Background/Purpose: Systemic sclerosis (SSC) is a chronic, multisystem autoimmune disease characterized by immune dysfunction, microangiopathy, and tissue remodelling. Orofacial manifestations, including xerostomia, microstomia, tooth decay, and periodontitis, affect up to 80% of SSC patients and significantly impact their quality of life. Despite their prevalence, these manifestations are often neglected compared to more life-threatening complications such as lung or kidney involvement. This study was designed to estimate the prevalence of oral-manifestations and to find their association with clinical and serological profiles in SSC patients.

Methods: A multi-centre study was conducted involving 131 SSC patients fulfilling ACR/EULAR-criteria. Comprehensive clinical-evaluation was performed including Modified-Rodnan-Skin-Score (MRSS) for skin tightness and Medsger’s-disease-severity-score for organ involvement. Oral-manifestations like presence of sicca symptoms, GERD were noted. Standardised-questionnaires like, Indian Cochin hand function Scale (ICHFS), Mouth Handicap in Systemic Sclerosis Scale (MHISS) were used to assess functional-impairment. Oro-facial health was evaluated using standardized dental indices such as Debri-Index(DI), Calculus-index(CI), number of missing-teeth, tooth-mobility, probing-depth(PD), gingival-bleeding(GB) and Clinical-attachment-level(CAL), Recession(REC) by a periodontist. Statistical-analysis was conducted using SPSS software V20, with statistical significance set at p < 0.05.

Results: Among 131 SSC patients, 45 were Limited Cutaneous SSC (LCSSC), 83 were Diffuse Cutaneous SSC (DCSSC) and 3 were sine scleroderma. The mean age was 42 years. Prevalence of oral manifestations like sicca symptoms was 59.5%, halitosis was 31.3%, Dysguesia was 36.6%, Reduced mouth opening was 63.4%, caries tooth was 60.3%%. Most of the oral manifestations were seen with a higher prevalence in DCSSC. Among the dental-examination findings, GB20,30,40, mean CAL, mean REC, DI and CI were higher in DSCC. The patients with early-disease ( < 5 years from first non-Raynauds symptom) constituted 43.5% and late-disease constituted 56.5%. All the oral-manifestations and dental-examination findings were higher in patients with late disease. The IC-HFS is higher in DCSSC patients with a mean score of 16.45 (p < 0.05) and among those with late disease with a mean score of 20.2(p < 0.05). Disease severity assessed by Medsger's score correlated positively with DCSSC, periodonditis, missing teeth, teeth mobility, GB, mean REC.

Conclusion: In this multicentre study, DCSSC exhibited significantly higher oral and dental manifestations with increased IC-HFS scores, GERD, reduced mouth opening, greater number of missing-teeth and periodontitis. Patients with late disease had more pronounced oral-manifestations and higher CAL, REC scores. These findings suggest that DCSSC and extended disease-duration are associated with more severe oral health complications, highlighting the importance of early dental intervention. Disease severity as assessed by Medsgers-score correlated-positively with presence of periodontitis indicating its possible role in disease pathogenesis.

Prevalence Of Oral Manifestations In Systemic Sclerosis Patients

Functional Measures Among Limited and Diffuse Cutaneous Systemic Sclerosis Patients

Functional Measures Among Early and Late Systemic Sclerosis Patients

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-oral-manifestations-and-their-association-with-clinical-and-serological-profile-in-systemic-sclerosis-patients-an-indian-study/