title: Recommendations for the care of oral involvement in patients with systemic sclerosis.
abstract: OBJECTIVE
  To review the literature and collect expert advice for proposing preventive and curative treatments of mouth and dental involvement in patients with systemic sclerosis (SSc; scleroderma).
  
  
  METHODS
  The literature pertaining to mouth and/or dental involvement related to SSc was reviewed, and recommendations were developed according to the suggestions of a French multidisciplinary working group of experts and validated by a lecture committee.
  
  
  RESULTS
  Dentists face 3 main issues in caring for SSc patients: oral mucosa involvement, manducatory apparatus and mouth involvement responsible for limitations in mouth opening, and treatment-related adverse events. An increased risk of tongue carcinoma has been noted. In patients with severe limitation in mouth opening (<30 mm), recommended treatments are a specific mouth-opening rehabilitation program, flexible sectional dentures, and splint therapy. Indications for dental implants depend on the severity of SSc, comorbidities, and/or ongoing bisphosphonate treatment. Prevention of mouth infections and caries implies patient education and teaching about mouth and dental hygiene, periodontal maintenance, and treatment of sicca syndrome. Cessation of tobacco use is mandatory. Patient-tailored rehabilitation may improve limitations in mouth opening. Systematic dental panoramic radiography allows for the early detection of dental caries.
  
  
  CONCLUSIONS
  Prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and ongoing treatments.
authors.affiliation: Department of Internal Medicine, Université Paris Descartes, Hôpital Cochin, AP-HOP, 27 Rue du Faubourg Saint-Jacques, Paris Cedex 14, France.
authors.forename: Alp
authors.initials: A
authors.lastname: Alantar
authors.forename: Jean
authors.initials: J
authors.lastname: Cabane
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.forename: Guy
authors.initials: G
authors.lastname: Princ
authors.forename: Danielle
authors.initials: D
authors.lastname: Ginisty
authors.forename: Michel
authors.initials: M
authors.lastname: Hassin
authors.forename: Marc
authors.initials: M
authors.lastname: Sorel
authors.forename: Louis
authors.initials: L
authors.lastname: Maman
authors.forename: Aurélie
authors.initials: A
authors.lastname: Pilat
authors.forename: Luc
authors.initials: L
authors.lastname: Mouthon
mesh_terms: D017742:Dental Care for Chronically Ill; D006801:Humans; D009059:Mouth Diseases / Q000150:complications / Q000517:prevention & control*; D012595:Scleroderma, Systemic / Q000150:complications* / Q000628:therapy; D014076:Tooth Diseases / Q000150:complications / Q000517:prevention & control*