patients to ask questions about their condition. The scope of this narrative review is to analyse the available evidences regarding the role of MDT in the management of SSc patients, and how this holistic approach may improve different disease domains and the overall prognosis. MDT regarding the cardiovascular and lung complication are the more represented in literature, given the great impact in prognosis. Nonetheless, MDT have been shown to be fundamental also in other disease domains as they can intercept early manifestations, thus stratifying patients based on the individual risks in order to personalize patients’ follow-up. MDTs may also minimize the treatment delay, enabling fast-track specialist referral. On the other hand, there are few trials specifically studying MDT in SSc and several authors have highlight the lack of standardization.
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Affiliation(s)
- Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Benanti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Palmisano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Clinical and Experimental Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Peretto
- Unit of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Ornella Forma
- Vulnology Nursing Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Clinical and Experimental Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvio Danese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Correspondence: Corrado Campochiaro, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, 20132, Italy, Tel +39 0226437060, Fax +39 0226433729, Email
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15
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Luquez-Mindiola A, Atuesta AJ, Gómez-Aldana AJ. Gastrointestinal manifestations of systemic sclerosis: An updated review. World J Clin Cases 2021; 9:6201-6217. [PMID: 34434988 PMCID: PMC8362561 DOI: 10.12998/wjcc.v9.i22.6201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/30/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Systemic sclerosis is an autoimmune disease characterized by vascular disease, fibrosis of the skin, and internal organ dysfunction. Gastrointestinal involvement is the most frequent complication of internal organs, impacting up to 90% of patients. Gastrointestinal involvement can affect any region of the gastrointestinal tract from the mouth to the anus, with a predominance of disorders being observed at the level of the upper digestive tract. The gastrointestinal involvement primarily involves the esophagus, small bowel, and rectum. The severity of gastrointestinal involvement affects quality of life and is a marker of worse prognosis and mortality in these patients. In this review, we describe the current findings regarding gastrointestinal involvement by this entity.
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Affiliation(s)
| | - Alexis Javier Atuesta
- Department of Internal Medicine, Universidad Nacional de Colombia, Bogota 11711, Colombia
| | - Andres Jose Gómez-Aldana
- Department of Endoscopy, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Bogotá 11711, Colombia
- Faculty of Medicine, Universidad de los Andes, Bogota 11711, Colombia
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16
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Hachulla E, Agard C, Allanore Y, Avouac J, Bader-Meunier B, Belot A, Berezne A, Bouthors AS, Condette-Wojtasik G, Constans J, De Groote P, Diot E, Dumas F, Jego P, Joly F, Launay D, Le Guern V, Le Quintrec JS, Lescaille G, Meune C, Moulin B, Nguyen C, Omeish N, Pene F, Richard MA, Rochefort J, Roren A, Sitbon O, Sobanski V, Truchetet ME, Mouthon L. French recommendations for the management of systemic sclerosis. Orphanet J Rare Dis 2021; 16:322. [PMID: 34304732 PMCID: PMC8310704 DOI: 10.1186/s13023-021-01844-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Systemic sclerosis (SSc) is a generalized disease of the connective tissue, arterioles, and microvessels, characterized by the appearance of fibrosis and vascular obliteration. There are two main phenotypical forms of SSc: a diffuse cutaneous form that extends towards the proximal region of the limbs and/or torso, and a limited cutaneous form where the cutaneous sclerosis only affects the extremities of the limbs (without passing beyond the elbows and knees). There also exists in less than 10% of cases forms that never involve the skin. This is called SSc sine scleroderma. The prognosis depends essentially on the occurrence of visceral damage and more particularly interstitial lung disease (which is sometimes severe), pulmonary arterial hypertension, or primary cardiac damage, which represent the three commonest causes of mortality in SSc. Another type of involvement with poor prognosis, scleroderma renal crisis, is rare (less than 5% of cases). Cutaneous extension is also an important parameter, with the diffuse cutaneous forms having less favorable prognosis.
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Affiliation(s)
- Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France.
| | - Christian Agard
- Internal Medicine, Nantes University Hospital, University of Nantes, Nantes, France
| | - Yannick Allanore
- Rheumatology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Jerome Avouac
- Rheumatology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Brigitte Bader-Meunier
- Department of Pediatric Immunology and Rheumatology; Hospital Necker, APHP, Paris, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, Bron, France
| | - Alice Berezne
- Department of Internal Medicine, CHR Annecy-Genevois, Annecy, France
| | - Anne-Sophie Bouthors
- Anaesthesia Intensive Care Unit, Jeanne de Flandre Women Hospital, Academic Hospital, ULR 7365 - GRITA - Groupe de Recherche Sur Les Formes Injectables Et Les Technologies Associées, University Lille, Lille, France
| | - Geraldine Condette-Wojtasik
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | - Joël Constans
- Vascular Medicine Department, Bordeaux University Hospital Centre, Saint André Hospital, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) PeripherAL Artery DIsease Network (PALADIN), Bordeaux, France
| | - Pascal De Groote
- Cardiology Department, Lung-Heart Institute, CHU de Lille, 59000, Lille, France
| | | | - Florence Dumas
- Emergency Department, Cochin Hospital, Paris University, Paris, France
| | - Patrick Jego
- Internal Medicine and Clinical Immunology Unit, CHU Rennes, Rennes, France
| | - Francisca Joly
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, INSERM UMRS-1149, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France
| | - David Launay
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | - Veronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares D'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), APHP-CUP, Hôpital Cochin, Université de Paris, 75014, Paris, France
| | | | - Geraldine Lescaille
- Centre d'Immunologie et Maladies Infectieuses (CIMI-Paris), Department of Odontology, Paris Diderot/Paris 07, Sorbonne Paris Cité, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christophe Meune
- Cardiology Department, Hôpital Avicenne, AP-HP, Université de Paris, Paris, France
| | - Bruno Moulin
- Department of Nephrology and Kidney Transplantation, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
| | - Christelle Nguyen
- Physical Medicine and Rehabilitation Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Nadine Omeish
- Oral and Dental Medicine, Hôpital Pitié-Salpêtrière, APHP, Université de Paris, Paris, France
| | - Frederic Pene
- Medical Intensive Care Unit, Hôpital Cochin, AP-HP. Centre & Université de Paris, Paris, France
| | - Marie-Aleth Richard
- Department of Dermatology, Timone Hospital, University Hospital of Marseille, Marseille, France
| | - Juliette Rochefort
- Oral and Dental Medicine, Hôpital Pitié-Salpêtrière, APHP, Université de Paris, Paris, France
| | - Alexandra Roren
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, INSERM U1153, Paris, France
| | - Olivier Sitbon
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Laboratoire d'Excellence en Recherche Sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Vincent Sobanski
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | | | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares D'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), APHP-CUP, Hôpital Cochin, Université de Paris, 75014, Paris, France.
