Mandibular function is severely impaired in systemic sclerosis patients.
OBJECTIVE
To evaluate the presence of temporomandibular disorders (TMD) in systemic sclerosis (SSc) patients and its possible association with the severity of skin involvement.


METHODS
The presence of TMD was evaluated in 35 SSc women and 30 age- and sex-matched healthy controls by means of the anamnestic (A(i)) and clinical (D(i)) Helkimo indices; the jaw mobility was further analyzed (M(I)). Skin involvement was scored by the Modified Rodnan Skin Score (MRSS).


RESULTS
Signs and symptoms of TMD were more frequent in SSc patients than in controls, the frequency distribution of the different clinical dysfunction indices differing significantly (P < .001) between patients (D(i)0 8.6%, D(i)I 48.6%, D(i)II 22.8%, and D(i)III 20%) and controls (D(i)0 50%, D(i)I 33.3%, and D(i)II 16.7%). Cyclophosphamide for severe and rapidly progressive cutaneous fibrosis was prescribed in six out of seven patients with severe signs (D(i)III), in contrast this treatment was indicated for only two out of 25 patients with mild to moderate signs (D(i)I and D(i)II, P < .001). Impaired jaw mobility was more frequent in SSc patients than controls (P < .001). It was severe in 77.1% (M(I)II) and mild in 22.9% (M(I)I) of the cases, in contrast to controls (M(I)0 33.4%, M(I)I 53.3%, and M(I)II 13.3%; P < .001). Approximately half of SSc patients with severe (M(I)II) but none of those with mild impairment were on cyclophosphamide treatment for severe cutaneous fibrosis (P = .02).


CONCLUSIONS
Severe signs of TMD according to the anamnestic and clinical Helkimo indices were very frequent in SSc patients.
Ferreira
Edna Livia A
EL
Christmann
Romy B
RB
Borba
Eduardo F
EF
Borges
Claudia T L
CT
Siqueira
Jose T T
JT
Bonfa
Eloisa
E
D000328:Adult; D016022:Case-Control Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008334:Mandible / Q000503:physiopathology*; D011862:Radiography, Panoramic; D016059:Range of Motion, Articular / Q000502:physiology; D045743:Scleroderma, Diffuse / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D045745:Scleroderma, Limited / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D016037:Single-Blind Method; D012867:Skin / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide