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Koppolu P, Sheethi KV, Swapna LA, Priyanka M, Abdelrahim RK, Basireddy A, Mandil O. Treatment of aggressive periodontitis in a patient with systemic lupus erythematosus: A case report with 8 years follow-up. Ann Afr Med 2023; 22:549-553. [PMID: 38358160 PMCID: PMC10775935 DOI: 10.4103/aam.aam_128_22] [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] [Received: 08/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 02/16/2024] Open
Abstract
Systemic lupus erythematosus (SLE) with oral desquamative lesions is one of the rare clinical entities. Periodontal disease and SLE display various mechanisms and possess a wide range of pathological characteristics. The tissue destruction mechanism of periodontitis and autoimmune diseases share similar pathways, and mounting reports studied the association between these two entities. The present case is of a 24-year-old female patient who complained of generalized widening of spaces in between the teeth. Along with it, She suffered from loss of hair, weakness, edema in the legs as well as arthralgia. The patient was identified to be suffering from SLE according to the American Rheumatism Association and European Academy of Dermatology and Venereology criteria 1 year before she reported to the dentist. She suffered from hair loss, weakness, arthralgia as well as edema in the legs. Based on the oral, clinical, and radiographic findings, she was diagnosed with aggressive periodontitis case. After nonsurgical periodontal treatment, the flap was reflected, debridement was done, after root conditioning with tetracycline, bovine osseous xenograft was placed in all the sites where ever there is angular bone loss, later sutured with interrupted direct loop suturing technique with 4-0 silk suture. Clinical and radiographic evaluation was done every 6 weeks to check the progress of the treatment. 6 months and 8-year follow-up revealed satisfactory clinical and radiographic outcomes. Based on the present case report and the previous literature, we recommend the use of xenograft in treating aggressive periodontitis patients.
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Affiliation(s)
- Pradeep Koppolu
- UWA Dental School, The University of Western Australia, Perth, Australia
| | | | - Lingam Amara Swapna
- Department of Surgical and Diagnostic Sciences, College of Dentistry Dar AlUloom University, Hyderabad, India
| | | | | | - Aravinda Basireddy
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Shaik MR, Shaik NA, Mikdashi J. Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment. Cureus 2023; 15:e41883. [PMID: 37581141 PMCID: PMC10423619 DOI: 10.7759/cureus.41883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Autoimmune dysphagia is defined as dysphagia caused by autoimmune processes affecting various components of the swallowing process such as muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. These autoimmune causes can be classified into gastroenterological, dermatological, rheumatologic, and neurologic. Rheumatological disorders, such as scleroderma, Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, Behcet's disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, or granulomatosis with polyangiitis, have been associated with dysphagia. Autoimmune dysphagia in the context of rheumatological disorders is particularly significant because it can occur as a sole manifestation or as part of a symptom complex associated with the underlying disorder and often responds to immunosuppressive therapies. However, diagnosing autoimmune dysphagia can be challenging as it requires the exclusion of structural and primary motility disorders through procedures such as endoscopy and manometry. Early diagnosis is important to improve the quality of life and prevent significant mortality and morbidity. Management focuses on treating the underlying disease activity, and a multidisciplinary approach involving various medical specialties may be necessary to achieve success. This article aims to review the autoimmune rheumatological conditions that can lead to dysphagia and discuss the associated pathophysiological mechanisms. We also outline the clinical clues and laboratory testing methods that facilitate early diagnosis, with the goal of improving patient outcomes through timely intervention and appropriate management.
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Affiliation(s)
- Mohammed Rifat Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Nishat Anjum Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, USA
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Demarchi LS, Vogel MT, Haubert G, Rigo L. Impact of xerostomia and the use of dental prosthesis on the quality of life of elderly. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023. [DOI: 10.20396/bjos.v22i00.8667543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Aim: To evaluate the impact of xerostomia, edentulism, use of dental prosthesis, and presence of chronic diseases on quality of life in relation to oral health in institutionalized elderly individuals. Methods: This is a cross-sectional study. A questionnaire was administered containing the following instruments: Oral Health Impact Profile (OHIP-14), which measures the quality of life related to oral health; the Summated Xerostomia Inventory questionnaire (SXI-PL) for evaluation of xerostomia, sociodemographic data, clinical description, and patient-reported factors was assessed (edentulism, use of dental prostheses, and chronic diseases). Results: Most elderly individuals did not have any teeth in their mouths and used dental prosthesis. The impact on quality of life, considering the mean of the OHIP-14 scores, was positive in 58.3% of the elderly. Those who used a dental prosthesis were three times more likely to have their oral health negatively impacted (OR=3.09; 95%CI =1.17 8.11), compared to those who did not use, and individuals with xerostomia were more likely to have their oral health negatively impacted (OR=1.57; 95%CI=1.25-1.98) compared to those without xerostomia. There was no difference in the quality of life of individuals with and without chronic diseases. Conclusions: The feeling of dry mouth and use of dental prostheses negatively impacted the quality of life in relation to oral health of the elderly.