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17
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Cüzdan N, Türk İ, Çiftçi V, Arslan D, Doğan MC, Ünal İ. The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: A single-blind prospective randomized controlled trial. Arch Rheumatol 2021; 36:176-184. [PMID: 34527921 PMCID: PMC8418773 DOI: 10.46497/archrheumatol.2021.8295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the effect of a home-based orofacial exercise program on the oral aperture (OA) of systemic sclerosis (SSc) patients. PATIENTS AND METHODS This single-blind prospective randomized controlled study performed between March 2017 and January 2019 included 56 SSc patients (3 males, 53 females; mean age 52.9±10.6 years; range, 31 to 70 years) with an OA of <40 mm. Patients were divided into two groups. Group 1 (n=28, mean age 53.8±9.6 years) was given orofacial exercise program twice a day for one month in addition to oral hygiene care advices, followed by no activity for the next month. Group 2 (n=28, mean age 50.0±11 years) received oral hygiene care advices for the first month followed by the same exercise program for the next month. Patients' OA was measured at baseline, and at first and second months. RESULTS After the first month, OA increased in Group 1 (p<0.001), whereas no change was observed in Group 2 (p=0.579). At the end of two months, there was no additional increase in Group 1 (p=0.352), while there was a significant increase in Group 2 (p<0.001). There was no difference between OAs of the groups at the end of the trial (p=0.564). CONCLUSION Our results suggest that home-based orofacial exercise program improves OA of SSc patients.
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Affiliation(s)
- Nihan Cüzdan
- Department of Physical Therapy and Rehabilitation & Rheumatology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - İpek Türk
- Rheumatology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Volkan Çiftçi
- Pediatric Dentistry, Çukurova University Faculty of Dentistry, Adana, Turkey
| | - Didem Arslan
- Department of Internal Medicine, Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Muharrem Cem Doğan
- Pediatric Dentistry, Çukurova University Faculty of Dentistry, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, Çukurova University Faculty of Medicine, Adana, Turkey
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18
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Benz K, Baulig C, Knippschild S, Strietzel FP, Hunzelmann N, Jackowski J. Prevalence of Oral and Maxillofacial Disorders in Patients with Systemic Scleroderma-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105238. [PMID: 34069099 PMCID: PMC8156713 DOI: 10.3390/ijerph18105238] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/02/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systematic scleroderma is a rare chronic autoimmune disease of unknown aetiology. The aim of this study was to identify the prevalence of orofacial pathognomonic conditions in patients with systemic scleroderma using only randomised prospective studies that investigated the treatment of oral and maxillofacial changes, highlighted associations between the disease and Sjogren's syndrome, and/or analysed the effect of oral hygiene. METHODS The literature was systematically reviewed based on Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science articles published up to March 2020. The primary endpoint of this analysis was defined as an estimation of the prevalence of oral mucosal changes in different areas of the oral cavity (oral mucosa, tongue, lip, periodontal status, bones, and other regions) in patients suffering from scleroderma. Therefore, a systematic literature search (Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science) was conducted and limited by the publication date (1950-03/2020) and the publication language (English). Extracted frequencies were pooled using methods for meta-analysis. In order to obtain the highest level of evidence, only prospective study reports were considered to be eligible. RESULTS After full-text screening, 14 (766 patients) out of 193 publications were eligible for the final analysis. Twelve studies produced reliable results in the final data sets. Calculation of the pooled effect estimate (random effects model) revealed a prevalence of 57.6% (95% CI: 40.8-72.9%) for the main area "lip". For the area "oral mucosa", a prevalence of 35.5% (95% CI: 15.7-62.0%) was calculated. The prevalence for "other regions" was only based on studies with salivary changes and was calculated to be 25.4% (95% CI: 14.2-41.3%). CONCLUSION The most pathognomonic conditions in the orofacial region in patients with systemic scleroderma affect the lips, oral mucosa, and salivary glands.
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Affiliation(s)
- Korbinian Benz
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, 58448 Witten, Germany;
- Correspondence: ; Tel.: +49-2302-926-678; Fax: +49-2302-926-680
| | - Christine Baulig
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; (C.B.); (S.K.)
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany; (C.B.); (S.K.)
| | - Frank Peter Strietzel
- Charité Centre for Dentistry, Department Periodontology, Oral Medicine and Oral Surgery, Charité-University Berlin, Assmannshauser Str. 4-6, 14197 Berlin, Germany;
| | - Nicolas Hunzelmann
- Department of Dermatology and Venerology, University of Cologne, Kerpener Str. 62, 50937 Köln, Germany;
| | - Jochen Jackowski
- Department of Oral Surgery and Policlinical Ambulance, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 45, 58448 Witten, Germany;
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19
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Dubourg S, Huck O, Jung S. Implant-based oral rehabilitation in systemic sclerosis patients: a systematic review. J ORAL IMPLANTOL 2021; 48:251-260. [PMID: 33945625 DOI: 10.1563/aaid-joi-d-20-00384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Systemic sclerosis is a rare multisystem autoimmune disorder that significantly impacts the orofacial region. Several oral features including microstomia and increased tooth loss contribute to the mouth-related disability. Prosthetic rehabilitation is very challenging in these patients. As the spectrum of dental implants indications has been recently extended to patients with various systemic disorders, the aim of this systematic review was to evaluate the outcome of dental implants in patients with systemic sclerosis. A literature search was conducted in Medline/PubMed database to identify eligible case-reports. 10 publications were included in qualitative synthesis. A total of 71 implants have been reported in 10 patients with systemic sclerosis with a mean of 7.1 +/- 3.8 implants per patient. Pre-implant surgeries have been described for 3 patients. Implant survival rates were higher than 98% but the mean follow-up time was only 28.3 +/- 18.6 months. Complications have been observed in 3 patients with 1 implant failure and peri-implant bone resorption in 2 patients. Although implant survival rates were high, an individualized assessment of risk-benefit balance is mandatory before indicating implant-based rehabilitation in patients suffering from systemic sclerosis and a scrupulous maintenance program has to be implemented. Further studies are strongly required to establish clinical guidelines.
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Affiliation(s)
- Sarah Dubourg
- Hôpitaux Universitaires de Strasbourg, Centre de Référence Maladies Rares Orales et Dentaires (O-Rares), Pôle de Médecine et de Chirurgie Bucco-Dentaires - Strasbourg, France
| | - Olivier Huck
- Université de Strasbourg, Faculté de Chirurgie Dentaire - Hôpitaux Universitaires de Strasbourg, Service de Parodontologie et Centre de Référence Maladies Rares Orales et Dentaires - INSERM UMR 1260 - Strasbourg, France
| | - Sophie Jung
- Universite de Strasbourg 1: Universite de Strasbourg Faculté de Chirurgie Dentaire 8 rue Sainte Elisabeth FRANCE STRASBOURG Alsace 67000 Université de Strasbourg, Faculté de Chirurgie Dentaire - Hôpitaux Universitaires de Strasbourg, Centre de Référence Maladies Rares Orales et Dentaires - INSERM UMR_S 1109 - Strasbourg, France
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20
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Sydow E, Van der Elst K, Verschueren P, Lenaerts J, Westhovens R, De Langhe E. A mixed method study exploring patient satisfaction and feasibility of two exercise programmes in systemic sclerosis-associated microstomia. Rheumatol Adv Pract 2021; 5:rkab017. [PMID: 34013159 PMCID: PMC8117948 DOI: 10.1093/rap/rkab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objective SSc often leads to fibrotic cutaneous involvement of the face and reduced oral aperture, with impaired food intake and oral hygiene. Oral exercises can increase oral aperture but are often hampered by low adherence rates. The aim of this mixed method study was to explore the feasibility, patient satisfaction and effectiveness of two exercise programmes in SSc-associated microstomia. Methods Adult patients suffering from SSc and microstomia (maximal oral aperture <40 mm) were randomized to two groups. Group A exercised with a jaw motion device (Therabite), whereas group B performed mouth-stretching exercises. Patients were expected to exercise for 10 min, three times per day for 3 months. Patients were evaluated at baseline, 3 months (period without intervention), 6 months (after 3 months of intervention) and 9 months (post-intervention). At month 6, semi-structured one-to-one interviews were conducted. Results We included six women and three men, median age 60 years and median disease duration 8 years. At 6 months, all patients in group A (n = 4) and four in group B (n = 5) improved, with a median of 9 and 7 mm, respectively. The adherence ranged between 63.7 and 98.9% in group A and between 48.5 and 97.4% in group B. The interview revealed three themes: drivers, challenges and perceived improvement. Conclusion Both interventions improved maximal oral aperture. The adherence to therapy was high, but none of the patients considered it feasible to continue practising three times per day. Future studies are needed in order to define feasible long-term exercise programmes.
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Affiliation(s)
- Ellinor Sydow
- Division of Rheumatology, University Hospitals Leuven
| | | | | | - Jan Lenaerts
- Division of Rheumatology, University Hospitals Leuven
| | | | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven.,Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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21
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Alhendi FJ, Werth VP, Sollecito TP, Stoopler ET. Systemic sclerosis: Update for oral health care providers. SPECIAL CARE IN DENTISTRY 2021; 40:418-430. [PMID: 33448431 DOI: 10.1111/scd.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.
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Affiliation(s)
- Fatmah J Alhendi
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Philadelphia V.A. Hospital, Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center, Philadelphia, Pennsylvania
| | - Thomas P Sollecito
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Eric T Stoopler
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
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22
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Creadore A, Watchmaker J, Maymone MBC, Pappas L, Lam C, Vashi NA. Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with morphea/systemic sclerosis. J Am Acad Dermatol 2020; 83:315-341. [PMID: 32360721 DOI: 10.1016/j.jaad.2019.12.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/06/2023]
Abstract
Morphea and systemic sclerosis are inflammatory, sclerosing disorders. Morphea primarily affects the dermis and subcutaneous fat, while systemic sclerosis typically involves the skin and internal organs. Functional impairment and cosmetic disfigurement are common in both diseases. Treatment options to mitigate disease progression remain limited. Both functional impairment and cosmetic deficits negatively impact quality of life and psychological well-being in this patient population. While the number of cosmetic procedures performed in the United States continues to rise each year, limited data exist regarding best practices for correcting aesthetic deficits caused by autoimmune conditions. There is scarce information to guide safety decisions regarding laser parameters, soft tissue augmentation, treatment intervals, and the concurrent use of immune-modifying or immune-suppressing medications. Given the fears of disease reactivation and exacerbation from postprocedural inflammation along with limited data, it is difficult for clinicians to provide evidence-based cosmetic treatment with realistic expectations with regard to short- and long-term outcomes. In the first article in this continuing medical education series, we attempt to address this practice gap.
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Affiliation(s)
| | - Jacqueline Watchmaker
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Leontios Pappas
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christina Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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23
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Aframian DJ, Keshet N, Nadler C, Zadik Y, Vered M. Minor salivary glands: Clinical, histological and immunohistochemical features of common and less common pathologies. Acta Histochem 2019; 121:151451. [PMID: 31653464 DOI: 10.1016/j.acthis.2019.151451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hundreds of minor salivary glands (MiSGs) are scattered in the oral cavity located at the submucosa layer. Beside their role in the oral cavity lubrication and immunity defence system, MiSGs are beneficial tissue source for diagnosing oral and non-oral related diseases. The advantage of MiSGs as a diagnostic tool reside on their fairly simple excisional procedure on one hand and negligible impact of the normal secretion capability of the salivary gland system on the other hand. The review focuses on pathologies related to developmental, reactive, metabolic, inflammatory and immunologic conditions, Iatrogenic causes and other undefined causes.
