Sir, we read with interest the article by Veale et al. (BDJ 2016; 221: 305–310) about the oral and maxilofacial manifestations of systemic sclerosis.1 Systemic sclerosis is a multisystem disease in which functional impairment and work disability are common. Oral manifestations of systemic sclerosis include caries, xerostomia, microstomia, gingival recession, periodontal disease and bone resorption of the mandible, sometimes leading to fractures.2
Instruments have been developed to assess oral health-related quality of life (OHRQoL) that may be diminished specifically by problems resulting from poor oral health.
Studies of oral health in systemic sclerosis have been performed with small samples, often without appropriate controls. Oral health-related quality of life in systemic sclerosis has not been robustly estimated.3
Global oral health-related quality of life is significantly impaired in systemic sclerosis. There is some evidence from studies in non-systemic sclerosis subjects that oral health-related quality of life is associated with global health-related quality. Oral health-related quality of life in systemic sclerosis is independently associated with global health-related quality of life. Oral health-related quality of life, however, is not related to physician-assessed disease severity. Systemic sclerosis patients have more missing teeth, more periodontal disease, less saliva production, smaller interincisal distance and poorer oral health-related quality of life than controls subjects.4,5
Given the impact of poor oral health on health-related quality of life, healthcare professionals caring for systemic sclerosis patients should pay more attention to oral health, as has been previously suggested, as interventions to improve oral health in systemic sclerosis have the potential to improve overall health-related quality of life.
References
Veale B J, Jablonski R Y, Frech T M, Pauling J D . Orofacial manifestations of systemic sclerosis. Br Dent J 2016; 221: 305–310.
Vincent C, Agard C, Barbarot S et al. [Orofacial manifestations of systemic sclerosis: A study of 30 consecutive patients]. Rev Stomatol Chir Maxillofac 2010; 111: 128–134.
Leung W K, Chu C H, Mok M Y et al. Periodontal status of adults with systemic sclerosis: case-control study. J Periodontol 2011; 82: 1140–1145.
Maddali Bongi S, Del Rosso A et al. The Italian version of the Mouth Handicap in Systemic Sclerosis scale (MHISS) is valid, reliable and useful in assessing oral health-related quality of life (OHRQoL) in systemic sclerosis (SSc) patients. Rheumatol Int 2012; 32: 2785–2790.
Alantar A, Cabane J, Hachulla E et al. Recommendations for the care of oral involvement in patients with systemic sclerosis. Arthritis Care Res 2011; 63: 1126–1133.
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Curto, A., Curto, D. & Sanchez, J. Oral health: OHRQoL in systemic sclerosis. Br Dent J 222, 67 (2017). https://doi.org/10.1038/sj.bdj.2017.51
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DOI: https://doi.org/10.1038/sj.bdj.2017.51