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Schnaufer TC, Tavares AL, Hoss IM, Correia BR, Pradal LDA, Piana EA, Wachter F, Stein T, Ayala TS, Menolli RA, Bertolini GRF, Meire Costa R, Ribeiro LDFC, Nassar CA, Nassar PO. Experimental model of periodontitis and rheumatoid arthritis potentiates the deleterious effects on functional capacity, leukocyte migration, synovial and periodontal tissues in Wistar rats. Acta Odontol Scand 2023; 81:40-49. [PMID: 35694780 DOI: 10.1080/00016357.2022.2078504] [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: 02/08/2023]
Abstract
OBJECTIVE This study aimed to evaluate whether ligature-induced periodontitis and rheumatoid arthritis (RA) potentiate the deleterious effects on functional capacity, periodontal and synovial tissues, leukocyte migration, and interleukin 17 (IL-17) levels, and to investigate the repercussions of single Freund's Complete Adjuvant (FCA) injection associated with periodontitis. MATERIALS AND METHODS Fifty-one male Wistar rats were randomised into six groups: control (CG, n = 8), RA (RAG, n = 9), periodontitis (PG, n = 9), periodontitis and RA (PRAG, n = 9), periodontitis and intradermal injection (PIDG, n = 9), and periodontitis and intra-articular injection (PIAG, n = 7). The animals underwent ligature placement and one or two injections with FCA to induce RA. Motor disability, nociceptive threshold, joint edema, and muscle strength were assessed, and the animals were euthanized on day 30. Synovial fluid, hemimandibles, and knee joints were collected. RESULTS PRAG showed no reduction of edema or improvement of muscle strength, whereas it showed most significant changes in leukocyte migration, morphological analyses of the synovial membrane (SM), and radiographic and histometric analyses of the jaw. The PIAG showed some alterations, though not permanent. CONCLUSION Ligature-induced periodontitis and RA induced by two FCA injections accentuated the deleterious effects on functional capacity, leukocyte migration, synovial and periodontal tissues.
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Affiliation(s)
- Thaís Caroline Schnaufer
- Master's of Science in Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Alana Ludemila Tavares
- Master's of Science in Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Iranilda Moha Hoss
- Master's of Science in Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Bruna Rafaela Correia
- Master's of Science in Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Lilian de Araújo Pradal
- Master's of Science in Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Ediana Amanda Piana
- Department of Periodontology, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Franciane Wachter
- Department of Periodontology, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Taciane Stein
- Health and Bioscences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Thais Soprani Ayala
- Center of Medical and Pharmaceutical Sciences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | - Rafael Andrade Menolli
- Center of Medical and Pharmaceutical Sciences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | | | - Rose Meire Costa
- Center of Biological and Health Sciences, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
| | | | - Carlos Augusto Nassar
- Department of Periodontology, State University of Western Paraná - UNIOESTE, Cascavel, Brazil
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de Carvalho HN, Dos Santos YL, Bernardino ÍDM, de Lima KC, Granville-Garcia AF, Melo de Brito Costa EM. Accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation. Int Dent J 2020; 70:427-434. [PMID: 32830311 DOI: 10.1111/idj.12586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Determine the accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation. METHODS A total of 402 adults awaiting dental care at a public healthcare service answered an eight-item questionnaire addressing xerostomia and were submitted to stimulated sialometry, with ≤ 0.7 mL/min considered indicative of hyposalivation. Reproducibility and internal consistency of the questionnaire were evaluated. The correlation between the score and salivary flow was investigated. The total score was also compared between groups with and without hyposalivation and diagnostic precision measures were calculated. RESULTS Hyposalivation was identified in 162 participants (40.3%) and a total of 229 (57.0%) answered affirmatively to at least one question. The responses to each question revealed variable reproducibility (κ = 0.450-0.785) and satisfactory internal consistency (Cronbach's α = 0.70). Individuals with a larger number of positive answers had lower salivary flow (Spearman's ρ = -0.193; P < 0.001). The mean number of positive answers was greater in the group with a clinical diagnosis of hyposalivation compared to those without low salivary flow. The sensitivity of the screening tool was 64.8%, with an area under the ROC curve of 0.60 (95% confidence interval: 0.547-0.645; P < 0.001). CONCLUSION The questionnaire proved to be useful for the epidemiological screening of individuals with possible hyposalivation.
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Affiliation(s)
- Handerson Nunes de Carvalho
- Programa de Pós-Graduação em Odontologia, Departamento de Odontologia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Yuri Lins Dos Santos
- Graduação em Odontologia, Departamento de Odontologia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Ítalo de Macedo Bernardino
- Programa de Pós-Graduação em Odontologia, Departamento de Odontologia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Kênio Costa de Lima
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Ana Flávia Granville-Garcia
- Programa de Pós-Graduação em Odontologia, Departamento de Odontologia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Edja Maria Melo de Brito Costa
- Programa de Pós-Graduação em Odontologia, Departamento de Odontologia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
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Manzano BR, da Silva Santos PS, Bariquelo MH, Merlini NRG, Honório HM, Rubira CMF. A case-control study of oral diseases and quality of life in individuals with rheumatoid arthritis and systemic lupus erythematosus. Clin Oral Investig 2020; 25:2081-2092. [PMID: 32803443 DOI: 10.1007/s00784-020-03518-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 08/10/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the impact of oral alterations on the quality of life (QoL) of individuals with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). METHODS A case-control study in 32 individuals with RA, 28 with SLE, and 29 in the control group (CG). The questionnaire SF-36 (Medical Outcomes Study Short-Form 36) was used to evaluate the health-related quality of life (HRQoL), and OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the oral health-related quality of life (OHRQoL). The severity of xerostomia was evaluated by the Xerostomia Inventory (XI). In the clinical examination, decayed (D-T), missing(M-T), and filled teeth (F-T) (DMF-T), periodontal status, plaque index (PI), gingival index (GI), unstimulated whole salivary flow rate (UWSFR), and stimulated whole salivary flow rate (SWSFR) were also assessed. Data were analyzed by Student's t tests, chi-square test, Kruskal-Wallis test, ANOVA, Pearson's correlation, and Spearman's correlation. RESULTS Individuals with RA had a higher caries index (D-T/p = 0.004) and more frequent periodontal disease (PI/p = 0.017). In the SLE group, there was a significant lower salivary flow (SFR/p = 0.016, SFMS/p = 0.004) and severe xerostomia (p = 0.002). The impact of ORHQoL in individuals with RA occurred due to oral candidiasis, halitosis, and xerostomia, compromising the HRQoL. Overall, OHRQoL and HRQoL were more compromised in individuals with SLE, with xerostomia being the main oral problem. CONCLUSION Individuals with RA and SLE present oral diseases with negative impact on their QoL. CLINICAL RELEVANCE This study shows the main oral manifestations in rheumatic autoimmune diseases, with mainly xerostomia compromising the quality of life.
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Affiliation(s)
- Brena Rodrigues Manzano
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil.
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Matheus Henrique Bariquelo
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Silvio Marchione, 3-20, Bauru, 17012-900, Brazil
| | | | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
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Persistent Palatal Ulcerations. A Potential Manifestation of Juvenile Systemic Lupus Erythematosus. J Clin Pediatr Dent 2020; 44:52-54. [PMID: 31995413 DOI: 10.17796/1053-4625-44.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Oral ulcerations in children and adolescents is a common occurrence and affects about 20-30% of this population. This case report describes a unique and serious autoimmune condition that presented with distinct oral findings that significantly supported the differential diagnosis of Juvenile Systemic Lupus Erythematosus in a 15 year-old female. Pediatric and general dentists should familiarize themselves with the condition to facilitate diagnosis with collaborative efforts with the medical team.
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Gilheaney Ó, Zgaga L, Harpur I, Sheaf G, Kiefer L, Béchet S, Walshe M. The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis. Dysphagia 2017; 32:587-600. [PMID: 28508937 DOI: 10.1007/s00455-017-9808-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/10/2017] [Indexed: 01/03/2023]
Abstract
Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.
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Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
| | - Isolde Harpur
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Greg Sheaf
- Library of Trinity College Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - Liss Kiefer
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Sibylle Béchet
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
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Andrade KMD, Alfenas BFM, Campos CH, Rodrigues Garcia RCM. Mandibular movements in older people with rheumatoid arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e153-e159. [PMID: 28407990 DOI: 10.1016/j.oooo.2017.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to compare the mandibular movements in older people with and without temporomandibular disorder (TMD) associated with rheumatoid arthritis (RA). STUDY DESIGN Thirty partially or completely edentulous older adults (65.33 ± 4.7 years) were assigned to 2 groups: (1) with RA and TMD and (2) without RA and TMD. Chewing movements of the jaws during mastication of the test material (Optocal) and the range of mandibular movements were evaluated by using the JT-3-D kinesiographic device before and after new removable prosthesis insertion. Multiple comparisons were made with analysis of variance (ANOVA) and the Tukey-Kramer test. RESULTS Comparisons between the 2 groups before and after new prosthesis insertion revealed that the RA and TMD group had reduced opening angles (P < .05) during chewing. After insertion of new prostheses, both groups showed increased opening and closing angles during chewing (P < .05). The mandibular range of motion results showed that patients with RA and TMD exhibited lower aperture and laterality movements (P < .05) compared with controls before and after new prosthesis insertion. However, there was an increase in aperture, lefty laterality, and protrusion values after new prosthesis insertion in both groups. CONCLUSIONS TMD associated with RA may impair mandibular movements. Well-fitted prostheses may improve mandibular movements in older adults, especially those with RA.
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Affiliation(s)
- Kelly Machado de Andrade
- Graduate Student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Bruna Fernandes Moreira Alfenas
- Graduate Student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Camila Heitor Campos
- Assistant Professor, Department of Specific Formation, Nova Friburgo Health Institute, Fluminense Federal University, Rio de Janeiro, Brazil
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