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Affiliation(s)
- Doron J Aframian
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Naama Keshet
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Chen Nadler
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel; Department of Oral Medicine, The Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Marilena Vered
- Dept. Oral Pathology, Oral Medicine and Oral Radiology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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24
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Almadori A, Griffin M, Ryan CM, Hunt DF, Hansen E, Kumar R, Abraham DJ, Denton CP, Butler PEM. Stem cell enriched lipotransfer reverses the effects of fibrosis in systemic sclerosis. PLoS One 2019; 14:e0218068. [PMID: 31314805 PMCID: PMC6636710 DOI: 10.1371/journal.pone.0218068] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/17/2019] [Indexed: 12/15/2022] Open
Abstract
Oro-facial fibrosis in systemic sclerosis (Scleroderma;SSc) has a major impact on mouth function, facial appearance, and patient quality of life. Lipotransfer is a method of reconstruction that can be used in the treatment of oro-facial fibrosis. The effect of this treatment not only restores oro-facial volume but has also been found to reverse the effects of oro-facial fibrosis. Adipose derived stem cells (ADSCs) within the engrafted adipose tissue have been shown to be anti-fibrotic in SSc and are proposed as the mechanism of the anti-fibrotic effect of lipotransfer. A cohort of 62 SSc patients with oro-facial fibrosis were assessed before and after stem cell enriched lipotransfer treatment. Clinical evaluation included assessment of mouth function using a validated assessment tool (Mouth Handicap in Systemic Sclerosis Scale-MHISS), validated psychological measurements and pre and post-operative volumetric assessment. In addition, to understand the mechanism by which the anti-fibrotic effect of ADSCs occur, SSc derived fibroblasts and ADSCs from this cohort of patients were co-cultured in direct and indirect culture systems and compared to monoculture controls. Cell viability, DNA content, protein secretion of known fibrotic mediators including growth factor- β1 (TGF β-1) and connective tissue growth factor (CTGF) using ELISA analysis and fibrosis gene expression using a fibrosis pathway specific qPCR array were evaluated. Mouth function (MHISS) was significantly improved (6.85±5.07) (p<0.0001) after treatment. All psychological measures were significantly improved: DAS 24 (12.1±9.5) (p<0.0001); HADS-anxiety (2.8±3.2) (p<0.0001), HADS-depression (2.0±3.1) (p<0.0001); BFNE (2.9 ± 4.3) (p<0.0001); VAS (3.56±4.1) (p<0.0001). Multiple treatments further improved mouth function (p<0.05), DAS (p<0.0001) and VAS (p = 0.01) scores. SSc fibroblast viability and proliferation was significantly reduced in co-culture compared to monoculture via a paracrine effect over 14 days (p < 0.0001). Protein secretion of transforming growth factor (TGF-β1) and connective tissue growth factor (CTGF) was significantly reduced in co-culture compared to monoculture (p < 0.0001). Multiple fibrosis associated genes were down regulated in SSc co-culture compared to monoculture after 14 days including Matrix metalloproteinase-8 (MMMP-8), Platelet derived growth factor-β (PDGF-β) and Integrin Subunit Beta 6 (ITG-β6). Autologous stem cell enriched lipotransfer significantly improved the effects of oro-facial fibrosis in SSc in this open cohort study. Lipotransfer may reduce dermal fibrosis through the suppression of fibroblast proliferation and key regulators of fibrogenesis including TG-β1 and CTGF. Our findings warrant further investigation in a randomised controlled trial.
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Affiliation(s)
- Aurora Almadori
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- The Charles Wolfson Center for Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Michelle Griffin
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- The Charles Wolfson Center for Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- * E-mail: (MG); (PEMB)
| | - Caroline M. Ryan
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Debbie F. Hunt
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Esther Hansen
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Ravi Kumar
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- The Charles Wolfson Center for Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - David J. Abraham
- Centre for Rheumatology, UCL Division of Medicine and Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Christopher P. Denton
- Centre for Rheumatology, UCL Division of Medicine and Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Peter E. M. Butler
- UCL Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Plastic Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- The Charles Wolfson Center for Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- Centre for Rheumatology, UCL Division of Medicine and Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
- * E-mail: (MG); (PEMB)
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25
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Johnson SR, Devakandan K. Guidelines and Recommendations Towards Evidence-Based Management of Systemic Sclerosis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00120-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Gualtierotti R, Marzano AV, Spadari F, Cugno M. Main Oral Manifestations in Immune-Mediated and Inflammatory Rheumatic Diseases. J Clin Med 2018; 8:jcm8010021. [PMID: 30585183 PMCID: PMC6351952 DOI: 10.3390/jcm8010021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/18/2022] Open
Abstract
Oral manifestations are frequent in patients with rheumatic diseases. The aim of this review is to offer readers practical advice concerning the onset, diagnosis and treatment of the main oral manifestations encountered in rheumatological and dental clinics. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, periodontal disease, and dysphagia may be the first expression of a number of rheumatic diseases. Some of these manifestations are aspecific and very frequent, such as oral aphthosis, which can be the first manifestation in patients with systemic lupus erythematosus; some are potentially dangerous, such as jaw claudication during the course of giant cell arteritis; and some are very rare but peculiar, such as strawberry-like gingivitis in patients with granulomatosis with polyangiitis. Other oral manifestations are due to adverse reactions to disease-modifying anti-rheumatic drugs. Oral alterations in rheumatic diseases are frequently overlooked in clinical practice, but their prompt recognition not only allows the local lesions to be appropriately treated, but also makes it possible to identify an underlying systemic disease.
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Affiliation(s)
- Roberta Gualtierotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy.
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Dermatology Unit, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
| | - Francesco Spadari
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy.
| | - Massimo Cugno
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
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27
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Complete dentures: an update on clinical assessment and management: part 2. Br Dent J 2018; 225:933-939. [DOI: 10.1038/sj.bdj.2018.1023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/17/2022]
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28
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Smith V, Scirè CA, Talarico R, Airo P, Alexander T, Allanore Y, Bruni C, Codullo V, Dalm V, De Vries-Bouwstra J, Della Rossa A, Distler O, Galetti I, Launay D, Lepri G, Mathian A, Mouthon L, Ruaro B, Sulli A, Tincani A, Vandecasteele E, Vanhaecke A, Vanthuyne M, Van den Hoogen F, Van Vollenhoven R, Voskuyl AE, Zanatta E, Bombardieri S, Burmester G, Eurico FJ, Frank C, Hachulla E, Houssiau F, Mueller-Ladner U, Schneider M, van Laar JM, Vieira A, Cutolo M, Mosca M, Matucci-Cerinic M. Systemic sclerosis: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000782. [PMID: 30402270 PMCID: PMC6203100 DOI: 10.1136/rmdopen-2018-000782] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Systemic sclerosis (SSc) is an orphan disease characterised by autoimmunity, fibrosis of the skin and internal organs, and vasculopathy. SSc may be associated with high morbidity and mortality. In this narrative review we summarise the results of a systematic literature research, which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines or recommendations. Only in the domains ‘Vascular & Ulcers’ (ie, non-pharmacological approach to digital ulcer), ‘PAH’ (ie, screening and treatment), ‘Treatment’ and ‘Juveniles’ (ie, evaluation of juveniles with Raynaud’s phenomenon) evidence-based and consensus-based guidelines could be included. Hence there is a preponderance of unmet needs in SSc referring to the diagnosis and (non-)pharmacological treatment of several SSc-specific complications. Patients with SSc experience significant uncertainty concerning SSc-related taxonomy, management (both pharmacological and non-pharmacological) and education. Day-to-day impact of the disease (loss of self-esteem, fatigue, sexual dysfunction, and occupational, nutritional and relational problems) is underestimated and needs evaluation.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Airo
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology Unit, Charité University Hospital Berlin, Berlin, Germany
| | - Yannick Allanore
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Veronica Codullo
- Department of Rheumatology, University of Pavia, Pavia, Italy.,Department of Rheumatology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Virgil Dalm
- Department of Internal Medicine and Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Alexis Mathian
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Paris, France
| | - Luc Mouthon
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Els Vandecasteele
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Marie Vanthuyne
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Frank Van den Hoogen
- Department of Rheumatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Ronald Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elisabetta Zanatta
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Bombardieri
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Charissa Frank
- Flemish Patient Organization of Hereditary Collagen Disorders in Belgium, Koersel, Belgium
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Giessen, Germany
| | - Matthias Schneider
- Institute for Rheumatology, Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ana Vieira
- Núcleo Síndrome de Sjögren of Liga Portuguesa Contra as Doenças Reumáticas (LPCDR, Portuguese League Against Rheumatic Diseases), Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
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29
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Abstract
Although classification criteria for systemic sclerosis (SSc) do not incorporate gastrointestinal tract (GIT) manifestations often present in this disease, the GIT is the most common internal organ involved. Pathophysiology of GIT involvement is thought to be similar to other organs in SSc with fibroproliferative vascular lesions of small arteries and arterioles, increased production of profibrotic growth factors, and alterations of innate, humoral, and cellular immunity. These processes result in neuropathy progressing to myopathy with eventual fibrosis. Proper diagnostics and therapeutics for SSc-GIT involvement require the treating physician to have an understanding of an integrated approach and potential medication adverse effects.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah, Salt Lake Veterans Affair Medical Center, Salt Lake City, UT, USA.
| | - Diane Mar
- Department of Internal Medicine, University of Colorado, Denver, 12631 East 17th Avenue, Aurora, CO 80045, USA
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30
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Smirani R, Truchetet M, Poursac N, Naveau A, Schaeverbeke T, Devillard R. Impact of systemic sclerosis oral manifestations on patients’ health‐related quality of life: A systematic review. J Oral Pathol Med 2018; 47:808-815. [DOI: 10.1111/jop.12739] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rawen Smirani
- Unité de Médecine Bucco‐Dentaire Hôpital Pellegrin CHU de Bordeaux Bordeaux France
- Laboratoire BioTis Inserm 1026 Université de Bordeaux Bordeaux France
- UFR des Sciences Odontologiques Université de Bordeaux Bordeaux Cedex France
| | - Marie‐Elise Truchetet
- Service de Rhumatologie Hôpital Pellegrin CHU de Bordeaux Bordeaux Cedex France
- Laboratoire ImmunoConCEpT UMR CNRS 5164 Université de Bordeaux Bordeaux France
| | - Nicolas Poursac
- Service de Rhumatologie Hôpital Pellegrin CHU de Bordeaux Bordeaux Cedex France
| | - Adrien Naveau
- Unité de Médecine Bucco‐Dentaire Hôpital Pellegrin CHU de Bordeaux Bordeaux France
- Laboratoire BioTis Inserm 1026 Université de Bordeaux Bordeaux France
- UFR des Sciences Odontologiques Université de Bordeaux Bordeaux Cedex France
| | | | - Raphaël Devillard
- Unité de Médecine Bucco‐Dentaire Hôpital Pellegrin CHU de Bordeaux Bordeaux France
- Laboratoire BioTis Inserm 1026 Université de Bordeaux Bordeaux France
- UFR des Sciences Odontologiques Université de Bordeaux Bordeaux Cedex France
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31
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Abstract
Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.
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32
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Smirani R, Poursac N, Naveau A, Schaeverbeke T, Devillard R, Truchetet ME. Orofacial consequences of systemic sclerosis: A systematic review. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:81-90. [PMID: 35382129 PMCID: PMC8892883 DOI: 10.1177/2397198317746966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Orofacial involvement is common and often understated in the treatment clinical guidelines of systemic sclerosis. It impairs daily life by having repercussions on comfort, nutrition, aesthetics and self-confidence. This review aimed at describing exhaustively the different orofacial consequences of systemic sclerosis. A systematic search was conducted using four databases (PubMed, Cochrane Library, Dentistry & Oral Sciences Source and SCOPUS) up to December 2016 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Grey literature and hand search were also included. To be eligible for the inclusion, studies needed to meet the following criteria: randomised controlled trials, cross-sectional studies, case-control studies, pilot studies or cohort studies and full text available in English or French, with abstract. The studies had to concern at least 30 patients suffering from systemic sclerosis and having clinical and radiological oropharyngeal examination. The diagnosis of systemic sclerosis had to be determined according to precise recommendations; the retrieved oropharyngeal manifestations had to affect hard or soft tissues of the mouth and/or pharynx and needed to be evaluated with clinical measures. Study selection, risk bias assessment (Newcastle-Ottawa scale) and data extraction were performed by two independent reviewers. The retrieved features were microstomia and xerostomia associated with real hyposialia, temporomandibular joint symptoms, high caries experience, periodontal diseases as well as an increased risk of oral cavity and pharynx cancer. Early diagnosis enabling early management, prevention and oral hygiene is the key to avoid complicated and invasive procedures. Studies with higher level of evidence remain necessary to create standardised protocols.
