# Evaluation of oral health in 148 patients with systemic sclerosis—data from a prospective interdisciplinary monocentric cohort

## TL;DR

This study examines oral health in 148 systemic sclerosis patients, finding a high risk of periodontitis, especially in males, despite good dental care habits.

## Contribution

The study highlights gender-specific differences in periodontitis risk among systemic sclerosis patients and links oral health indicators to disease progression.

## Key findings

- 90% of patients reported regular dental visits, but over half had missing teeth and mouth-opening issues.
- Periodontitis risk was higher in males (80%) compared to females (60%), despite overall good dental care.
- Gingival bleeding correlated with salivary flow and skin fibrosis severity (mRSS).

## Abstract

In daily rheumatology practice, systemic sclerosis is primarily regarded as a potentially life-threatening disease characterized by fibrosis of various organs. Therefore, other manifestations, such as orofacial involvement, are often not of primary concern. Furthermore, due to its rarity, the disease might not be well known by dentists, which contrasts with the increased risk of various problems in the oral cavity. Periodontitis in particular is a known risk factor for morbidity and mortality and is associated with various systemic diseases. The risk of periodontitis appears to be increased in patients with systemic sclerosis, but little is known about the gender-specific differences. This study aims to elucidate the health-conscious behaviour of patients, their dental care and the risk of periodontitis with regard to gender-specific differences. This descriptive study of the Interdisciplinary Centre of Rheumatic Diseases (INDIRA) in collaboration with the Department of Orthodontics at the University Hospital of Tuebingen, Germany, examined the data of 148 patients with systemic sclerosis with regard to their oral health using a questionnaire and evaluating the risk of periodontitis with the DG Paro self-assessment score in this cohort. Among the participating patients, 90% reported regular visits to the dentist and good dental care. Nevertheless, more than half of the patients had missing teeth and problems opening their mouths. Sicca symptoms in the oral cavity were also common (40%). The risk of periodontitis among female participants was high (around 60%), and even higher among male study participants (around 80%). Gingival bleeding as a surrogate parameter for periodontitis was associated with salivary flow and the modified Rodnan skin score (mRSS). Despite a high awareness of dental health, we observed a high risk of periodontitis, especially in male patients with systemic sclerosis. In addition, the association between xerostomia and missing teeth as well as gingival bleeding and mRSS may indicate an increased risk in patients with a more progressive disease. We would therefore recommend regular dental consultations and careful oral hygiene for patients with systemic sclerosis in addition to the—more organ-focused—regular examinations of patients.

The online version contains supplementary material available at 10.1007/s00296-024-05635-z.