We read with great interest the recently published article by Pischon et al.,1 and, being ourselves currently involved in research on the mechanism of periodontal and temporomandibular (TMJ) diseases during systemic sclerosis (SSc), we wish to make the following observations and additions to the results obtained by these authors. In their case-control study, the authors analyzed a possible association between periodontal disease and SSc by examining 58 patients with SSc and 52 controls, matched for age and sex. Using a linear regression analysis, the authors found that patients affected by SSc presented a significantly higher periodontal attachment loss (AL) (P = 0.002) compared with healthy controls. Through a stepwise logistic regression, including SSc status and the different potential risk factors such as poor oral hygiene, smoking, level of education, daily alcohol consumption, and body mass index, in SSc patients, only SSc status, age, and sex were significantly associated with periodontal disease. Moreover, a significantly high number of patients with SSc presented TMJ symptoms and disorders compared with controls (P <0.001). Among the authors’ main conclusions is that patients with SSc, although they presented with fewer clinical signs of periodontitis such as bleeding on probing and gingival inflammation, have an increased periodontal AL compared with healthy individuals. In this report, the authors investigated SSc activity through the activity index (in accordance to the European Scleroderma Study Group and Research guidelines), whereas the thickness of the skin was assessed, at baseline, by the modified Rodnan skin score (MRSS).2 SSc is a multisystem disorder of the connective tissue of the skin and underlying tissues that can have significant adverse effects on the health of the mouth. Periodontal disease,3 as well as widening of periodontal ligament spaces and abnormalities in periodontal microcirculation, have been reported as a frequent finding as part of the global fibrosing aspects of SSc.4 Recently, in accord with the authors’ results, we reported a detectable prevalence of symptoms and signs of dysfunction of TMJs and self-reported symptoms in SSc patients (limited and diffuse) compared with healthy subjects.5 Notably, our study primarily demonstrated in the SSc group an association between TMJ symptoms with MRSS and the mean duration of SSc. SSc is considered a disabling condition, closely correlated with the extent of skin sclerosis and vasculopathy of inner organs and muscles, that is associated with a low score of oral health–related quality of life.6 This condition may determine, during the SSc extent and duration, the presence of the physical impairment that, due to reduced mouth opening, might contribute to limited oral hygiene, increased plaque accumulation, and consequently to periodontal disease tissue breakdown. In conclusion, we believe that the study by Pischon et al.1 contributed valuable information on the association between periodontal disease and SSc subtypes. However, a further analysis regarding also the association of periodontal disease and other disease characteristics of SSc, such as MRSS or mean duration of disease, should provide further and interesting information to better understand the role and the main cause of the association between periodontal disease and SSc.
|Titolo:||Letter to the Editor: Re: Increased Periodontal Attachment Loss in Patients With Systemic Sclerosis|
ISOLA, GAETANO [Writing – Review & Editing] (Corresponding)
|Data di pubblicazione:||2017|
|Appare nelle tipologie:||1.1 Articolo in rivista|