title: Gingival capillary changes and oral motor weakness in juvenile dermatomyositis.
abstract: OBJECTIVE
  We assessed the orofacial involvement in JDM, and evaluated the possible association of gingival and mandibular mobility alterations with demographic data, periodontal indices, clinical features, muscle enzyme levels, JDM scores and treatment.
  
  
  METHODS
  Twenty-six JDM patients were studied and compared with 22 healthy controls. Orofacial evaluation included clinical features, dental and periodontal assessment, mandibular function and salivary flow.
  
  
  RESULTS
  The mean current age was similar in patients with JDM and controls (P > 0.05). A unique gingival alteration characterized by erythema, capillary dilation and bush-loop formation was observed only in JDM patients (61 vs 0%, P = 0.0001). The frequencies of altered mandibular mobility and reduced mouth opening were significantly higher in patients with JDM vs controls (50 vs 14%, P = 0.013; 31 vs 0%, P = 0.005). Comparison of the patients with and without gingival alteration showed that the former had lower values of median of cementoenamel junction (-0.26 vs -0.06 mm, P = 0.013) and higher gingival bleeding index (27.7 vs 14%, P = 0.046). This pattern of gingival alteration was not associated with periodontal disease [plaque index (P =0.332) and dental attachment loss (P = 0.482)]. The medians for skin DAS and current dose of MTX were higher in JDM with gingival alteration (2.5 vs 0.5, P = 0.029; 28.7 vs 15, P = 0.012). A significant association of lower median manual muscle testing with a reduced ability to open the mouth was observed in patients with JDM than those without this alteration (79 vs 80, P = 0.002).
  
  
  CONCLUSIONS
  The unique gingival pattern associated with cutaneous disease activity, distinct from periodontal disease, suggests that gingiva is a possible target tissue for JDM. In addition, muscle weakness may be a relevant factor for mandibular mobility.
authors.affiliation: Rua Maria Candida, 135. Vila Guilherme São Paulo, -SP, CEP 02071-010, Brazil.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Savioli
authors.forename: Clovis A A
authors.initials: CA
authors.lastname: Silva
authors.forename: Gisele M C
authors.initials: GM
authors.lastname: Fabri
authors.forename: Katia
authors.initials: K
authors.lastname: Kozu
authors.forename: Lucia M A
authors.initials: LM
authors.lastname: Campos
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
authors.forename: Adriana M E
authors.initials: AM
authors.lastname: Sallum
authors.forename: José T T
authors.initials: JT
authors.lastname: de Siqueira
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002196:Capillaries / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005881:Gingiva; D005882:Gingival Diseases / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009055:Mouth; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors