On Sunday morning, June 19, 2005, I provided a workshop on dentistry members of the National Scleroderma Foundation at their national convention in Cambridge, Ma. Scleroderma is a disease that causes the skin to thicken and become less pliable and less resilient. The same disease may affect internal organs causing hardening of the arteries, lung disease, and kidney disease. Although there is no cure for scleroderma, many treatments are available. The treatments slow the progression of the disease.
A quick survey of the audience demonstrates many of the attributes of the disease. Most of the audience members are women. Many show outward signs of their affliction. Due to scleroderma’s effect on the lungs, one carries a small oxygen tank. Several, who have severe arthritis, use assistive devices such as canes or crutches, and one is in a wheelchair. Scleroderma affects the circulatory system causing high blood pressure and Raynaud’s syndrome, a painful loss of blood flow to the fingers and toes when there is a chill in the air, so many wear gloves and blankets to stave off the air conditioning. One woman appears to nod off when I begin to speak. The rest, however, sit in rapt attention as they all have dental problems due to scleroderma.
Four effects of scleroderma affect dental health. The tightening skin of the face causes microstomia or small mouth. Xerostomia, dry mouth, often accompanies scleroderma. Many scleroderma sufferers have depression. Finally, the medications that physicians prescribe to treat scleroderma and depression effect oral health in a variety of ways.
Microstomia is a classic symptom of scleroderma. Skin on the face tightens and becomes smooth and shiny. The tongue may loose mobility as well; without a free moving tongue, bits of food accumulate around the mouth. Many people find that they can no longer close their lips together. Some find that they cannot speak the way they always have. They cannot kiss normally. For some, the emotional toll of not being able to show their affection for their spouse or children is unbearable.
The tightening skin and muscles make it difficult and uncomfortable to open wide enough for routine dental treatment. This is frustrating to patients and dentists. The dentist may feel that the patient is not cooperating. The disaffection between the patient and the dentist is liable to prevent the patient from returning to that office or even finding another dental provider.
Talking with the dentist before or during the appointment about any condition that affects treatment is very important. A dentist who knows that a patient is not able to open wide or hold their mouth open for long periods will make shorter appointments. There are instruments available for smaller mouths. Dentists and dental hygienists know exercises that help maintain and increase the size of the mouth. Surgical procedures can improve mobility of the lips and tongue.
Saliva is very important to oral health. The lack of saliva is called xerostomia*. Saliva is a solution of electrolytes, proteins, immunogloben, and water that cleans, protects, and restores teeth. Bacteria create acid that robs the teeth of calcium. Saliva contains calcium, which can remineralize teeth. Without saliva, bacterial plaque covers teeth and creates tooth decay. Dry mouths are more prone to candidiasis (yeast infection) which many notice as a burning sensation or cracks in the corners of the mouth. Antibodies and proteins in the saliva protect the lining of the mouth from yeast infection. Saliva is important to denture wearers. Saliva lubricates the lining of the mouth and helps maintain suction for the upper denture.
Drinking more water and sucking on sugar free hard candies increases the flow of saliva. Dentists can prescribe antifungal medications to treat candidiasis, artificial saliva to lubricate the oral tissues, and fluoride to make teeth more resistant to decay.
Many of the medications that physicians prescribe to treat scleroderma have side effects that effect oral health. Some cause very uncomfortable mouth ulcerations. Dentists can help diagnose this effect and recommend palliative (soothing) treatments. Many medications cause xerostomia. Some cause delayed wound healing which effects gingival health, and delay healing after surgery such as tooth extraction. Keep a current list of medications in your purse or wallet. Ask your dentist to review the list with you with an eye toward how the medications affect oral health.
Depression is a hallmark of scleroderma. Patients become demoralized when facing the inexorable progression of their disease. In the face of scleroderma, people ignore their oral health until they feel better or have dental emergency. Microstomia and xerostomia make treatment difficult and uncomfortable. It is important for scleroderma patients to maintain their oral health throughout the course of their disease to decrease the necessity for long, uncomfortable treatments. Additionally, some antidepressant medications cause xerostomia.
Scleroderma is a serious disease. Dentistry is important to maintain sufferers’ comfort and quality of life. If you have scleroderma, discuss your condition, your medications, and your feelings with your dentist.