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Affiliation(s)
- Rawen Smirani
- Unité de médecine bucco-dentaire,
Hôpital Pellegrin, CHU de Bordeaux, Bordeaux - France
- Laboratoire BioTis, Inserm U1026,
Université de Bordeaux, Bordeaux - France
| | - Nicolas Poursac
- Service de Rhumatologie, Hôpital
Pellegrin, CHU de Bordeaux, Bordeaux - France
| | - Adrien Naveau
- Unité de médecine bucco-dentaire,
Hôpital Pellegrin, CHU de Bordeaux, Bordeaux - France
- Laboratoire BioTis, Inserm U1026,
Université de Bordeaux, Bordeaux - France
- UFR des Sciences d’odontologie,
Université de Bordeaux, Bordeaux - France
| | | | - Raphaël Devillard
- Unité de médecine bucco-dentaire,
Hôpital Pellegrin, CHU de Bordeaux, Bordeaux - France
- Laboratoire BioTis, Inserm U1026,
Université de Bordeaux, Bordeaux - France
- UFR des Sciences d’odontologie,
Université de Bordeaux, Bordeaux - France
| | - Marie-Elise Truchetet
- Service de Rhumatologie, Hôpital
Pellegrin, CHU de Bordeaux, Bordeaux - France
- Laboratoire ImmunoConcEpT, UMR CNRS
5164, Université de Bordeaux, Bordeaux - France
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33
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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Curto A, Curto D, Sanchez J. Oral health: OHRQoL in systemic sclerosis. Br Dent J 2017; 222:67. [DOI: 10.1038/sj.bdj.2017.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kalogirou EM, Sklavounou A. Is dental implantation indicated in patients with oral mucosal diseases. BALKAN JOURNAL OF DENTAL MEDICINE 2017. [DOI: 10.1515/bjdm-2017-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Aim: Dental implants are a reliable treatment choice for rehabilitation of healthy patients as well as subjects with several systemic conditions. Patients with oral mucosal diseases often exhibit oral mucosal fragility and dryness, erosions, blisters, ulcers or microstomia that complicate the use of removable dentures and emphasize the need for dental implants. The aim of the current study is to review the pertinent literature regarding the dental implantation prospects for patients with oral mucosal diseases. Material and Method: The English literature was searched through PubMed and Google Scholar electronic databases with key words: dental implants, oral mucosal diseases, oral lichen planus (OLP), epidermolysis bullosa (EB), Sjögren’s syndrome (SS), cicatricial pemphigoid, bullous pemphigoid, pemphigus vulgaris, scleroderma/systemic sclerosis, lupus erythematosus, leukoplakia, oral potentially malignant disorders, oral premalignant lesions, oral cancer and oral squamous cell carcinoma (SCC). Results: Literature review revealed dental implantation in patients with OLP (14 articles), EB (11 articles), pemphigus vulgaris (1 article), SS (14 articles), systemic sclerosis (11 articles), systemic lupus erythematosus (3 articles) and oral SCC development associated with leukoplakia (5 articles). No articles regarding dental implants in patients with pemphigoid or leukoplakia without SCC development were identified. Most articles were case-reports, while only a few retrospective, prospective or observational studies were identified. Conclusions: Dental implants represent an acceptable treatment option with a high success rate in patients with chronic mucocutaneous and autoimmune diseases with oral manifestations, such as OLP, SS, EB and systemic sclerosis. Patients with oral possibly malignant disorders should be closely monitored to rule out the development of periimplant malignancy. Further studies with long follow-up, clinical and radiographic dental data are required to predict with accuracy the outcome of dental implants in patients with oral mucosal diseases.
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Abrão ALP, Santana CM, Bezerra ACB, Amorim RFBD, Silva MBD, Mota LMHD, Falcão DP. What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:441-450. [PMID: 27692394 DOI: 10.1016/j.rbre.2016.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.
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Affiliation(s)
- Aline Lauria Pires Abrão
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brazil.
| | - Caroline Menezes Santana
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Ana Cristina Barreto Bezerra
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brazil
| | | | | | | | - Denise Pinheiro Falcão
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brazil
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Orofacial Manifestations and Temporomandibular Disorders of Systemic Scleroderma: An Observational Study. Int J Mol Sci 2016; 17:ijms17071189. [PMID: 27455250 PMCID: PMC4964558 DOI: 10.3390/ijms17071189] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/22/2022] Open
Abstract
Scleroderma is a disorder involving oral and facial tissues, with skin hardening, thin lips, deep wrinkles, xerostomia, tongue rigidity, and microstomia. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in Systemic Sclerosis (SSc) patients compared with healthy people. Eighty patients (6 men, 74 women) fulfilling ACR/EULAR SSc Criteria were enrolled. A randomly selected group of 80 patients, matched by sex and age served as control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. SSc patients complained more frequently (78.8%) of oral symptoms (Xerostomia, dysgeusia, dysphagia and stomatodynia) than controls (28.7%) (χ2 = 40.23 p = 0.001). TMD symptoms (muscle pain on chewing, difficulty in mouth opening, headaches) were complained by 92.5% of SSc patients and by 76.2% of controls (χ2 = 8.012 p = 0.005). At the clinical examination, 85% of SSc patients showed restricted opening versus 20.0% of controls (χ2 = 67.77 p = 0.001), 81.2% of SSc showed reduced right lateral excursion versus 50% of controls (χ2 = 17.316 p = 0.001); 73.8% of SSc showed limited left lateral excursion versus 53.8% of controls (χ2 = 6.924 p = 0.009); and 73.8% of SSc had narrow protrusion versus 56.2% of controls (χ2 = 5.385 p = 0.02).
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Jung S, Martin T, Schmittbuhl M, Huck O. The spectrum of orofacial manifestations in systemic sclerosis: a challenging management. Oral Dis 2016; 23:424-439. [PMID: 27196369 DOI: 10.1111/odi.12507] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc) is a rare multisystem connective tissue disorder characterized by the triad fibrosis, vasculopathy and immune dysregulation. This chronic disease has a significant impact on the orofacial region that is involved in more than two-thirds of the cases. SSc patients can show a wide array of oral manifestations, which are usually associated with a severe impairment of the quality of life. They often present a decreased the salivary flow and a reduced mouth opening that contribute substantially to the worsening of the oral health status. Therefore, SSc patients require specific and multidisciplinary interventions that should be initiated as early as possible. The identification of specific radiological and clinical signs at the early stage will improve the management of such patients. This study reviews the wide spectrum of orofacial manifestations associated with SSc and suggests clues for the oral management that remains challenging.
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Affiliation(s)
- S Jung
- Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, France.,Center of Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - T Martin
- Service d'Immunologie Clinique, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Médecine, Université de Strasbourg, France.,CNRS UPR 3572 'Immunopathologie et Chimie Thérapeutique', Institut de Biologie Moléculaire et Cellulaire (IBMC), Strasbourg, France
| | - M Schmittbuhl
- Faculté de Médecine Dentaire, Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - O Huck
- Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, France.,INSERM, UMR 1109 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
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Bennani I, Lopez R, Bonnet D, Prevot G, Constantin A, Chauveau D, Paul C, Bulai Livideanu C. Improvement of Microstomia in Scleroderma after Carbon Dioxide Laser Treatment. Case Rep Dermatol 2016; 8:142-50. [PMID: 27403126 PMCID: PMC4924459 DOI: 10.1159/000445821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Limited mouth opening (LMO) is a frequent complication of systemic sclerosis (SS). Its management is complex and there are limited treatment options. We report four patients with SS and severe LMO [interincisal distance (IID) <30 mm] treated with pulsed carbon dioxide (CO2) laser. Pulsed CO2 laser treatment of the white lips was performed after all patients had signed a written informed consent in the absence of alternative treatment. Treatment was carried out under locoregional anaesthesia using a Sharplan 30C CO2 laser in the Silk Touch® resurfacing mode. One to three laser sessions were performed at intervals of 8-12 months between sessions. Assessments were performed at 3 and 12 months with measurement of the IID using a ruler, calculation of the Mouth Handicap in Systemic Sclerosis (MHISS) scale and global evaluation by the patients. Adverse events were also reported. In all four patients, an improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range: 2-7). At 12 months, a mean gain of +8.5 mm (range: 7-10) in IID was observed. The MHISS score decreased by a mean of •14 (range: 11-17). All patients showed improvement of lip flexibility or mouth opening, allowing better phonation and mastication and easier dental care. Adverse effects were transient erythema and/or dyschromia. CO2 laser appears to be effective and well tolerated in the improvement of LMO in SS.
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Affiliation(s)
- Imane Bennani
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - Raphael Lopez
- Departments of Oral and Maxillofacial Surgery, Toulouse University Hospital, Toulouse, France
| | - Delphine Bonnet
- Departments of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Gregoire Prevot
- Departments of Pulmonology, Toulouse University Hospital, Toulouse, France
| | - Arnaud Constantin
- Departments of Rheumatology, Toulouse University Hospital, Toulouse, France
| | - Dominique Chauveau
- Departments of Nephrology, Toulouse University Hospital, Toulouse, France
| | - Carle Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
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Morrisroe K, Frech T, Schniering J, Maurer B, Nikpour M. Systemic sclerosis: The need for structured care. Best Pract Res Clin Rheumatol 2016; 30:3-21. [PMID: 27421213 DOI: 10.1016/j.berh.2016.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Autoimmune connective tissue diseases (CTDs) have a propensity to affect multiple organ systems as well as physical function, quality of life, and survival. Their clinical heterogeneity, multisystem involvement, and low worldwide prevalence present challenges for researchers to establish a study design to help better understand the course and outcomes of CTDs. Systemic sclerosis (SSc) is a notable example of a CTD, wherein longitudinal cohort studies (LCS) have enabled us to elucidate disease manifestations, disease course, and risk and prognostic factors for clinically important outcomes, by embedding research in clinical practice. Nevertheless, further efforts are needed to better understand SSc especially with regard to recognizing organ involvement early, developing new therapies, optimizing the use of existing therapies, and defining treatment targets. The heterogeneous multi-organ nature of SSc would lend itself well to a structured model of care, wherein step-up treatment algorithms are used with the goal of attaining a prespecified treatment target. In this chapter, we discuss the rationale for a structured treatment approach in SSc and propose possible treatment algorithms for three of the more common disease manifestations, namely skin involvement, digital ulcers and gastrointestinal tract involvement. We discuss possible strategies for evaluating and implementing these algorithms in the setting of LCS. We conclude by presenting a research agenda for the development of structured models of care in SSc.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Rheumatology, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Tracy Frech
- Division of Rheumatology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Salt Lake Regional Veterans Affair Medical Center, Salt Lake City, UT, USA
| | - Janine Schniering
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Rheumatology, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia.
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Abrão ALP, Santana CM, Bezerra ACB, Amorim RFBD, Silva MBD, Mota LMHD, Falcão DP. What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:S0482-5004(16)00021-8. [PMID: 26947177 DOI: 10.1016/j.rbr.2015.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/10/2015] [Accepted: 08/28/2015] [Indexed: 12/30/2022] Open
Abstract
Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.
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Affiliation(s)
- Aline Lauria Pires Abrão
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brasil.
| | - Caroline Menezes Santana
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil
| | - Ana Cristina Barreto Bezerra
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brasil
| | | | | | | | - Denise Pinheiro Falcão
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil
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Fixed Implant Supported Rehabilitation of Partially Edentulous Posterior Maxilla in a Patient With Systemic Scleroderma. IMPLANT DENT 2016; 25:155-9. [DOI: 10.1097/id.0000000000000367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Panchbhai A, Pawar S, Barad A, Kazi Z. Review of orofacial considerations of systemic sclerosis or scleroderma with report of analysis of 3 cases. Indian J Dent 2016; 7:134-139. [PMID: 27795648 PMCID: PMC5015564 DOI: 10.4103/0975-962x.186702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Scleroderma (skleros; hard, and derma; skin), is currently known as systemic sclerosis due to its progressive nature and widespread tissue involvement. It is a rare connective tissue disorder with a wide range of oral manifestations. Thickening of the skin is the hallmark of the disease. The patient education for self-care and multidisciplinary approach would be needed to manage the condition. The article presents the review of orofacial considerations in scleroderma with a report of analysis of orofacial manifestations 3 cases.
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Affiliation(s)
- Arati Panchbhai
- Department of Oral Medicine and Radiology, SP Dental College and Hospital, DMIMS University, Wardha, Maharashtra, India
| | - Sangita Pawar
- Department of Oral Pathology, HSRSM, Hingoli, Maharashtra, India
| | - Anuradha Barad
- Department of Oral Pathology, HSRSM, Hingoli, Maharashtra, India
| | - Zamzam Kazi
- Department of Oral Medicine and Radiology, SP Dental College, Wardha, Maharashtra, India
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Reichart PA, Schmidt-Westhausen AM, Khongkhunthian P, Strietzel FP. Dental implants in patients with oral mucosal diseases - a systematic review. J Oral Rehabil 2015; 43:388-99. [DOI: 10.1111/joor.12373] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/27/2023]
Affiliation(s)
- P. A. Reichart
- Department of Oral Medicine, Dental Radiology and Oral Surgery; Center for Dental, Oral and Maxillary Medicine; Charité - Universitätsmedizin Berlin/Germany; Berlin Germany
| | - A. M. Schmidt-Westhausen
- Department of Oral Medicine, Dental Radiology and Oral Surgery; Center for Dental, Oral and Maxillary Medicine; Charité - Universitätsmedizin Berlin/Germany; Berlin Germany
| | - P. Khongkhunthian
- Faculty of Dentistry; Center of Excellence for Dental Implantology; Chiang Mai University/Thailand; Chiang Mai Thailand
| | - F. P. Strietzel
- Department for Oral Medicine, Dental Radiology, and Oral Surgery; Charité Centre 3 for Dental, Oral, and Maxillary Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
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45
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Willems LM, Vriezekolk JE, Schouffoer AA, Poole JL, Stamm TA, Boström C, Kwakkenbos L, Vliet Vlieland TPM, van den Ende CHM. Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review. Arthritis Care Res (Hoboken) 2015; 67:1426-39. [PMID: 25832447 DOI: 10.1002/acr.22595] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/24/2015] [Accepted: 03/24/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). METHODS Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. RESULTS Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. CONCLUSION The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.
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Affiliation(s)
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden, and Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Linda Kwakkenbos
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Ramazani M, Zarenejad N, Ebrahimi K. The Help of Hypnodontics to a Patient With Scleroderma ‒ Case Report. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e211. [PMID: 26251657 PMCID: PMC4525446 DOI: 10.17795/ijpbs211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 12/13/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
Introduction: Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally
classified as one of the autoimmune rheumatic diseases Case Presentation: A 58-year-old woman was informed of her scleroderma, while receiving oral prosthetic
rehabilitation. Mouth opening limitation had unfortunately led to treatment
interruption. The psychological load of the disease itself, along with dental treatment
cessation, resulted in patient’s disappointment and social separation. Three hypnosis
sessions were conducted for normalizing patient’s psychological status primarily, and
for the facilitation of dental treatment, as well. The range of mouth opening changed
from 3.7 to 6.2 cm, allowing for easier entrance of dental appliances into the mouth
for completion of prosthetic rehabilitation. With the tooth prostheses in place, the
patient gained more social confidence and started sharing her experience with other
patients with the same condition. Discussion: This case illustrates that hypnosis therapy may prove beneficial for patients with
limited mouth opening secondary to scleroderma, facilitating the prosthetic
rehabilitation programs for both dental specialists and patients, with a secondary
important impact on the patient’s social perception of himself.
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Affiliation(s)
- Mohsen Ramazani
- Department of Endodontics, School of Dentistry, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Nafiseh Zarenejad
- Department of Restorative Dentistry, School of Dentistry, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Kaveh Ebrahimi
- Department of Prosthodontics, School of Dentistry, Mazandaran University of Medical Sciences, Sari, IR Iran
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Baron M, Hudson M, Tatibouet S, Steele R, Lo E, Gravel S, Gyger G, El Sayegh T, Pope J, Fontaine A, Masetto A, Matthews D, Sutton E, Thie N, Jones N, Copete M, Kolbinson D, Markland J, Nogueira-Filho G, Robinson D, Gornitsky M. The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis. Rheumatology (Oxford) 2014; 54:692-6. [PMID: 25288781 DOI: 10.1093/rheumatology/keu396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Both oral and global health-related quality of life (HRQoL) are markedly impaired in SSc. In this study we aimed to determine the degree of association between oral HRQoL and global HRQoL in SSc. METHODS Subjects were recruited from the Canadian Scleroderma Research Group registry. Global HRQoL was measured using the Medical Outcomes Trust 36-item Short Form Health Survey (SF-36) and oral HRQoL with the Oral Health Impact Profile (OHIP). The Medsger Disease Severity Score was used to determine organ involvement. Multivariate regression models determined the independent association of the OHIP with the SF-36 after adjusting for confounders. RESULTS This study included 156 SSc subjects. The majority (90%) were women, with a mean age of 56 years, mean disease duration 13.8 years (s.d. 8.5) and 29% of the subjects had dcSSc. Mean total OHIP score was 40.8 (s.d. 32.4). Mean SF-36 mental component summary (MCS) score was 49.7 (s.d. 11.1) and physical component summary (PCS) score was 37.0 (s.d. 10.7). In adjusted analyses, the total OHIP score was significantly associated with the SF-36 MCS and PCS, accounting for 9.7% and 5.6% of their respective variances. Measures of disease severity were not related to OHIP score. CONCLUSION Oral HRQoL in SSc is independently associated with global HRQoL. Oral HRQoL, however, is not related to physician-assessed disease severity. This suggests that physicians may be disregarding issues related to oral health. HRQoL is an additional dimension of HRQoL not captured by generic instruments such as the SF-36.
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Affiliation(s)
- Murray Baron
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Marie Hudson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Solène Tatibouet
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Russell Steele
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Ernest Lo
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sabrina Gravel
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Geneviève Gyger
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Tarek El Sayegh
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet Pope
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Audrey Fontaine
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ariel Masetto
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Debora Matthews
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Evelyn Sutton
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Norman Thie
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Niall Jones
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maria Copete
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Dean Kolbinson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet Markland
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Getulio Nogueira-Filho
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - David Robinson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mervyn Gornitsky
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
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Del Rosso A, Maddali-Bongi S. Oral health in patients with systemic sclerosis. Rheumatology (Oxford) 2014; 53:1355-6. [PMID: 24825915 DOI: 10.1093/rheumatology/keu179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Angela Del Rosso
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
| | - Susanna Maddali-Bongi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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Salem B, Rim BHA, Sihem BK, Maher B. [Oral manifestations of systemic sclerosis]. Pan Afr Med J 2013; 16:114. [PMID: 24778751 PMCID: PMC3998902 DOI: 10.11604/pamj.2013.16.114.3065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022] Open
Abstract
Nous rapportons l'observation d'une jeune femme de 26 ans ayant une sclérodermie systémique diffuse présentant une atteinte bucco-dentaire complexe: microstomie, hyperplasie gingivale, parodontite, dépôts tartriques, caries multiples et chevauchement dentaire antéro-inférieur. Nous discuterons à travers cette observation les manifestations bucco-dentaires de cette connectivite qui sont loin d’être rares mais souvent négligées par les cliniciens malgré leur retentissement fonctionnel majeur. Il convient de surveiller régulièrement l’état bucco-dentaire chez tout patient sclérodermique afin de diagnostiquer précocement ces atteintes. Diagnostiquées à un stade tardif les complications bucco-dentaires de la sclérodermie seront très difficiles à traiter.
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Affiliation(s)
- Bouomrani Salem
- Service de Médecine Interne, hôpital Militaire de Gabes 6000, Tunisie
| | - Bel Hadj Ali Rim
- Service de Chirurgie Dentaire, hôpital Militaire de Gabes 6000, Tunisie
| | - Ben Khoud Sihem
- Service de Chirurgie Dentaire, hôpital Militaire de Gabes 6000, Tunisie
| | - Béji Maher
- Service de Médecine Interne, hôpital Militaire de Gabes 6000, Tunisie
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