Background Decreased ability of mouth opening has a remarkable impact on oral hygiene, nutrition and quality of life in systemic sclerosis (SSc).
Objectives To evaluate different parameters of oral aperture in a large consecutive SSc patient cohort, and to examine their relationships with clinical parameters, disability indicators and the SF-36 Health Survey.
Methods 131 consecutive SSc patients (91 with lcSSc and 40 with dcSSc) were enrolled into a prospective observational study. Mean (SD) disease duration was of 8.1 (7.2) years, mean age at enrollment was 55.9 (11.6) years. Patients were re-evaluated 12 and 36 months later. Vertical interincisial distance at maximally opened mouth (VIID), vertical interlabial distance at maximally opened mouth (VILD), horizontal width at closed mouth (HWCM), and horizontal width at maximally opened mouth (HWOM) were measured. The area and circumference of the mouth was also estimated by considering it as an ellipse. Detailed physical examination included the modified Rodnan skin score (MRSS), number of joint contractures, hand anatomic index (HAI) and presence of ulcers on the whole body surface. The European Scleroderma Study Group Activity Index was calculated. Patients filled the Health Assessment Questionnaire (HAQ) and the SF-36. Enrolled patients learned the physiotherapeutic protocol taught for each SSc patient in our tertiary centre (including extensive orofacial exercises, respiratory exercises, and exercises for hands and large joints).
Results VIID decreased significantly from a mean (S.D.) 33.2 (8.3) mm to 31.6 (7.2) mm after 12 months, but showed significant improvement (34.9 (7.3) mm) at 36 months. The VILD, HWOM, area and circumference showed also significant worsening after 12 months, and did not improve back to the original value. The HWCM showed a progressive significant worsening (from 51.3 (7.5) mm to 48.7 (5.8) mm). At baseline only the VIID differed significantly in the two SSc subsets, being higher in lcSSc patients. At 36 months the HWCM, mouth area and circumference had also significantly higher values in lcSSc patients compared to the dcSSc subset. The VIID, VILD, mouth area and circumference correlated negatively with the HAQ disability index (HAQ-DI), number of contractures and DASH, and positively with the HAI in all three evaluations. In addition, VIID correlated positively with the body weight and VILD correlated positively with the ulcer score. The investigated parameters of oral aperture did not consistently correlate with disease duration, age and MRSS. Changes in the area and circumference correlated with the changes in HAQ-DI between the 1st and 2nd, and 1st and 3rd examination.
Conclusions The HAQ-DI and number of contractures correlated with the estimated mouth area and circumference, and furthermore with the interincisial and interlabial distances. The change in HAQ-DI also correlated with the changes in mouth area and circumference, thus these two parameters might be useful outcome measures in assessing damage in SSc and their significance should be further tested.
Disclosure of Interest None Declared
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