title: Relationship between disease characteristics and orofacial manifestations in systemic sclerosis: Canadian Systemic Sclerosis Oral Health Study III.
abstract: OBJECTIVE
  Systemic sclerosis (SSc; scleroderma) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. We undertook this study to determine the clinical correlates of SSc with these oral abnormalities.
  
  
  METHODS
  Subjects were recruited from the Canadian Scleroderma Research Group cohort. Detailed dental and clinical examinations were performed according to standardized protocols. Associations between dental abnormalities and selected clinical and serologic manifestations of SSc were examined.
  
  
  RESULTS
  One hundred sixty-three SSc subjects were included: 90% women, mean ± SD age 56 ± 11 years, mean ± SD disease duration 14 ± 8 years, 72% with limited cutaneous disease, and 28% with diffuse cutaneous disease. Decreased saliva production was associated with Sjögren's syndrome-related autoantibodies (β = -43.32; 95% confidence interval [95% CI] -80.89, -5.75), but not with disease severity (β = -2.51; 95% CI -8.75, 3.73). Decreased interincisal distance was related to disease severity (β = -1.02; 95% CI -1.63, -0.42) and the modified Rodnan skin thickness score (β = -0.38; 95% CI -0.53, -0.23). The number of missing teeth was associated with decreased saliva production (relative risk [RR] 0.97; 95% CI 0.94, 0.99), worse hand function (RR 1.52; 95% CI 1.13, 2.02), and the presence of gastroesophageal reflux disease (GERD; RR 1.68 [95% CI 1.14, 2.46]). No clinical or serologic variables were correlated with periodontal disease.
  
  
  CONCLUSIONS
  In SSc, diminished interincisal distance is related to overall disease severity. Decreased saliva production is related to concomitant Sjögren's syndrome antibodies. Tooth loss is associated with poor upper extremity function, GERD, and decreased saliva. The etiology of excess periodontal disease is likely multifactorial and remains unclear.
authors.affiliation: Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.forename: Solène
authors.initials: S
authors.lastname: Tatibouet
authors.forename: Russell
authors.initials: R
authors.lastname: Steele
authors.forename: Ernest
authors.initials: E
authors.lastname: Lo
authors.forename: Sabrina
authors.initials: S
authors.lastname: Gravel
authors.forename: Geneviève
authors.initials: G
authors.lastname: Gyger
authors.forename: Tarek
authors.initials: T
authors.lastname: El Sayegh
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
authors.forename: Audrey
authors.initials: A
authors.lastname: Fontaine
authors.forename: Ariel
authors.initials: A
authors.lastname: Masetto
authors.forename: Debora
authors.initials: D
authors.lastname: Matthews
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sutton
authors.forename: Norman
authors.initials: N
authors.lastname: Thie
authors.forename: Niall
authors.initials: N
authors.lastname: Jones
authors.forename: Maria
authors.initials: M
authors.lastname: Copete
authors.forename: Dean
authors.initials: D
authors.lastname: Kolbinson
authors.forename: Janet
authors.initials: J
authors.lastname: Markland
authors.forename: Getulio
authors.initials: G
authors.lastname: Nogueira
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Marvin
authors.initials: M
authors.lastname: Fritzler
authors.forename: Mervyn
authors.initials: M
authors.lastname: Gornitsky
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010510:Periodontal Diseases / Q000175:diagnosis / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D012472:Salivation; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D016388:Tooth Loss / Q000175:diagnosis / Q000209:etiology*; D034941:Upper Extremity / Q000503:physiopathology; D014987:Xerostomia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers